Notice of Privacy Practices (HIPAA)

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.

If you have any questions about this Notice please contact: Compliance Officer

This notice is intended to inform you about our practices related to the protection of the privacy of your medical records. Generally, we are required by law to ensure that medical information that identifies you is kept private. Further, we must give you this information related to our legal duties and privacy practices with respect to any medical information we create or receive about you. We are required to follow the terms of the notice.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. In addition to hospital departments, employees, staff and other hospital personnel, the following persons will also follow the practices described in this Notice of Privacy Practices:

• Any health care professional who is authorized to enter information in your medical record;

• Any member of a volunteer group that we allow to help you while you are in the hospital; and

• Troy Surgical Clinic, Doctors Professional Clinic, Troy Family Practice, Lincoln County Home Health Care; these other entities follow the terms of this Notice of Privacy Practices. In addition, these entities will form an Organized Health Care Arrangement. They may share medical information for treatment, payment or health care operations as they are described in this Notice of Privacy Practices. These other entities are hereinafter referred to collectively with the LincolnCountyMedicalCenter as “LincolnCountyMedicalCenter”.

We reserve the right to change or modify the information in this Notice of Privacy Practices. Any changes that we make can be effective for any health information that we have about you and any information that we might obtain. Each time you receive services from the hospital, we will provide the most current copy of our Notice of Privacy Practices. The most recent version of Privacy Practices will be posted in our building. Also, you can call or write our Chief Compliance Officer.

1. Uses and Disclosures of Protected Health Information

We can use or disclose medical information about you regarding your treatment, payment for services or for hospital operations.

Treatment: To provide you with medical treatment or services, we may need to use or disclose information about you to doctors, nurses, technicians, medical students or other hospital personnel who are involved in your treatment. For example, a doctor may need to know what drugs you are allergic to before prescribing medications. Departments within the hospital may share medical information about you to coordinate your care. For instance, the laboratory may request information to complete lab work. We may also disclose medical information about you to people who may be involved in your medical care after you leave the hospital, such as home health agencies, your family and clergy members.

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as; making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of LincolnCountyMedicalCenter. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, marketing and fundraising activities, and conducting or arranging for other business activities.

For example, we may disclose your protected health information to medical school students who see patients at LincolnCountyMedicalCenter. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

We will share your protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services) for LincolnCountyMedicalCenter. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also use and disclose your protected health information for other marketing activities. For example, your name and address may be used to send you a newsletter about our practice and the services we offer. We may also send you information about products or services that we believe may be beneficial to you. You may contact our Director of Medical Records to request that these materials not be sent to you.

We may use or disclose your demographic information and the dates that you received treatment from your physician, as necessary, in order to contact you for fundraising activities supported by our office. If you do not want to receive these materials, please contact our Director of Medical Records and request that these fundraising materials not be sent to you.

2. Uses and Disclosures of Protected Health Information Based upon Your Written Authorization

Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that your physician or LincolnCountyMedicalCenter has taken an action in reliance on the use or disclosure indicated in the authorization.

3. Other Permitted and Required Uses and Disclosures to which You May Object

We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your physician may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your health care will be disclosed.

· Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

· Fundraising : We may use health information in an effect to raise money for the hospital. A foundation related to LincolnCountyMedicalCenter may receive contact information which includes your name, address, and phone number, and dates you received service from LCMC.

· Emergencies: We may use or disclose your protected health information in an emergency treatment situation. If this happens, LCMC shall try to obtain your written acknowledgement of receipt of the notice of privacy practices as soon as reasonably practicable after the delivery of treatment. If LCMC is required by law to treat you and the physician may still use or disclose your protected health information to treat you.

· Communication Barriers: We may use and disclose your protected health information if LincolnCountyMedicalCenter attempts to obtain your written acknowledgement of receipt of the notice of privacy practices from you but is unable to do so due to substantial communication barriers. LincolnCountyMedicalCenter will determine that your acknowledgement is inferred from the circumstances.

· 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 LCMC.

