THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW THIS NOTICE CAREFULLY.

At Faith Community Hospital (“FCH”), we know you value your privacy.  That is why we are committed to the confidentiality and security of your health information.  We maintain physical, administrative, and technical safeguards to protect against unauthorized access, use, or disclosure of your health information.  We are required by law to maintain the privacy of this information and to explain our legal duties and privacy practices.  FCH applies the practices described in this notice to all health information that we maintain, including the health information of former patients.  We hope this notice clarifies our responsibilities to you and helps you understand your privacy rights.  We abide by the notice that is currently in effect.  This notice is effective January 30, 2015.

Your Rights

Inspection and Copies.  You have the right to request an inspection or copies of the health information that FCH maintains about you in a “designated record set” except for psychotherapy notes; certain information subject to the Clinical Laboratory Improvements Amendments of 1988; and information that we compiled in anticipation of, or for use in, a civil, criminal or administrative proceeding.  A “designated record set” is a group of records relating to your health care, payment for your health care, or that contain information FCH used to make a decision about you.  FCH may limit the health information that you can inspect or copy if we have reason to believe that is necessary to protect you or another person from harm.  If we limit your right to inspect or copy, you can ask for a review of that decision.  You may request a copy of the designated record set in an electronic, machine-readable format.  FCH will respect your request if the records are maintained electronically and are readily producible in the format you request.  FCH charges fees for providing copies in accordance with federal and State laws.

Amendment. If you believe the health information FCH maintains about you in a designated record set is inaccurate or incomplete, you have the right to request an amendment.  You must submit your request in writing and explain the reason for your request.  If the amendment is made, we will make reasonable efforts to inform others (that you identify) and we will include the amendment in future disclosures.  We may decline to amend information under certain circumstances.  This is likely to occur if we did not create the original record or if the record is deemed accurate as is.  If we decline to amend a record, you have the right to submit a statement of disagreement which will be attached to the record.  Please be aware that FCH may attach a rebuttal statement in response to your statement of disagreement.

Notice. You have the right to receive a paper copy of this notice upon request.

Accounting. You have the right to request a list of certain disclosures of protected health information.  The list will not include disclosures made for treatment, payment, or health care operations.  It also will not include disclosures made pursuant to an authorization, made prior to six years before the date of the request, incidental disclosures, disclosures made for national security or intelligence, disclosures made for facility directory purposes, disclosures to persons involved in your care or payment for your care, disclosures to correctional institutions or for law enforcement purposes, or disclosures made as part of a limited data set.  The list will include the date of any accountable disclosure, a brief description of the information disclosed, and the purpose of the disclosure (provided this information is known to us).  If you request the list more than once in a 12-month period, you will be charged a reasonable fee.

Special Handling. If you pay for your care solely out of pocket, you may ask FCH not to disclose your care to your insurer.  In addition, if you explain that you may be harmed if FCH communicates with you in the usual way, you may request that we communicate with you in confidence.  We will make every effort to accommodate your request if it is reasonable and you provide an alternative way to contact you. Furthermore, you have the right to request restrictions on FCH’s use or disclosure of health information.  FCH is not required to agree to your request and we may be unable to do so.  If we agree to comply with your request, we will do so except in the case of an emergency.

Complaints.  You have the right to submit a complaint if you believe FCH has violated your privacy rights.  To submit a complaint, write to: FCH Community Hospital, Privacy Official, 215 Chisholm Trail Jacksboro, TX 76458 or call 940-567-6633.  You also have the right to submit a complaint to the Secretary of the U.S. Department of Public Health & Human Services.  Be assured that we will not retaliate against you for submitting a complaint.

Electronic Health Information Exchange.  FCH participates in an electronic health information exchange.  The exchange allows FCH to share health information with other providers and to receive health information from other providers so that you can receive better care.  You have the right to ask FCH not to share your health information through the exchange.

Breach Notification.  In the event that FCH discovers an unauthorized use or disclosure of unsecured protected health information which constitutes a breach, you have the right to receive notice of the breach if it impacts health information maintained about you.

