Patient Privacy Notice

IBERIA MEDICAL CENTER NOTICE OF PRIVACY PRACTICES Effective Date: September 23, 2013

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 cannot read or understand this document, someone will read or explain it to you.

OUR PLEDGE REGARDING YOUR 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 each of our health care delivery sites (hospital, clinics and other departments). 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 generated by each of our health care delivery sites, whether made by our employees or your personal doctor.

This notice will tell you about the ways in which we may use and disclose medical information about you. Disclosure means the release, transfer, or provision of or access to Protected Health Information (PHI). This Notice of Privacy Practices also describes your rights, your obligations, and our obligations regarding the use and disclosure of your medical information.

YOUR RIGHTS

Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the following rights regarding the medical information we maintain about you:

Right to access and copy your record:

You have the right to access, inspect and request a paper copy or electronic copy of your health record maintained in electronic format in accordance with Louisiana Law (R.S. 40:1299.96).
If you request a copy of the information, we are allowed by law to charge a fee for the cost of copying, mailing or other supplies associated with your request. If you wish to inspect and/or obtain a copy of your own medical records, you must submit your request in writing to the Receptionist in the Medical Records Department. The Medical Records Department has a form you may use to make this request. In some limited circumstances, we may deny your request to inspect and/or copy your medical records.

Right to amend or make changes to your record

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 each of our health care delivery sites. Ask us how to do this.
We may deny your request for an amendment, but we will tell you why in writing within 60 days. The reasons for denying your request include, but are not limited to, the following: 1) the information you are asking to amend is part of a record which was not created by Iberia Medical Center; 2) the information you ask us to amend is not part of the information kept by this hospital; or, 3) the information is accurate and complete.

Right to an accounting of disclosures

You have the right to ask for an "accounting of disclosures.” This is a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and health care operations, for disclosures permitted by law, for disclosures pursuant to an authorization, for disclosures related to national security or intelligence purposes, for disclosures to correctional institutions, and certain other disclosures. We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Right to request restrictions

You have the right to request that we not use or disclose your health information, sometimes referred to as restrictions. Please be aware that in some instances we are not required to agree to your request.
You have the right to request a limit on the information to someone who is involved in your care or payment for your care. Please be aware that in some instances 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.
If you request that we not disclose your information to your insurer about a specific health product or service, and you pay for that product or service out-of-pocket in full, we must agree to your request. We are not required to honor this request not to disclose to your insurer or other third-party payor unless you provide payment in full for the undisclosed healthcare services.
To request that confidential information not be shared with your payor source, you must make this request in writing, and provide us with your preferred method of contact. We will not ask you the reason for the request and will accommodate reasonable requests.

Right to receive confidential communications

You have the right to request that we communicate with you about medical manners in a certain way or at a certain location. For example, you can ask that we only contact you by work or by mail or to send mail to a different address. However, you are responsible for insuring that we have been provided with updated contact information for you so that we can most effectively respond to this request.

Right to a copy of this notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
You may obtain a copy of our most current notice in person from any Registration area at each of our health care delivery sites or from our website, www.iberiamedicalcenter.com,

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, let us know and we will follow your instructions:

Unless you notify us that you object, we will use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.

We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care about your location and general condition. In addition, we may disclose 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.

Communication with others

Health professionals, using their best judgment, may disclose relevant health information to a family member or any other person you identify, regarding your health care or health care payment obligations.

If you are not able to tell us your preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share information when needed to lessen a serious and imminent threat to health or safety.

Authorization

Without your authorization, we may not use or disclose your psychotherapy notes, unless the notes are being used for carrying out treatment, payment or healthcare operations, or the notes are necessary to defend the hospital from a legal action brought by the individual who is the subject of the notes. We may not use or disclose your health information for our own marketing, or not sell your health information to a third-party without your authorization.

Fundraising

We may use certain information to contact you for the purpose of raising money for our organization. For the same purpose we may provide your name to our hospital’s foundation. The money raised will be used to expand and improve the services and programs we provide the community. You are free to opt out of fundraising solicitation, and your decision will have no impact on your treatment or payment for services at Iberia Medical Center. If you do not want to be contacted for fundraising efforts, you must notify our Director of Marketing by calling our local phone number at (337) 364-0441.

OUR RESPONSIBILITIES

Make sure that medical information that identifies you is kept private.
Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.
We will notify you if there is a breach (an inappropriate use or disclosure of your health information that the law requires us to report).
Abide by the terms of the notice that is currently in effect.
Notify you if we are unable to agree to a restriction or an amendment that you request.
Accommodate reasonable requests you may have to communicate health information by alternate means or at alternative locations.

OUR USES AND DISCLOSURES

We will not use or disclose your health information without your authorization except as provided by law or described in this notice. Not every use or 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 the categories.

