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Methodist Healthcare Ministries of South Texas

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH 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 our
Privacy Officer at (210) 692-0234

This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It describes how Methodist Healthcare Ministries may use or disclose your protected health information, with whom that information may be shared and the safeguards we have in place to protect it. This notice also describes your rights to access, amend, or restrict the use and disclosure (except as required or authorized by law) of your protected health information.

Acknowledgement of Receipt of This Notice

You will be asked to provide a signed acknowledgement of receipt of this notice. Our intent is to make you aware of the possible uses and disclosures of your protected health information and your privacy rights. The delivery of your health care services will in no way be conditioned upon your signed acknowledgement. If you decline to provide a signed acknowledgement, we will continue to provide your treatment, and will use and disclose your protected health information for treatment, payment and health care operations when necessary.

Understanding Your Health Record / Information

Each time you visit a hospital, physician, dentist, or other healthcare provider, 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 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.
Tool in educating health professionals.
Source of data for medical research.
Source of information for public health officials charged with improving the health of the nation.
Source of data for facility planning and marketing.
Tool with which we can assess and continually work to improve the care we rendered 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, why and how others may access your health information.
Make more informed decisions when authorizing disclosure to others.

Your Health Information Rights

Although your health record is the physical property of Methodist Healthcare Ministries of South Texas, 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. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. To request restrictions, you must make your request in writing to the 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. A request form is available at the MHM facility where you receive services. 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 emergency treatment.
Obtain a paper copy of the Notice of Privacy Practices upon request. You may ask us to give you a copy of this notice at any time. You may obtain a copy of this notice at our website, www.mhm.org. To obtain a paper copy of this notice, contact the Custodian of Records at the facility where you receive services.
Amend your health record as provided in 45 CFR 164.528. 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. To request an amendment, your request must be made in writing and submitted to the Custodian of Records. A request form is available at the MHM facility where you receive services. 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; does not include a reason to support the request; the information was not created by us; the information in question is not part of the medical information kept in the record; if the information in question is not part of the information which you would be permitted to inspect and copy; or the information in question is accurate and complete.
Inspect and obtain a copy of your health record as provided for in 45 CFR 164.524. Usually, this includes medical and billing records, but does not include psychotherapy notes. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Custodian of Records. A request form is available at the MHM facility where you receive services. 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.
Obtain an accounting of disclosures of your health information as provided in 45 CFR.164.528. This is a list of the disclosures we made of medical information about you. To request this list or account of disclosures, you must submit your request in writing to the Custodian of Records. A request form is available at the MHM facility where you receive services. Your request must state the time period, which may not be longer than six years and may not include dates before April 1, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first two lists you request within a 12-month period will be free. For additional requests within the 12-month period, we may charge you for the costs of providing the list.
Request communications of your health information by alternative means or at alternative locations. To request confidential communications, you must make your request in writing to the Custodian of Records. Your request must specify how or where you wish to be contacted. A request form is available at the MHM facility where you receive services.
Authorize the disclosure of your protected health information to another entity. MHM must have a completed authorization form signed by you, identifying what information is to be disclosed, to whom the information is to be disclosed and for what time period. The form should be submitted to the Custodian of Records.
Revoke your authorization to use or disclose health information except to the extent that action has already been taken. To revoke your authorization, you should make your request in writing to the Privacy Officer. A request form is available at the MHM facility where you receive services.

Our Responsibilities To You Regarding Protected Health Information

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 provision effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you have supplied us.

We will not use or disclose your health information without your authorization, except as described in this notice.

How We May Use or Disclose Your Protected Health Information

The following are examples of permitted uses and disclosures of your protected health information. These are examples only and do not represent a complete or exhaustive list of uses and disclosures.

Required Uses and Disclosures
By Law, we must disclose your health information to you unless it has been determined by a competent medical authority that it would be harmful to you. We must also disclose health information to the Secretary of the Department of Health and Human Services (DHHS) for investigations or determinations of our compliance with laws on the protection of your health information.

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 healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.

We may provide other physicians, hospitals, outpatient facilities or ambulances with copies of various reports that would provide assistance in your treatment.

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 staff 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 healthcare and service we provide.

Business Associates: There are some services provided in our organization through contacts with business associates. Examples include computer software services and a transcription service. When these services are used, we may disclose your health information to our business associate so they can perform the job we have asked them to do. To protect your health information, however, we require the business associate to appropriately safeguard your information.

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 or Individuals Involved in Your Health Care: Health professionals, using their best judgment, 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.

Research: We may disclose 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 health information.

Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Fund Raising: We will not use or disclose to any state, federal, or local government, or to a foundation; any individually identifiable health information, for the purpose of raising funds for our own benefit or for the benefit of any other organization without your prior written authorization.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, products 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, abuse, neglect or disability.

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

Schools: We may disclose health information concerning the student served by the School Based Health Centers to the student’s school to ensure the health and safety of the student and other students.

Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections and licensure.

Required by Law: We may use or disclose your protected health information if law or regulations requires the use or disclosure.

Federal law makes provisions 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 Methodist Healthcare Ministries has engaged in unlawful conduct or has otherwise violated professional or clinical standards and is potentially endangering one or more patients, workers or the public.

For More Information or to Report a Problem

If you have any questions and would like additional information, you may contact our Privacy Officer, at Methodist Healthcare Ministries, 4507 Medical Drive, San Antonio, Texas, 78229, (210) 692-0234.

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.