Notice of Patient Privacy

Explanation of Your Health Record

Lake Charles Memorial Hospital (LCMH) understands your privacy is important. 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.

Each time you come to the hospital for any reason a record of your visit is made. The records will contain your symptoms, examination, procedures and test results, diagnoses, treatment and a plan for future care or treatment. This information referred to as your chart or medical record serves as a:

1. Basis for planning your care and treatment
2. Means of communication among the many health professionals who contribute to your care
3. Legal document describing the care you received
4. Means by which you or a third-party payer can verify that services billed were actually provide
5. A tool in educating health professionals
6. A source of data for medical research
7. A source of information for public health officials charged with improving the health of the nation
8. A source of data for facility planning and marketing
9. A tool with which the hospital can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what your record contains 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
• Make more informed decisions when authorizing disclosure to others

Your Health Information Rights

Your health record is the physical property of the healthcare provider that compiled it: the information belongs to you. You have the right to:

1. Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164 522. We are not required to grant such requests, except for certain disclosures to health plans where you have paid for services out of pocket.
2. Obtain a paper copy of the Notice of Privacy Practices upon request.
3. Inspect and copy your health record as provided for in 45 CFR 164.524.
4. Amend your health record as provided in 45 CFR 164.528.
5. Obtain an accounting of disclosures of’ your health information at any time upon giving written notice as provided in 45 CFR 164.528.
6. Request communication of your health information by alternative means or alternative locations.
7. Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Healthcare Provider Responsibilities

LCMH is required to:

• Maintain the privacy of your health information, and notify you of a breach of your unsecured health information.
• Provide you with 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 alternative locations.

Who Will Follow This Notice?

This Notice describes our organization’s practices and those of:

• Health Care professionals who are members of our workforce authorized to access and/or enter information into your medical record or billing record.
• All departments and units of this facility.
• All employees, volunteers and other facility personnel considered a part of our workforce.
• Any health care entities and medical offices owned by or affiliated with this facility.
• This facility is a part of an organized health care arrangement (OHCA). An OHCA is (1) a clinically integrated setting in which individuals typically receive health care from more that one health care provider or (2) an organized system of health care in which more than one health care provider participates. The health care providers who participate in the OHCA will share medical and billing information about you with one another as may be necessary to carry out treatment, payment, and health care operations activities. This Notice of Privacy Practices constitutes the Notice of Privacy Practices for the OHCA and all health care providers participating in the OHCA. The health care providers who participated in the OHCA and to which this Notice of Privacy Practices applies include this facility, the members of its medical staff, and the other health care providers affiliated with Lake Charles Memorial Health System.
• Certain physicians who provide medical services in this facility are members of the facility’s medical staff and, as such, are part of the OHCA. Such physicians are, however, self-employed independent contractors; they are not agents, servants, or employees of this facility, and the facility is not responsible for their judgement or conduct.

LCMH reserves the right to change our practices and to make the new provisions effective for all protected information we maintain. Should our information practices change, we will post the revised notice inn our facilities and on our web site and provide you a copy upon request.

LCMH will not use or disclose your health information without your authorization, except as described in this notice. In any event, LCMH will obtain your authorization before any use or disclose of psychotherapy notes about you, for marketing, or to ask permission to sell your information.

For Additional Information Or To Report A Problem

If you have questions and would like additional information, you may contact the Chief Privacy Officer at 337.494.2846 or the Health Information Management Director at 337.494.3140. If you believe your privacy rights have been violated, you can file a complaint with the Chief Privacy Officer or the Health Information Management Director at the numbers listed above. If you wish you can file a complaint with: Region VI, Office for Civil Rights, U.S. Department of Health and Human Services 1301 Young Street, Suite 1169, Dallas, TX 75202. Voice Phone 214.767.4056, Fax 214.767.0432 TDD 214.767.8940. We are not permitted to retaliate against you for filing a complaint.

Uses And Disclosures For Treatment, Payment And Health Operations

LCMH will use your health information for treatment.

For example: Information obtained by a nurse, physician or other health care professional 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 what he or she expects from the members of your healthcare team. Your healthcare team members will record the actions they took and their observations. In this way the physician will know how you are responding to treatment.

