DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
WHO WILL FOLLOW THIS NOTICE.
This notice describes privacy practices at the following locations:
Southeastern Regional Medical Center and related organizations, referred to (Southeastern Health)
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 Southeastern Regional Medical Center and its affiliates (Southeastern Health). Your health information is contained in a medical record that is the physical property of SRMC. 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 and billing for care that are created at Southeastern Health, whether made by Southeastern Health personnel, your independent personal doctor or other independent health care personnel. Your personal doctor or other independent health care personnel treating you may have different policies or notices regarding confidentiality and disclosure of your medical information that is created in their office or other location outside Southeastern Health.
This notice will tell you how Southeastern Health and your care givers 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:
- Make sure that medical information that identifies you is kept private;
- Give you this notice of our legal duties and privacy practices with respect to medical information about you; and
- Follow the terms of the notice that is 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.
If you do not give your consent for Southeastern Health to use and disclose your medical information as outlined in this Notice, we will only use and disclose your medical information in the following circumstances:
- To providers who are personally involved in providing care pursuant to your consent to treatment (whether such consent is expressed, implied by law, or through substituted consent as authorized by law), but only during the period of time they are providing care to you;
- To bill you for the charges you incurred while you were a patient of Southeastern Health;
- To third parties when required by law or by appropriate legal process issued by a court or governmental agency with jurisdiction;
- If you are a Medicare, Medicaid, CHAMPUS/TriCare, or other federal or state program beneficiary or enrollee, for treatment and payment purposes as outlined in this Notice;
- In the case of an emergency, when we are transferring you to a receiving facility for care; and
- In the case of an emergency, in order to provide you with care that is required by federal and state law.
Should you give your consent, we will use and disclose your medical information as outlined in this Notice. 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 of 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 these 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 who are members of the Southeastern Health medical staff and to nurses, technicians, medical students, or other Southeastern Health personnel who are involved in taking care of you at Southeastern Health. 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. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of Southeastern Health also may share medical information about you in order to coordinate what you need, such as prescriptions, lab work and x-rays. We also may need to disclose medical information about you to people outside Southeastern Health who may be involved in your medical care before or after you leave Southeastern Health, such as family members, or others who provide services (such as home health agencies, nursing homes) that are part of your care.
For Payment. We may need to use and disclose medical information about you so that the treatment and services you receive at Southeastern Health or as given by other providers may be billed by Southeastern
Health or other independent providers, i.e., Anesthesiologist, Emergency Room Physician, Pathologist and Radiologist, and payment may be collected from you, an insurance company or health plan, or a third party. For example, we may need to give your insurance company or health plan information about surgery you received at Southeastern Health so your insurance company or health plan will pay us or reimburse you for the surgery. We may also tell your insurance company or health plan about a treatment you are going to receive to obtain prior approval or to determine whether your insurance company or health plan will cover the treatment.
For Health Care Operations. Our staff and business associates may use and disclose medical information about you for Southeastern Health operations. These uses and disclosures are necessary to run Southeastern Health and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the qualifications and performance of our staff and medical staff in caring for you. We may also combine medical information about many Southeastern Health patients to decide what additional services Southeastern Health should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to Southeastern Health personnel, doctors, and students for review and learning purposes. We may also combine the medical information we have about you and other patients with medical information from other hospitals to compare how we are doing and see where we can make improvements in the care and services we offer. We will 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 you are.
Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at Southeastern Health. We will leave a message for you at any telephone number you give us stating the time of the appointment and the name of the person with whom you have the appointment unless we have agreed in writing to your written request to handle appointment reminders differently.
Treatment Alternatives. We may use and disclose medical information to tell you about or recommend different ways to treat you.
Health-Related Benefits and Services. We may use and disclose medical information to tell you about healthrelated benefits or services that may be of interest to you. You may elect not to receive any communications from us that encourage you to purchase or use any particular product or services by notifying the Southeastern Health Privacy Officer in writing. Beginning on February 17, 2010, if we receive direct or indirect payment in exchange for such communications to you, we will obtain your written authorization to use or disclose your medical information before advising you in writing about such benefits or services, unless the communication either describes a drug you currently are being prescribed and the payment we receive for that communication is reasonable, or the communication to you is made by a business associate of Southeastern Health acting on our behalf and in accordance with a written agreement between the business associate and Southeastern Health.
Fundraising Activities. We may share information about you with people or organizations that are involved in fundraising activities by or for the benefit of Southeastern Health. We only would release contact information, such as your name, address and phone number and the dates you received treatment or services at Southeastern Health. If you do not want Southeastern Health to contact you for fundraising efforts, you may notify the Southeastern Health Privacy Officer in writing. We must ask you each time we contact you for fundraising efforts if you wish to opt out of all future fundraising communications. If you do opt out of future fundraising communications, we will not disclose your information for fundraising purposes unless in the future we receive your written authorization to do so.
