THIS NOTICE DESCRIBES HOW
MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT
CAREFULLY.
If you have any questions
about this notice, please contact the Children's Clinic of Southwest Louisiana.
WHO WILL
FOLLOW THIS NOTICE
This
notice describes our facility's practices and that of:
1.
Any
health care professional authorized to enter information into your facility
chart.
2.
All
departments and units of the facility.
3.
Any
member of a volunteer group we allow to help you while you are in the facility.
4.
All
employees, staff and other facility personnel.
OUR PLEDGE REGARDING MEDICAL
INFORMATION
We
understand that medical information about you and your health is personal. We
are committed to protecting medical information about you. We create a record
of the care and services you receive at the facility. We need this record to
provide you with quality care and to comply with certain legal requirements.
This notice applies to all of the records of your care generated by the
facility, whether made by facility personnel or you personal doctor.
This
notice will tell you about the ways in which we may use and disclose medical
information about you. We also describe your rights and certain obligations we
have regarding the use and disclosure of medical information.
We are required by law to:
1.
Make
sure that medical information that identifies you is kept private;
2.
Give
you this notice of our legal duties and privacy practices with respect to
medical information about you; and
3.
Follow
the terms of the notice that are currently in effect.
HOW WE MAY USE
AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The
following categories describe different ways that we use and disclose medical
information. For each category of uses or disclosures we will explain what we
mean and try to give some examples. Not every use or disclosure in a category
will be listed. However, all of the ways we are permitted to use and disclose
information will fall within one of the categories.
For Treatment. We may use medical information about you to
provide you with medical treatment or services. We may disclose medical
information about you to doctors, nurses, technicians, medical students, or
other facility personnel who are involved in taking care of you at the
facility. For example, a doctor treating you for a broken leg may need to know
if you have diabetes because diabetes may slow the healing process. Different
departments of the facility also may share medical information about you in
order t to
coordinate the different things you need, such as prescriptions, lab work and
x-rays. We also may disclose medical information about you to people outside
the facility who may
be involved in your medical care after you leave the facility, such as family
members, clergy or others we use to provide services that are part of your
care.
For Payment.
We may use and disclose medical information about you so that the treatment and
services you receive at the facility may be billed to and payment may be collected from
you, an insurance company or a third party. For example, we may need to give
your health plan information about care you received at the facility so your health plan will pay
us or reimburse you for the care. We may also tell you health plan about a
treatment you are going to receive to obtain prior approval or to determine
whether your plan
will cover the treatment.
For Health Care Operations. We may use and disclose medical information about
you for facility operations. These uses and disclosures are necessary to run
the facility and make
sure that all of our patients receive quality care. For example, we may use
medical information to review out treatment and services and to evaluate the
performance of out
staff in caring for you. We may also combine medical information about many
facility patients to decide what additional services the facility should offer,
what services are not
needed, and whether certain new treatments are effective. We may also disclose
information to doctors, nurses, technicians, medical students, and other
facility personnel for review and learning purposes. We may also combine the
medical information we have with medical information from other facilities to
compare how we are doing and see where we can make improvements in the
care and services we offer. We may remove information that identifies you from
this set of medical information so others may use it to study health care and
health care delivery without learning who the specific patients are.
Treatment Alternatives. We may use and disclose
medical information to tell you about or recommend possible treatment options
or alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use and disclose
medical information to tell you about health-related benefits or services that
may be of interest to you.
Individuals
Involved in Your Care or Payment for Your Care. We may release medical
information about you to a friend or family member who is involved in your
medical care. We may also give information to someone who helps pay for your
care.
As Required By
Law. We
will disclose medical information about you when required to do so by federal,
state or local law.
To Avert a Serious Threat to Health or Safety. We may use and disclose
medical information about you when necessary to prevent a serious threat to
your health and safety or the health and safety of the public or another
person. Any disclosure, however, would only be to someone able to help prevent
the threat.
SPECIAL
SITUATIONS
Military and Veterans. If you are a member of the armed forces, we
may release medical information about you as required by military command
authorities. We may also release medical information about foreign military
personnel to the appropriate foreign military authority.
Workers' Compensation. We may release medical information about you for
workers' compensation or similar programs. These programs provide benefits for
work-related injuries or illness.
Public Health Risks. We may
disclose medical information about you for public health activities. These
activities generally include the following:
·
To
prevent or control disease, injury or disability;
·
To
report births and deaths;
·
To
report child abuse or neglect;
·
To
report reactions to medications or problems with products;
·
To
notify people of recalls of products they may be using;
·
To
notify a person who may have been exposed to a disease or may be at risk for
contracting or spreading a disease or condition; To notify the appropriate
government authority if we believe a patient has been the victim of abuse,
neglect or domestic violence. We will only make this disclosure if you agree or
when required or authorized by law.
Health Oversight Activities. We may disclose medical information to a health
oversight agency for activities authorized by law. These oversight activities
include, for example, audits, investigations, inspections, and licensure. These
activities are necessary for the government to monitor the health care system,
government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we
may disclose medical information about you in response to a court or
administrative order. We may also disclose medical information about you in
response to a subpoena, discovery request, or other lawful process by someone
else involved in the dispute, but only if efforts have been made to tell you
about the request or to obtain an order protecting the information requested.