For Treatment. We may use medical information about you to provide you with medical treatment or services and share it with other professionals who are treating you. 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. Medical information about you may be disclosed to people outside each of our health care delivery sites who may be involved in your care such as family members, your physicians, or a subsequent health care provider in order to assist this health care provider in treating you once you are discharged from our facility.

For Payment. We may use and disclose medical information about you so that we may bill, receive and collect payment for services rendered by each of our health care delivery sites. For example, we may need to give your health insurance plan some information about surgery you received at each of our health care delivery sites so your health insurance plan will pay us or reimburse you for the surgery.

For Health Care Operations. We may use and disclose your health information to run our practice, improve your care, and contact you when necessary. We use health information about you to manage your treatment and services. We may also use and disclose your information other health care operations, such as quality assurance, training, case management, accreditation, certification, licensing, auditing and business planning. These uses are necessary to run each of our health care delivery sites and make sure that all of our patients receive quality care.

Health Information Exchange (HIE). We may make your health information available electronically through an information exchange network to other providers involved in your care who request your electronic health information. The purpose of this exchange is to support the delivery of safer, better coordinated patient care. Participation in the information exchange is voluntary. If you do not want your Iberia Medical Center health information to be accessible to authorized health care providers through the HIE, you may opt-out. Information about the HIE is available in one of our Registration areas.

Business Associates. There are some services provided in our organization through contracts with business associates. Examples include, certain laboratory tests, collection agencies, and a copy service we might use when making copies of your health record. When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we’ve asked them to do and to allow them to bill you or your health insurance plan for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

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 each of our health care delivery sites.

Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law. For example, we are required to notify law enforcement about the incidents of abuse or suspected abuse of a child/children, disabled/dependent persons, and the elderly. We are also required to notify law enforcement when patients present with certain types of wounds such as gunshot wounds.

Public Health Purposes. We may disclose medical information about you for public health activities. These activities generally include the following: to prevent disease, injury or disability; to report births and deaths; 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.

Food and Drug Administration (FDA). We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement.

A Prospective Employer. We may disclose information about you to a prospective employer if we have been requested by your employer to conduct pre-employment testing.

Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include 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 subpoena, court order or other lawful process. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or efforts have been made by you or someone on your behalf to obtain an order protecting the information requested.

Law Enforcement. We may release medical information for law enforcement purposes as required by law such as providing limited information to locate a missing person or respond to a search warrant. We may also disclose protected health information to law enforcement if we believe that a crime has been committed on our premises.

Coroners, Medical Examiners and Funeral Directors. We may release 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 deceased patients to funeral directors as necessary to carry out their duties.

Organ Procurement Organizations. Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of tissue or organs for the purpose of tissue donation and transplantation.

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. All research projects are subject to a special approval process and very specific privacy requirements must be met.

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 for the purpose of helping to prevent the threat from occurring.

Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

Military and Veterans. If you are a member of the U. S. Armed Forces, we may release medical information about you as required by military command authorities.

National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Protective Services for the President and Others. We may disclose 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.

Workers' Compensation. We may release health information to the extent authorized by and the extent necessary to comply with laws relating to workers’ compensation or other similar programs established by law.

For Proof of Immunizations. We may disclose protected health information about an individual who is a student or prospective student of a school if the information is limited to proof of immunizations.

Change of Ownership. In the event this organization is sold or merged with another organization, your health information will become property of the new owner.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical 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 medical information about you for the reasons covered by your written authorization. Understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

WHO WILL FOLLOW THIS NOTICE

This notice describes Iberia Medical Center practices and that of:

Anyone authorized to enter information into your chart.

All department, units and clinics of Iberia Medical Center.

Any member of a volunteer group we allow to help while you are receiving care from one of our health care delivery sites.

All employees, staff, and other personnel at each of our health care delivery sites.

All physicians on staff at Iberia Medical Center follow the terms of this notice in regards to services rendered by our health care delivery sites. These physicians may have different policies or notices regarding his/her use and disclosure of your medical information created in his/her office or clinic. Our health care delivery sites and the physicians on our medical staff may share medical information with each other for treatment, payment or operational purposes as described in this notice.

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 at each of our healthcare delivery sites and on our website. 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 one of our healthcare delivery sites for treatment or health care services, we will offer you a copy of the current notice in effect.

FOR MORE INFORMATION OR TO REPORT A PROBLEM

If you have a question or would like additional information, you may contact our Privacy Officer at: Iberia Medical Center; Privacy Officer; 2315 East Main St.; New Iberia, LA 70560. Our Privacy Officer can be reached by phone by dialing the hospital’s main number at (337) 364-0441. If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the U.S. Department of Health and Human Services Office for Civil Rights. All complaints must be submitted in writing. There will be no retaliation for filing a complaint.