Permitted Uses and Disclosures

Treatment.  FCH will use and disclose health information to care for you.  You should be aware that the physicians providing treatment, including the physicians in the Emergency Department, may not be employees of FCH.  They may be physicians employed by others who have been granted privileges to use FCH’s facilities.  FCH may also use and disclose health information to coordinate care with your other health care providers or to provide appointment reminders.

Payment.  FCH will use or disclose health information for payment purposes, including to submit claims to insurers, to determine coverage or eligibility status, and to obtain prior approval for services.

Operations.  FCH may use or disclose health information to facilitate operations, including for credentialing physicians, quality improvement programs, case management, and for the detection and prevention of fraud.

Business Associates.  Occasionally, FCH contracts with business associates to perform services on FCH’s behalf.  We may disclose health information to these business associates.  The business associates also may collect, use or disclose health information on our behalf.   Our business associates must provide the same privacy protections that we provide.

Required by Law.  FCH will use or disclose health information as required by law.  For example, FCH reports certain wounds or diseases to government agencies when required by law. 

Directory Services.  FCH provides limited health information about patients admitted to the hospital.  For example, if a person calls FCH and asks for you by name while you are in the hospital, FCH will disclose your hospital location and a general health status, such as “critical” or “stable.”  If you do not want your location and status to be disclosed, tell your health care provider that you wish to opt out of directory services.

Public Health Activities.  FCH may disclose health information for public health activities.  These activities include prevention and control of disease; activities performed by the medical examiner or coroner, organ or tissue donation and transplantation services, and by the Food and Drug Administration; medical research; activities necessary to avert a serious threat to the health or safety of a person; and activities relating to the administration of workers’ compensation benefits.

Health Oversight Activities.  FCH may disclose health information to health oversight agencies.  These agencies are authorized by law to conduct audits, perform inspections and investigations, license hospitals and health care providers, and to enforce regulatory requirements.  Examples of these types of agencies include the Department of Health & Human Services, the Texas Board of Medicine, and the U.S. Department of Labor.
Legal Proceedings.  FCH may disclose health information in the course of a judicial or administrative proceeding; in response to a court order, subpoena, or discovery request; or to satisfy lawful process.

Law Enforcement.  FCH may disclose health information to law enforcement officials in response to a qualified administrative request, administrative subpoena, or warrant.  FCH also may disclose limited health information for the purpose of reporting a crime on our premises or to locate a suspect, victim, or witness.

Military and National Security.  FCH may disclose health information to armed forces personnel and to authorized federal officials for national security or intelligence activities.

Correctional Institutions.  If you are an inmate, FCH may disclose health information to your correctional institution for treatment purposes or to ensure the safety of yourself or others.

Students and Trainees.  We may disclose health information to doctors, nurses, technicians, house-staff (including residents and interns), medical students, other health care students and other FCH personnel to conduct training and education programs.

Marketing.  FCH does not sell protected health information for marketing purposes.  We do not use or disclose health information for marketing purposes without your authorization.  However, we may communicate with you about health-related products or services that may interest you or we may provide a promotional gift of nominal value.

Others Involved in Your Care.  FCH may disclose health information to persons involved in your care or involved in the payment for your care (to the extent of their involvement).  If you give us permission or if your permission can be implied, we may disclose health information to family members or others that call on your behalf.  For example, FCH may provide your prescription to a person that you asked to pick up the prescription.  In emergencies, FCH may disclose health information to persons who accompany you to the hospital.

Authorizations.  FCH must obtain your authorization to use or disclose your health information for purposes other than those described in this notice.  Your authorization is also required to disclose psychotherapy notes.  If you provide authorization, you have the right to revoke your authorization by notifying FCH in writing.  Any revocation will not affect uses or disclosures made prior to your revocation.

Future Changes

FCH reserves the right to change our privacy practices and this notice at any time without advance notice.  If we make a material change to our privacy practices, we will make a new, updated notice available to you.  The new notice will apply to all health information in our possession, including any information created or received before the revised notice became effective.