960
Avent Drive
Grenada, Mississippi 38901-5094
Phone (662) 227-7000
NOTICE OF
PRIVACY PRACTICES
FOR
PROTECTED
HEALTH INFORMATION
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.
Grenada Lake Medical Center is dedicated to
protecting your medical information. We
are required by law to maintain the privacy of protected health information and
to provide you with this Notice of our legal duties and privacy practices with
respect to protected health information.
Grenada Lake Medical Center is required by law to abide by the terms of
this Notice, and we reserve the right to change the terms of this Notice,
making any revision applicable to all the protected health information we
maintain. If we revise the terms of
this Notice, we will post a revised notice at the Hospital and will make paper
copies of this Notice of Privacy Practices for Protected Health Information
available upon request. Grenada Lake Medical Center and its Medical Staff are
presenting this document as a joint notice. Your personal physician may have a
different notice regarding the use and disclosure of your health information
created in his/her office.
HOW YOUR MEDICAL INFORMATION WILL BE USED AND DISCLOSED
We will use your medical information as part of
rendering patient care. For example,
your medical information may be used by the health care professional treating
you, by the business office to process your payment for the services rendered
and by administrative personnel reviewing the quality and appropriateness of
the care you receive.
We may also use and/or disclose your information in
accordance with federal and state laws for the following purposes:
·
We
may contact you to provide appointment reminders or information about treatment
alternatives or other health-related benefits and services that may be of
interest to you.
·
We
may contact you to raise funds for the hospital.
·
We
may disclose medical information when required by the United States Department
of Health and Human Services as part of an investigation or determination or
the Hospitals' compliance with relevant laws.
·
Unless
you object, we will include general information, including your name, location
in the hospital, and your religious affiliation in a directory of individuals
located in the hospital. The directory
information, except for your religious affiliation, will be released to people
who ask for you by name. Unless you
object, your religious affiliation may be given to members of the clergy, even
if they do not ask for you by name.
·
Unless
you object, we may disclose to family members, other relatives or close
personal friends the medical information directly relevant to such person's
involvement with your care.
·
Unless
you object, we may use or disclose your medical information to notify a family
member, a personal representative or another person responsible for your care
of your location, general condition or death.
·
We
may disclose your medical information to a public or private identity for the
purpose of coordinating with that entity to assist in disaster relief
efforts.
·
We
may use or disclose your medical information for public health activities,
including the reporting of disease, injury, vital events and the conduct of
public health surveillance, investigation and/or intervention. We may disclose your medical information to
a health oversight agency for oversight activities authorized by law, including
audits, investigations, inspections, licensure or disciplinary actions,
administrative and/or legal proceedings.
We may disclose your medical information concerning abuse, neglect or
violence in accordance with federal and state law.
·
We
may disclose your medical information in the course of certain judicial or
administrative proceedings.
·
We
may disclose your medical information for law enforcement purposes or other
specialized governmental functions.
·
We
may disclose your medical information to a coroner, medical examiner or a
funeral director.
·
We
will disclose your medical information to an organ donation or procurement
organization.
·
We
may use or disclose your medical information for certain research purposes.
·
We
may use or disclose your medical information to prevent or lessen a serious threat
to the health and safety of another person or the public.
·
We
may disclose your medical information as authorized by laws relating to
workers' compensation or similar programs.
We will not use or disclose your medical information
for any other purpose without your written authorization. Once given, you may revoke your
authorization in writing at any time.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION:
You have the following rights with respect to your
medical information:
·
The
right to request restrictions on certain uses and disclosures of your medical
information. We are not required to
agree to your requested restriction, but if we do, we will honor it.
·
The
right to receive communications from us in a confidential manner.
·
The
right to inspect and copy your medical information. This right is subject to certain specific exception, you or your
patient representative may be required to provide a picture ID to authenticate
identity, you or your patient representative
will be asked to sign a written authorization, patient representatives
will be asked to prove rights to your patient information (will, power of
attorney, custody documents), and you
may be charged a reasonable fee for any copies of your records. GLMC has 30
days from the request for viewing or copying to comply.
·
The
right to request an amendment of your medical information. The right to
amend is not the right to obliterate or
totally remove documentation from a medical record. Rather it is an opportunity
to "append" a statement of counter-opinion to the record and to know
that when the original statement is used or disclosed, the new
"corrective" statement will accompany any released copies. We require
the amendment be in writing and provide a reason to support the requested
amendment. We may deny your request for certain specific reasons, and, if
denied, we will provide you with a written explanation for the denial and
information regarding further rights you would have at that point.
·
The
right to receive an accounting of the disclosures of your medical information
made by Grenada Lake Medical Center in the six years prior to your request
(following April 14, 2003), except for disclosures for treatment, payment or
Hospital operational purposes and for certain other specific disclosure types.
·
The
right to request a paper copy of this Notice of Privacy Practices for Protected
Health Information.
·
The
right to complain to the Hospital and/or to the United States Department of
Health and Human Services if you believe that the Hospital has violated your
privacy rights. To complain to the
Hospital, please contact:
Tracie
Turbeville,
Privacy Officer
Grenada Lake Medical Center
960 Avent Drive
Grenada, MS 38901
662-227-7588
If you believe that your privacy rights have
been violated, you should call the matter to our attention by sending a letter
or contacting the number above
describing the cause of your concern to the same address.
You will not be penalized or otherwise retaliated
against for filing a complaint.
If you would like further information regarding your
rights or regarding the uses and disclosures of your medical information, you
may contact:
Tracie
Turbeville, Privacy Officer
Grenada Lake Medical Center
960 Avent Drive
Grenada, MS 38901
662-227-7588
THIS NOTICE IS EFFECTIVE APRIL 14, 2003.