The Southeastern Health Directory. Unless you tell us otherwise, we may include certain limited information about you in the Southeastern Health directory while you are a patient at Southeastern Health. This information may include your name, location in Southeastern Health, and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a minister or priest even if they don’t ask for you by name. This is so your family, friends and clergy can visit you in Southeastern Health and generally know how you are doing. If you do not want anyone to know this information about you, if you want to limit the amount of information that is disclosed, or if you want to limit who gets this information, you may notify the Patient Representative in writing or indicate your choice on the Southeastern Health Patient Directory Instructions Form.
Individuals Involved in Your Care. We may disclose medical information about you to an immediate family member or other individual who is directly involved in your medical care, unless you object. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location. You can object to these disclosures by telling us that you do not wish any or all individuals involved in your care to receive this information. If you are not present or cannot agree or object, we will use our professional judgment to decide whether it is in your best interest to disclose relevant information to someone who is involved in your care or to an entity assisting in a disaster relief effort.
Individuals Involved in the Payment for your Care (spouse or other responsible party) - If you have consented to our disclosure of medical information for the purpose of obtaining payment for the care provided to you, such disclosure may also entail giving information to other family members who are insureds on your policy or to someone who helps pay for your care, and your consent authorizes such disclosure.
Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another for the same condition. All research projects, however, are subject to a special approval process and will require your written consent if the researchers will know who you are. Medical information about you that has had all identifying information removed may be used for research without your consent. We will not be permitted to receive any money or other thing of value in connection with the use or disclosure of your medical information for research purposes unless the money we receive reflects the costs to prepare and transmit the medical information to the researcher, or unless we notify you in advance and we obtain your written authorization.
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.
Organ and Tissue Donation. We are required by law to release medical information concerning deceased patients to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary for them to determine organ or tissue donation potential. If you are an organ or tissue donor, we are also required by law to provide medical information about you after your death to the person or entity who receives the organ or tissue donation.
Workers’ Compensation. We may release without your consent medical information about you for workers’ compensation or similar programs under appropriate circumstances. These programs provide benefits for workrelated injuries or illness.
Public Health Risks. We may disclose without your consent medical information about you for public health activities. These activities generally include but are not limited to the following: To prevent or control disease, injury, or disability;
- To report deaths;
- 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; and
- To report suspected abuse or neglect as required by law.
Health Oversight Activities. We may disclose without your consent 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 also may disclose medical information about you in response to a subpoena or other lawful process by someone else involved in the dispute by furnishing your medical records or information under seal to the court. The copies of your medical record under seal may only be opened by the parties to the case or their attorneys unless a judge orders otherwise.
Law Enforcement. We may release without your consent medical information to a law enforcement official:
- In response to a court order, warrant, summons, grand jury demand, or similar process;
- To comply with mandatory reporting requirements for violent injuries, such as gunshot wounds, stab wounds, and poisonings;
- In response to a request from law enforcement for certain information to help locate a fugitive, material witness, suspect, or missing person;
- To report a death or injury we believe may be the result of criminal conduct;
- To report suspected criminal conduct committed at Southeastern Health facilities; or
- Concerning your name, current location, and whether you appear to be impaired if you were involved in a
- motor vehicle accident.
Coroners, Medical Examiners, and Funeral Directors. We may release without your consent medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of Southeastern Health to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities. We may release without your consent medical information about you to authorized federal or state officials for intelligence, counterintelligence, and other governmental activities authorized by law. We may disclose without your consent 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 to conduct special investigations.
Inmates. If you are an inmate of a correctional institution or under the custody of law enforcement, we may release medical information about you to the correctional institution or law enforcement official who has custody of you, if the correctional institution or law enforcement official represents to Southeastern Health that such medical information is necessary: (1) to provide you with health care; (2) to protect your health and safety or the health and safety of others; (3) to protect the safety and security of officers, employees, or others at the correctional institution or involved in transporting you; (4) for law enforcement to maintain safety and good order at the correctional institution; or (5) to obtain payment for services provided to you.
Psychotherapy Notes. Regardless of the other parts of this Notice, psychotherapy notes will not be disclosed outside Southeastern Health except as authorized by you in writing, pursuant to a court order, or as required by law. Psychotherapy notes about you will not be disclosed to personnel working within Southeastern Health, other than to the person who wrote the notes, except for training purposes or to defend a legal action brought against Southeastern Health, unless you have properly authorized such disclosure in writing. However other routine medical records may be shared among your health care provider involved in your patient care.