Your physician will be provided with various reports that should assist him or her in treating you once you are discharged from the hospital.

LCMH 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, the procedures performed and the supplies used.

LCMH will use your health information for regular health operations.

For example: Members of the medical staff, the risk manager, the quality improvement manager or members of the quality management 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 healthcare and services provided by LCMH.

BUSINESS ASSOCIATES – There are some services provided in this facility for which we contract, such as copying, transcription, accounting, and legal. When these services are contracted, we may disclose your health information to these business associates so that they can provide the job we have asked them to do. To protect your health information, however, we require the business associates to appropriately safeguard your information.

INFORMATION- Unless you notify LCMH that you object, we will provide to persons asking for you by name your physical location in the hospital. This does not apply to any patient on a psychiatric unit.

NOTIFICATION – LCMH may use or disclose information to notify or assist in notifying a family member, personal representative, or guardian, about your location, general condition or death. This includes disclosure to a public or private entity authorized to assist in disaster relief efforts.

COMMUNICATION WITH FAMILY – Healthcare professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you may identify, health information relevant to that person’s involvement in your care or payment related to your care.

RESEARCH - LCMH may disclose your personal health information to researchers when its Internal Review Board has reviewed the research proposal and has determined that protocols have been established to ensure the privacy of your health information.

FUNERAL DIRECTORS – Consistent with applicable laws of the State of Louisiana, LCMH may disclose to funeral directors that portion of your personal health information necessary to create the death certificate.

LOUISIANA ORGAN PROCUREMENT AGENCY – Consistent with applicable laws of the State of Louisiana, LCMH may disclose health information related to organ and tissue donation as well as transplantation.

APPOINTMENT REMINDERS AND TREATMENT OPTIONS – LCMH may contact you to provide appointment reminders, treatment options, or other health related benefits and/or services that may be of interest to you.

FUND-RAISING – LCMH may contact you as a part of a fund raising effort. You may notify us that you would like to opt out of fund raising communications.

FOOD AND DRUG ADMINISTRATION – LCMH may disclose to the FDA your personal health information relative to adverse events with respect to food, supplements, products, product defects, or post marketing surveillance information to enable product recalls, product tracking, repairs or replacement.

EQUIPMENT VENDORS – LCMH may disclose your personal health information to suppliers of medical equipment and/or device information to enable product recall, product tracking, repairs or replacement.

WORKERS COMPENSATION – LCMH may disclose your health information to the extent authorized and to the extent necessary to comply with laws of the State of Louisiana relating to workers compensation.

PUBLIC HEALTH – As required by laws of the State of Louisiana, LCMH may disclose your personal health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.

CORRECTIONAL INSTITUTIONS – LCMH may disclose to the institution or the agents thereof the personal health information of inmate’s necessary for their health and the health and safety of other individuals.

LAW ENFORCEMENT – In response to a valid subpoena, LCMH may disclose your personal health information for law enforcement purposes as required by laws of the State of Louisiana or as otherwise permitted by federal law.

Federal law makes provision for your health information to be released to a health agency, public health authority or their attorney, provided that a workforce member or business associate believes in good faith that LCMH has engaged in unlawful conduct or clinical standards and are potentially endangering one or more patients, workers or the public. Federal law also makes provision for inspection of those health records of individuals who are brought to LCMH for treatment from a long term care facility if there is reason to believe unlawful conduct or clinical standards has endangered the resident of that facility necessitating the admission to LCMH.

Alcohol And Drug Abuse Patients

The confidentiality of alcohol and drug abuse patient records maintained by the program at LCMH is protected by federal law and regulations. LCMH may not say to a person outside the drug and alcohol abuse program that a patient is being treated in the program, or disclose any information identifying a patient as an alcohol or drug abuser unless one of the following conditions is met:

1. The patient consents in writing.
2. The disclosure is allowed by court order.
3. The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit or program evaluation.

Violation of the federal law and regulations by the chemical dependency unit is a crime. Suspected violations may be reported to appropriate authorities in accordance with federal guidelines.

Federal law and regulations do not protect any information about a crime committed by a patient either at the program or against any person who works for the program or about any threat to commit such a crime.

Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under state law to appropriate authorities.