Law Enforcement. We may release
medical information if asked to do so by a law enforcement official:
·
In
response to a court order, subpoena, warrant, summons or similar process;
·
To
identify or locate a suspect, fugitive, material witness, or missing person;
·
About
the victim of a crime if, under certain limited circumstances, we are unable to
obtain the person's agreement;
·
About
a death we believe may be the result of criminal conduct;
·
About
criminal conduct at the facility; and
·
In
emergency circumstances to report a crime; the location of the crime or
victims; or the identity, description or location or the person who committed
the crime.
National Security and Intelligence Activities. We may release medical
information about you to authorized federal officials for intelligence,
counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others. We may disclose medical
information about you to authorized federal officials so they may provide protection
to the President, other authorized persons or foreign heads of state or conduct
special investigations.
Inmates.
If you are an inmate of a correctional institution or under the custody of a
law enforcement official, we may release medical information about you to the
correctional institution or law enforcement official. This release would be
necessary (1) for the institution to provide you with health care; (2) to
protect your health and safety or the health and safety of others; or (3) for
the safety and security of the correctional institution.
YOUR RIGHTS REGARDING MEDICAL
INFORMATION ABOUT YOU
You have the following rights regarding medical
information we maintain about you:
Right to Inspect and Copy. You have the right to inspect and copy medical
information that may be used to make decisions about you care. Usually, this
includes medical and billing records, but does not include psychotherapy notes.
To inspect and copy medical information that may be
used to make decisions about you, you must submit your request in writing to
Children's Clinic. If you request a copy of the information, we may charge a
fee for the costs of copying, mailing or other supplies associated with you
request.
We may deny your request and copy in certain very
limited circumstances. If you are denied access to medical information, you may
request that the denial be reviewed. Another licensed health care professional
chosen by the facility will review your request and the denial. The person
conducting the review will not be the person who denied your request. We will
comply with the outcome of the review.
Right to Amend. If you feel that medical information we have about
you is incorrect or incomplete, you may ask us to amend the information. You
have the right to request an amendment for as long as the information is kept
by or for the facility.
To request an amendment, your request must be made
in writing and submitted to Children's Clinic. In addition, you must provide a
reason that supports your request.
We may deny your request for an amendment if it is
not in writing or does not include a reason to support the request. In
addition, we may deny your request if you ask us to amend information that:
·
Was
not created by us, unless the person or entity that created the information is
no longer available to make the amendment;
·
Is
not part of the medical information kept by or for the facility;
·
If
not part of the information which you would be permitted to inspect and copy;
or Is accurate and complete.
Right to an Accounting of Disclosures. You have the right to
request an "accounting of disclosures." This is a list of the
disclosures we made of medical information about you.
To request this list or accounting of disclosures, you
must submit your request in writing to Children's Clinic. Your request must
state a time period, which may not be longer than six years and may not include
dates before April 14, 2003. Your request should indicate in what form you want
the list (for example, on paper, electronically). The first list you request
within a 12-month period will be free. For additional lists, we may charge you
for the costs of providing the list. We will notify you of the cost involved
and you may choose to withdraw or modify your request at that time before any
costs are incurred.
Right to Request Restrictions. You have the right to request a restriction or
limitation on the medical information we use or disclose about you for
treatment, payment or health care operations. You also have the right to
request a limit on the medical information we disclose about you to someone who
is involved in your care of the payment for your care, like a family member or
friend. For example, you could ask that we not use or disclose information
about a surgery you had.
We are not required to agree to your request. If we
do agree, we will comply with your request unless the information is needed to
provide you emergency treatment.
To request restrictions, you must make your request
in writing to Children's Clinic. In your request, you must tell us (1) what
information you want to limit; (2) whether you want to limit our use,
disclosure or both; and (3) to whom you want the limits to apply, for example,
disclosures to your spouse.
Right to Request Confidential Communications. You have the right to
request that we communicate with you about medical matters in a certain way or
at a certain location. For example, you can ask that we only contact you at
work or by mail.
To request confidential communications, you must
make your request in writing to Children's Clinic. We will not ask you the
reason for your request. We will accommodate all reasonable requests. Your
request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. You have the right to a
paper copy of this notice. You may ask us to give you a copy of this notice at
any time. Even if you have agreed to receive this notice electronically, you
are still entitled to a paper copy of this notice.
To obtain a paper copy of this
notice contact Children's Clinic.
CHANGES TO
THIS NOTICE
We
reserve the right to change this notice. We reserve the right to make the
revised or changed notice effective for medical information we already have
about you as well as any information we receive in the future. We will post a
copy of the current notice in the facility. The notice will contain on the
first page, in the top right-hand corner, the effective date. In addition, each
time you register at the facility for treatment or health care services, we
will offer you a copy of the current notice in effect.
COMPLAINTS
If
you believe your privacy rights have been violated, you may file a complaint
with the facility or with the Secretary of the Department of Health and Human Services.
To file a complaint with the facility, contact Chuck Self at 337-478-6480.
OTHER USES OF
MEDICAL INFORMATION
Other
uses and disclosures of medical information not covered by this notice or the
laws that apply to us will be made only with your written permission. If you
provide us permission to use or disclose medical information about you, you may
revoke that permission, in writing, at any time. If you revoke your permission,
we will no longer use or disclose medical information about you for the reasons
covered by your written authorization. You understand that we are unable to
take back any disclosures we have already made with your permission, and that
we are required to retain our records of the care that we provided to you.