HIPAA DISCLAIMER:

HIPAA is the Health Insurance Portability and Accountability Act of 1996. HIPAA regulations are established by the Department of Health and Human Services. This legislation affects the way health information is handled by health care providers. Sequoyah Memorial Hospital maintains a strong, longstanding commitment to patient confidentiality and patient privacy. Policies, procedures, and training are in place to ensure that employees understand the importance of patient privacy and confidentiality and do their best to uphold this trust.

HIPAA Contact: Robert Wade, RN; Privacy Officer, (918) 774-1100

SEQUOYAH MEMORIAL HOSPITAL and HOME CARE
Notice of Health Information Practices

This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Understanding Your Health Record/Information

Each time you visit Sequoyah Memorial Hospital and Homecare or use one of our health care services, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

· basis for planning your care and treatment
· means of communication among the many health professionals who contribute to your care
· legal document describing the care you received
· means by which you or a third-party payer can verify that services billed were actually provided
· a tool in educating heath professionals
· a source of information for public health officials charged with improving the health of the nation
· a source of data for facility planning
· a tool with which we can assess and continually work to improve the care we render and the outcomes we achieve
Understanding what is in your record and how your health information is used helps you to:
ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

Your Health Information Rights

Although your health record is the physical property of Sequoyah Memorial Hospital, the information belongs to you. You have the right to:

· Request that we not use or disclose your health information for a particular reason related to treatment, payment, the facility's general health care operations, and/or to a particular family member, other relative or close personal friend. We ask that such requests be made in writing. Although we will consider your request, please be aware that we are under no obligation to accept it or to abide by it. For more information about this right, See 45 CFR 164.522.
· Obtain a paper copy of the notice of information practices upon request
· Inspect and/or obtain copies of your health record, which will be provided to you in the time frames established by law. Once you have obtained copies of your health information, it is your responsibility to keep those records private. This includes home charts that are left in the home during Home Health or Hospice services. In some instances, state law may prevent release of information that could result in harm or potential harm to you or someone else named in the record. If you request copies, we will charge you a reasonable fee. For more information about this right, see 45 CFR 164.524
· Amend your health record. If you believe that any health information in your record is incorrect or if you believe that important information is missing, you may request that we correct the existing information or add the missing information. Such requests must be made in writing, and must provide a reason to support the amendment. The facility has the right not to agree to the amendment if proper support is not attached. For more information about this right, see 45 CFR 164.528
· Obtain an accounting of disclosures of your health information. You may request that we provide you with a written accounting of all disclosures made by us during the time period for which you request (not to exceed 6 years). We ask that such requests be made in writing. Please note that an accounting will not apply to any of the following types of disclosures: disclosures made for reasons of treatment, payment or health care operations; disclosures made to you or your legal representative, or any other individual involved with your care; disclosures to correctional institutions or law enforcement officials; and disclosures for national security purposes. You will not be charged for your first accounting request in any 12-month period. However, for any requests that you make thereafter, you will be charged a reasonable, cost-based fee. For more information about this right, see 45 CFR 164.528
· Request communications of your health information by alternative means or at alternative locations
· Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Our Responsibilities

This organization is required to:

· maintain the privacy of your health information
· provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
· abide by the terms of this notice
· notify you if we are unable to agree to a requested restriction
· accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will post the revised notice according to law.
We will not use or disclose your health information without your authorization, except as described in this notice.

For More Information or to Report a Problem

If you have questions and would like additional information, you may contact the Privacy Officer at (918) 774-1100 for the hospital or (918) 774-1171 for the Home Care division.

If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer or with the secretary of Health and Human Services. There will be no retaliation for filing a complaint.

Examples of Disclosures for Treatment, Payment and Health Operations

We will use your health information for treatment.

For example: Information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health care team. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. This includes having your name prominently placed on the chart. It also includes using any previous health records you may have.

We will also provide your physician or a subsequent health care provider with copies of various reports that should assist him or her in treating you once you're discharged from this hospital.

We will use your health information for payment.

For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

We will use your health information for regular health operations.

For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.

Business associates: There are some services provided in our organization through contacts with business associates. Examples include physician services in the radiology department, certain laboratory tests, transcription services, software vendors, accounting, consultants, board members, and attorneys. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Directory: Unless you notify us that you object, we will use your name, location in the facility, and general condition for directory purposes. This information may be provided to various departments and to other people who ask for you by name.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.

Communication with family: Health professionals, using their best judgement, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care. This may include family members that are present in the home during Home Care visits.

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Funeral directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.

Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Appointment reminders:. We may contact you at home to provide appointment reminders. This may include use of answering machines or leaving messages with family members.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Workers' compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Emergency services: In the event of a natural or man-made disaster, your information may be released to organizations such as the Red Cross, FEMA, rescue services, EMS, etc. Such information will be limited to the minimum necessary for those services to maintain accountability of patients.

Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.

Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

Effective Date: [08-02-02]