Minors. A parent, guardian, or other person with authority to act in loco parentis has authority to have access to and decide the use and disclosure of protected health information concerning a minor patient, except when:
- A custody order or agreement provides otherwise;
- A court order provides otherwise;
- There is a reasonable basis to suspect abuse or neglect of the minor and providing such information or authority to the parent, guardian, or other person acting in loco parentis is reasonably believed to present a risk of injury or harm to the minor;
- The minor has the right to obtain health care on his or her own behalf as is permitted in the following cases:
(a) For outpatient diagnosis or treatment of emotional illness;
(b) For diagnosis or treatment of pregnancy (not abortion);
(c) For diagnosis or treatment of sexually transmitted diseases; In these circumstances, however, Southeastern Health may choose to disclose such information to the parent or guardian if the parent or guardian contacts Southeastern Health and requests such information.
(d) The parent or guardian has agreed that such information will be confidential between the minor and Southeastern Health.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
You have the following rights regarding medical information we maintain about you:
Right to Inspect and Copy. You have the right to inspect and receive a copy of medical information that may
be used to make decisions about your care, unless your treating physician determines that providing you with such information would be injurious to your well-being.
To inspect and receive a copy of medical information that may be used to make decisions about you, you must submit your request in writing to the Southeastern Health Privacy Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request and may collect the fee before providing the copy to you.
If we have all or any portion of your health information in an electronic format, you may request an electronic copy of those records or request that we send an electronic copy to any person or entity you designate in writing.
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 Southeastern Health.
To request an amendment, your request must be made in writing and submitted to the Southeastern Health Privacy Officer. 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 created by a provider other than Southeastern Health, unless the provider who created the information is no longer available to consider or make the amendment;
- Is not part of the medical information kept by or for Southeastern Health;
- Is not part of the information which you would be permitted to inspect and copy; or Has been determined to be accurate and complete.
If we deny your request for an amendment, you may submit in writing a statement of disagreement and ask that it be included in your medical record.
Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we have made of medical information about you. To request this list or accounting of disclosures, you must submit your request in writing to the Southeastern Health Privacy Officer. Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003.
Right to Request Restrictions. Except where we are required to disclose the information by law, you have the right to request a restriction or limitation on the medical information we use or disclose about you. For example, you could revoke any and all authorizations you had given to us relating to disclosure of your protected health information.
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 with emergency treatment.
To request restrictions, you must make your request in writing to the Southeastern Health Privacy Officer. 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. You may request that we not disclose your medical information to any persons or entities that may be responsible for paying all or any portion of the charges you incur while a patient of Southeastern Health. If you pay all charges in full for (Southeastern Regional Medical Center) at the time services are provided, you may request that we not disclose your medical information.
Right to Request Alternative Type of Communication. 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, or at a mailing address other than your home address. To request certain types of communications, you must make your request in writing to the Southeastern Health Privacy Officer and specify how or where you wish to be contacted. We will not ask you the reason for your request. We will accommodate all reasonable requests.
Right to a Paper Copy of This Notice. You have a right to a paper copy of this notice or any revised notice.
You may ask for a copy of this notice at any time.
To obtain a paper copy of this notice, contact Patient Relations at (910) 671-5592
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 Southeastern Health. The notice will remain in effect for each subsequent visit unless changed. If the notice changes, a copy will be available to you upon request.
INVESTIGATIONS OF BREACHES OF PRIVACY
We will investigate any discovered unauthorized use or disclosure of your protected health information to determine if it constitutes a breach of the federal privacy or security regulations governing unsecured protected health information. If we determine that such a breach has occurred, we will provide you with notice of the breach and advise you what we intend to do to mitigate the damage (if any) caused by the breach, and about the steps you should take to protect yourself from potential harm resulting from the breach.
If you believe your privacy rights have been violated, you may file a complaint with Southeastern Health or with the Secretary of the Department of Health and Human Services. To file a complaint with Southeastern Health, contact the Patient Representative at (910) 671-5592, or submit a complaint in writing.
Southeastern Regional Medical Center will not withhold treatment, or penalize you in any way for filing a complaint.
OTHER USES OF MEDICAL INFORMATION.
Other uses and disclosures of medical information not covered by this notice will be made only with your written permission or as required by law.
North Carolina Law. In the event that North Carolina Law requires us to give more protection to your health information than stated in this notice or required by Federal Law, we will give that additional protection to your health information. Example, we will comply with additional state law confidentiality protection related to communicable diseases, such as HIV and AIDS. We will also comply with additional state law protecting confidentiality related to treatment for mental health and drug or alcohol abuse. Protected Health Information will also be released during reviews conducted by regulatory and licensure agencies.
If you have any questions about this notice, please contact the Privacy Officer at (910) 671-5723.