St. Dominic-Jackson Memorial Hospital 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 St. Dominic’s Privacy Officer at 601-200-2464.
This notice describes St. Dominic-Jackson Memorial Hospital’s practices and that of:
- Any healthcare professional authorized to enter information into your hospital chart such as nurses, therapists, etc.;
- All departments and units of the hospital;
- All employees, staff, volunteers, contractors, advanced practice professionals, clinical assistants, medical product personnel and other hospital personnel; and
- Any physician who is a member of the Hospital Medical Staff and involved in your treatment.
- Make sure that health information that identifies you is kept private;
- Give you this notice of our legal duties and privacy practices with respect to health information about you;
- Notify you following a breach of your protected health information that was unsecured; and
- Follow the terms of the notice that are currently in effect.
The following categories describe examples of different ways that we may use and disclose health 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. However, the ways we are permitted to use and disclose information fall within one of the categories. For a more inclusive description of permitted uses, see 45 C.F.R. Part 164.
Public Health Information
As required by law, we may disclose your health information to public health or legal authorities for public health activities. For example, we report information about births, deaths, and various diseases to government officials in charge of collecting that information, and we provide coroners, medical examiners and funeral directors necessary information relating to an individual’s death.
Health Oversight Activities
We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include accreditations, 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.
Organ and Tissue Donation
If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or we also may release information to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
In certain circumstances, we may disclose your health information in order to conduct medical research.
To Avert a Serious Threat to Health or Safety
We may use and disclose health information about you when necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person. Such disclosure would only be to someone able to help prevent the threat.
Specific Government Functions
We may disclose health information of military personnel and veterans in certain situations. We may also disclose information for national security purposes, such as protecting the President of the United States or conducting intelligence operations.
We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Appointment Reminders and Health Related Benefits and Services
We may use and disclose health information to provide appointment reminders or give you information about treatment alternatives, or other health care services or benefits we offer.
If you are an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.
We may contact you to raise funds for a particular hospital service or project. You have the right to opt out of receiving such communications.
OTHER USES OF HEALTH INFORMATION
Other uses and disclosures of health information not described in the notice will be made only with your written permission. We must have a written authorization for most uses and disclosures of psychotherapy notes, for marketing purposes, and for sale of protected health information. If you give us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. Please understand that we are unable to take back any disclosure we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
Right to Access
You have the right to inspect and copy health information that may be used to make decisions about your care. You have the right to request a copy of your health information in written or electronic format.
Usually, this includes medical and billing records, but does not include for example, psychotherapy notes, information compiled for a civil, criminal or administrative proceeding, or information obtained by the Hospital from another source.
To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing to St. Dominic-Jackson Memorial Hospital, Attn.: Health Information Management Department, 969 Lakeland Drive, Jackson, MS 39216.
There may be a fee for the costs of copying, mailing or other supplies associated with your request.
We reserve the right to deny you access to all or part of your health information in limited circumstances. For example, psychotherapy notes, or information compiled in reasonable anticipation of, or for use in a civil, criminal or administrative action proceeding. If you are denied access to all or part of your protected health information, we will do our best to provide you with access to any other protected health information requested after excluding the protected health information to which we have grounds to deny. St. Dominic will also give you a written denial that describes the basis for the denial and, if applicable, a statement of your review rights and a description of how you can exercise those rights. We will also include information on how to file a complaint with St. Dominic or with the Secretary of Health and Human Services.
Right to Amend
If you feel that health 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 the hospital.
To request an amendment, you must submit your request in writing and include reasons that support your requested amendment.
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 not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the health information kept by or for the hospital;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
Right to an Accounting of Disclosures
You have the right to request an “Accounting of Disclosures.” This is a list of the disclosures we made of health information about you to external organizations that is not included in this notice or part of treatment, payment and healthcare operations. St. Dominic will provide your requested accounting within 60 days after receipt of the request or notify you in writing if we are unable to meet that deadline.
To request this list or accounting of disclosures, you must submit your request in writing to St. Dominic-Jackson Memorial Hospital, Attn.: Health Information Management Department, 969 Lakeland Drive, Jackson, MS 39216. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003.
Right to Request Restrictions
You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on health 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. If you would like additional information about your rights on requesting restrictions please contact St. Dominic’s Privacy Officer, at 969 Lakeland Drive, Jackson, MS 39216 or by calling 601-200-2464. We are not required to agree to your request. However, if you request that we restrict the disclosure of your health information to your health plan for the purpose of carrying out payment or health care operations (and not otherwise required by law) and you pay out of pocket for your service in full at the time of service, we agree not to disclose your information to your health plan for that date of service.
To request restrictions, you must make your request in writing to St. Dominic’s Health Information Management Department. 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.
Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. We will accommodate all requests for such confidential communication to the best of our abilities.
To request communication in a confidential location or way, you must make your request in writing to our Privacy Officer. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of this Notice
You have the right to a paper copy of this notice. You may request this at any time, even if you have agreed to receive this notice electronically.
You may obtain a copy of this notice at our web site, www.stdom.com or by contacting our Privacy Officer at 601-200-2464.
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 health 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 the hospital. The notice will contain on the first page, in the top right hand corner, the effective date. In addition, each time you register at or are admitted to the hospital for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect. You may also obtain a copy of our most recent notice at our web site, www.stdom.com.
Click here to download a printable PDF copy of the notice.