· Hospital Directory: Unless you advise the registration representative otherwise, we may include certain limited information about you in the hospital directory while you are a patient at LCMC. This information may include your name, location in the hospital, your general condition (good, fair, etc) 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 even if they don’t ask for you by name. This is so your family, friends, and clergy can visit you in the hospital and generally know how you are doing. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that you’re your family can be notified about your condition, status and location.

4. Other Permitted and Required Uses and Disclosures that do not Require Your Authorization or Opportunity to Object

We may use or disclose your protected health information about you without your authorization when there is an emergency or when we are required by law to treat you, when we are required by law to use or disclose certain information. These situations include:

> Required By Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, if required by law, of any such uses or disclosures.

> Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made in accordance with state law for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.

> Communicable Diseases: We may disclose your protected health information, according to state law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

> Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

> Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information under law. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

> Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.

> Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

> Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on LCMC’s premises) and it is likely that a crime has occurred.

> Coroners, Funeral Directors, and Organ Donation: We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

> Research: We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

> Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

> Military Activity and National Security: When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.

> Workers’ Compensation: Your protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally-established programs.

> Inmates: We may use or disclose your protected health information if you are an inmate of a correctional facility and your physician created or received your protected health information in the course of providing care to you.

5. Required Uses and Disclosures:

Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.

Your Rights with Respect to Health Information

· You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other records that may be used to make decisions about your care. Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.

If you want to see or copy your medical information, you must submit your request in writing to the Director of Medical Records. Depending on the circumstances, a decision to deny access may be reviewed. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Contact if you have questions about access to your medical record. If you requests copies of information, we may charge a fee for any costs associated with your request, including the cost of copies, mailing, other supplies.

· You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

We are not required to agree to a restriction that you may request. If we do agree to your restrictions, we will comply with your request unless it is needed to provide you treatment. Any request to restrict uses or disclosures must be made in writing to Director of Medical Records. Your request must indicate (1) what information you want limited; (2)whether you want to limit our use, disclosure or both (3) and to whom you want the limits to apply.

· You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. To request confidential communications, you must make your request in writing to the Director of Medical Records.

· You may have the right request amendment to your protected health information. You have a right to request that your health information be changed if you believe that it is incorrect or incomplete. You have a right to request changes for as long as we maintain the information. To request a change in your information, you must submit it in writing to The Director of Medical Records. In addition, you must give the reason that you want the information changed, including why you think the information is incorrect and incomplete.

We can deny your request if it is not in writing and if it does not include a reason why the information should be changed. We can also deny your request for the following reasons: (1) the information was not created by Lincoln County Medical Center, unless the person or entity that did create the information is no longer available; (2) the information is not part of the medical record kept by or for Lincoln County Medical Center;(3) the information is not part of the information that you would be permitted to inspect and copy; (4) We believe the information is accurate and complete.

· You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You must submit your request in writing to the Director Medical Records. Your request must state the time period that may not be longer than six (6) years and may not include dates before April 14, 2003. You have a right to a free accounting every twelve (12) months. If you request more than one (1) accounting in a twelve month period, we may charge you a reasonable fee for requesting that list. We will notify you of the charge for such a request and you can choose to withdraw or change your request before any costs are incurred.

· You have the right to obtain a paper copy of this notice from us, upon request. You may obtain a paper copy of this notice from Patient Registration, Medical Records Department, Clinic Offices, Home Care, and Compliance Office.

In an effort to enhance access to health care throughout LincolnCounty and surrounding areas, LCMC provides care to patients outside our hospital facility. When family members need assisted in-home medical care, or when recovery is more practical in a home-based setting, our Home Care Agency can coordinate and assist with many forms of therapy or medical care.

Another point of access to LCMC's modern system of health care exists through our network of conveniently located physician clinics providing primary care for all ages.

6. Complaints

If you believe that we have violated any of your privacy rights or have not adhered to the information contained in this Notice of Privacy Practices, you can file a complaint by putting it in writing and sending it to: Chief Compliance Officer, 1000 E. Cherry St., Troy, MO 63379 and 636-528-3322. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint with either the hospital or the U.S. Department of Health and Human Services. This notice was published and becomes effective on April 14, 2003.