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| NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU CAN BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Obligation of the Provider Cheraw Healthcare, Inc. (Provider) will follow the privacy practices that are described in this notice while it is in effect. The notice takes effect April 14, 2003. This notice will remain in effect until it is revised or replaced. We are required to: • Maintain the privacy of protected health information • Provide you with this notice of our legal duties and privacy practices with respect to your health information • Abide by the terms of this notice or the notice currently in effect • Comply the certain objections you may have with regard to our use and disclosure of your medical information as specified herein • Obtain your written authorization to use or disclose your health information for reasons other than those listed above and permitted under law. We reserve the right to change our privacy practices and the terms of this notice at any time as long as the law allows it. We reserve the right to make these changes effective for all medical information that we maintain, including medical information we created or received before the changes were made. Before we make a significant change in our privacy practices, we will revise this notice and send the new notice to you at the time of the revision. You may request a copy of our Notice of Privacy Practices at any time. Use or Disclosures of Medical Information Treatment. We may use your medical information to provide you with medical treatment or services. During your care at our facility, it may be necessary for various personnel to have access to your protected health information. For example, information obtained by us will be recorded in your record that is related to your treatment. This information is necessary for us to determine what treatment you should receive. We will also record actions taken by us in the course of your treatment. In addition, we will use your medical information to coordinate or manage your care and consult with other health care providers outside our facility regarding your care. Payment. We may use and disclose your medical information to obtain payment for services we render. For example, it will be necessary for us to use or disclose your medical information so that we may bill and collect from you, your insurance company, or other third party for treatment and services we render. Health Care Operations. We may use and disclose medical information about you for operational purposes. For example, your medical information may be disclosed for: • quality assessment or risk management purposes; • reviewing competence or qualification of health care professionals; • conducting or arranging for medical review, legal services, and auditing functions; • business planning and development; • business management and general administrative actions. Appointments. We may use your medical information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. Authorization. You may give us written authorization to use your medical information or to disclose it to anyone for any purpose. You may revoke your authorization in writing at any time. Unless you give us a written authorization, we will not use or disclose your medical information for any reason except those described in this notice. Facility Directory. Our facility maintains a directory. Unless you object, your name, location in the facility, general condition, and religious affiliation will be contained in the directory. The information contained in the directory is disclosed to persons who specifically ask for the information by your name and members of the clergy, except for your religious affiliation. You are not obligated to consent to the inclusion of your information in the facility directory. Please contact us using the contact information at the end of this notice if you do not want your information to be included in the facility directory or if you want your information or disclosure of your information to be limited in any way. Communication to Individuals Involved in Your Care. Your medical information may be used or disclosed by us to notify or communicate to your family members or other persons involved in your care. Unless you object and inform us of your objection, your medical information may be released to a family member, close personal friend or other person who is involved in your care to the extent necessary for such persons to participate in your care. Please contact us using the contact information at the end of this notice if you want uses and disclosures regarding medial information to individuals involved in your care to be limited any way. Required by Law. We may use and disclose information about you as required by law. For example, we may disclose information for the following purposes: • for judicial and administrative proceedings pursuant to legal authority; • to report information related to victims of abuse, neglect or domestic violence; • to assist law enforcement officials in their law enforcement duties; Public Health. Your medical information may be used or disclosed for public health activity such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities. Marketing. We may use your medical information to contact you to describe a health-related product or service that may be of interest to you. Decedents. Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties. Organ Tissue Donation. Your health information may be used or disclosed for cadaver organ, eye or tissue donation purposes. Health and Safety. Your medical information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law. Research. We may use your health information for research purposes when an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved the research. Government Functions. Your medical information may be disclosed for specialized government functions such as protection of public officials or reporting to various branches of the armed services that may require use or disclosure of your health information. Workers Compensation. Your health information may be used or disclosed in order to comply with laws and regulations related to Workers Compensation. Your Individual Rights Access. You have the right to inspect or obtain copies of your medical information, with some exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless it is not practical to do so. To obtain a copy of your medical information, you must make a request in writing. If you request copies, you may be charged a reasonable fee, including the cost of copying and postage. You may make a written request for your medical information using the contact address at the end of this notice. Accounting. You have the right to receive an accounting in which we or our business associated used or disclosed your medical information for purposes other than treatment, payment, and health care operations, as authorized by you, or for certain other activities, on or after April 14, 2003. To obtain a copy of an accounting, you must make a request in writing using the contact address at the end of this notice. Amendments. You have the right to request that we amend your medical information. Your request must be in writing and it must explain why we should amend the information. We may deny your request if we did not create the information you want amended or we may deny your request for other reasons. If we deny your request, we will send you a written explanation. You may respond with a statement of disagreement, that we will add to the information you want amended. To request an amendment, you must make a written request using the contact address at the end of this notice. Confidential Communications. You have the right to request that we communicate with you about your medical information by other means or to other locations. You must make your request in writing using the contact address at the end of this notice. We must accommodate your request if it is reasonable. Restrictions. You have the right to request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to those additional restrictions, but if we do, we will abide by our agreement except in emergency situations. To request restrictions, you must make a request in writing using the contact address at the end of this notice. Any agreement to additional restrictions must be in writing signed by a person authorized to make such an agreement for us. Questions and Complaints If you want more information about our privacy practices or have questions or concerns, please contact us using the information below. If you think that we may have violated your privacy rights or you disagree with a decision we made about your privacy rights, you may file a complaint with us using the contact information listed below. You may also submit a written complaint to the U.S. Department of Health and Human Services. We support your right to the privacy of your medical information. We will not retaliate in any way if you choose to file a complaint. Contact Information: HIPAA Compliance Officer 400 Moffat Road Post Office Box 967 Cheraw, South Carolina 29520 (843) 537-5253 |
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