NOTICE OF HEALTH INFORMATION PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GET ACCESS TO THIS INFORMATION. PLEASE READ THIS NOTICE CAREFULLY.

This notice describes the privacy practices of Jefferson Regional Medical Center with regard to your medical information and how we may use and disclose your protected health information (PHI) for treatment, payment and for health care operations, as well as for other purposes that are permitted or required by law. You have certain rights regarding the privacy of your protected health information and we describe those rights in this notice.

We reserve the right to change the provisions of our Notice and make new provisions to the terms of this Notice and our Privacy Practices. If JRMC makes a material change to our Notice, we will post the changes promptly on our website at http://www.jhsmo.com.

Protected Health Information (PHI) consists of individually identifiable health information, which may include demographic information JRMC collects from you, creates, or receives by a health care provider, a health plan, your employer, or a health care clearinghouse and that relates to: (1) your past, present or future physical or mental health or condition; (2) the provision of health care to you; or (3) the past, present or future payment for the provision of health care to you.

How We May Use and Disclose Health Information About You

Treatment - We may use and/or disclose your protected health information to provide, coordinate or manage your health care and any related services. We may also disclose your health information to other providers who may be treating you. We may also from time to time disclose your health information to another provider such as a home health agency, skilled nursing facility or durable medical equipment provider, who has been requested to be involved in your care.

Payment - We will use and disclose your protected health information to obtain payment for the health care services we provide you. For example, a bill may be sent to you, your health insurer including Medicare or Medicaid, or another group or individual responsible for payment of your health services that identifies you, your diagnosis, procedures performed and supplies used in providing services for you.

Health Care Operations - We perform many activities to help improve the health or other services that we provide. This may include the use of medical information about you to review and evaluate our treatment and services while caring for you. This information may be used for educational and quality reviews, conducting patient opinion surveys, developing clinical protocols, engaging in case management and care coordination, insurance or legal compliance reviews, or participation in accrediting surveys. In addition, we may disclose your health information to third party business associates who perform billing, consulting, transcription or other services for our facility. These activities are referred to as "health care operations."

Other Ways We May Use and Disclose Your Protected Health Information

As Required by Law - We will use and disclose your protected health information when required to by federal, state, or local law or in response to a valid subpoena, court order, or search warrant.

Research - We may use and disclose your protected health information to researchers, provided the research has been approved by an Institutional Review Board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Appointment Reminders - If we call to remind you of an appointment at our facility, we will only leave the name of the hospital and the time of the appointment. Please let us know if you do NOT wish to be called.

Public Health - As required by law, we may disclose your protected health information to public health authorities permitted to collect or receive the information for the purpose of controlling disease, injury, or disability.

Worker's Compensation - We may disclose your protected health information for worker's compensation or similar programs established by law that provide benefits for work-related injuries or illness.

Correctional Institution - We may use and disclose your protected health information to a correctional institution or agents thereof, health information necessary for your health and the health and safety of others; or for the safety and security of the correctional institution.

Coroners, Medical Examiners and Funeral Directors - We may disclose protected health information consistent with applicable law to carry out their duties.

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

Uses and disclosures that require we give you the opportunity to object or "opt out"

If you do not object, we may include your name, location, general condition and religious affiliation in our facility Patient Directory. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name. Upon admission, you may indicate you do not want your information provided in the Directory.

Others Involved in Your Care
We may provide relevant portions of your protected health information (PHI) to a family member, a relative, a close friend or any other person you identify as being involved in your medical care or payment for care. In an emergency or when you are not capable of agreeing or objecting to these disclosures, we will disclose PHI as we determine is in your best interest, but will tell you about it after the emergency, and give you the opportunity to object to future disclosures to family and friends.

Fund Raising
We may also provide your contact information (name, address and dates of service) to contact you to raise funds for JRMC. You are under no obligation to respond to such communications and you may "Opt Out" of receiving these communications. To Opt Out, please inform the admitting clerk, your nurse, or call the privacy officer at 636/933-1102. Additionally, any written fundraising communications from JRMC and affiliates must state clearly and conspicuously, your opportunity and the manner in which you may elect not to receive further communications.

Uses or Disclosures Not Covered by this Notice

Uses or disclosures of your health information not covered by this notice or the laws that apply to us may only be made with your written authorization. You may revoke such authorization in writing at any time and we will no longer disclose health information about you for the reasons stated in your written authorization. Disclosures made in reliance on the authorization prior to the revocation are not affected by the revocation.

Patient Rights Related to Protected Health Information
Although your health record is the physical property of the facility that compiled it, the information belongs to you. You have the right to:

Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522. Further if you pay in full for your services out of pocket, you may demand that the information regarding the service not be disclosed to a third party payer since no claim is being made against the third party payer.
Obtain a paper copy of the notice of information practices upon request.
Inspect and request copies of your health record as provided for in 45 CFR 164.522
Amend your health record as provided for in 45 CFR 164.528
Obtain an accounting of disclosures of your health information as provided for in 45 CFR 164.528
Request communications of your health information by alternative means or at alternative locations.
Be Notified of a breach. You have the right to be notified in the event your PHI has been breached as provided for in 45 CFR 164.528
Obtain a copy of your e-health record in an electronic format and to direct JRMC to send the e-health record directly to a third party. JRMC may charge for labor costs under these rules.

For More Information or to Report a Problem
If you have questions or would like additional information, you may contact the Privacy Officer at (636)933-1102. 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. You will not be penalized or retaliated against for filing a complaint.

References:
1) American Health Information Management Association (AHIMA)
2) Standards for Privacy of Individual Identifiable Health Information; Final Rule, 45 CFR Parts 160 & 164