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Notice of Privacy Practices
Deaths:
We may report information regarding deaths to coroners, medical examiners, funeral directors, and organ donation agencies.
Serious threat to health or safety:
We may use and disclose information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Military and Special Government Functions:
If you are a member of the armed forces, we may release information as required by military command authorities. We may also disclose information to correctional institutions or for national security purposes.
Research:
We may use or disclose information for approved medical research.
Workers Compensation:
We may release information about you for workers compensation or similar programs providing benefits for work-related injuries or illness.
Unless you object, we will place your name, location,
and one word condition in our facility directory. This
information will be disclosed to people who ask for you by name. We may disclose information to notify or locate your relatives or to assist disaster relief agencies. In any other situation, we will ask for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any future uses and disclosures.
Individual Rights
You have the following rights with regard to your health information. Please contact the person(s) listed below to obtain the appropriate forms for exercising these rights.
Request Restrictions:
You may request restrictions on certain uses and disclosures of your health information. We are not required to agree to such restrictions, but if we do agree, we must abide by those restrictions.
Confidential Communications:
You may ask us to communicate with you confidentially by, for example, sending notices to a special address or not using postcards to remind you of appointments.
Inspect and Obtain Copies:
In most cases, you have the right to look at or get a copy of your health information. There may be a small charge for
the copies.
Amend Information:
If you believe that information in your record is incorrect, or if important information is missing, you have the right to request that we correct the existing
information or add the missing information.
Accounting of Disclosures:
You may request a list of instances where we have disclosed health information about you for reasons other than
treatment, payment, or health care operations.
Our Legal Duty
We are required by law to protect and maintain the privacy of your health information, to provide this Notice about our legal duties and privacy practices regarding protected health information, and to abide by the terms of the Notice currently in effect.
Changes in Privacy Practices
We may change our policies at any time. Before we make a significant change in our policies, we will change our Notice and post the new Notice in the admissions area. You can also request a copy of our Notice at any time. For more
information about our privacy practices, contact the person(s) listed below.
Complaints
If you are concerned that we have violated your privacy rights, or if you disagree with a decision we made about your records, you may contact the the person(s) listed below. You also may send a written complaint to the U.S. Department of Health and Human Services. The person(s) listed below will provide you with the appropriate address upon request. You will not be penalized in any way for
filing a complaint.
Contact Person(s)
If you have any questions, requests, or complaints, please contact either:
Patsy Mauney, Compliance Officer
Address: 811 Hwy 65 South, Ph# 870-382-8264
Jenny Guthrie, Medical Records Director
Addrss: 811 Hwy 65 South, Ph# 870-382-8245
Independent Contractors
Delta Memorial Hospital and the physicians who practice at the hospital are independent contractors and do not hereby assume any liability for services or conduct of each other.
Effective Date:
The effective date of this Notice is April 14, 2003.
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