NOTICE OF PRIVACY PRACTICES
Effective Date: January 1, 2003

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 have any questions about this notice, please contact the Health Information Department .


OUR PLEDGE REGARDING MEDICAL INFORMATION

Winston Medical Center is committed to protecting your medical information We create a record of care and services you receive at the hospital. 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 the hospital, whether made by hospital personnel or your personal doctor. All employees and volunteers of WMC and any health care professional authorized to enter information in your record will follow this notice. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.

This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to make sure that medical information that identifies you is kept private and to give you this notice of our privacy practices. We are required by law to follow the terms of the notice that is currently in effect. We reserve the right to change this notice, making any revision applicable to all the protected health information we maintain about you as well as any information we receive in the future. We will post a copy of the current notice in the hospital and at the hospital 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 the hospital for treatment or services as an inpatient or outpatient, you may request a copy of the notice. If the notice changes, we will post a copy of the revised notice and will make paper copies of the revised Notice of Privacy Practices available upon request.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe different ways that we use and disclose medical information For each category we will try to give some examples. Not every use or disclosure in a category will be listed.

• For Treatment We may use medical information to provide you with medical treatment or services. 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. In addition, the doctor may need to tell the dietitian if you have diabetes so that we care arrange for appropriate meals.
  

• For Payment We may use and disclose medical information about you so that the payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about surgery you received at the hospital so they will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
  

• For Health Care Operations. These uses and disclosures are necessary to run the hospital and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine the medical information we have with medical information from other hospitals to compare how we are doing and see where we can make improvements in the care and services we offer.
  

• Business Associates. There are some services provided in the hospital through contracts with business associates. Examples include certain laboratory tests and the copy service we use when making copies of your health record. We may disclose health information to our business associate so they can perform their job; 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 services at the hospital.
  

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

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

• Fundraising Activities. We may contact yon or a foundation related to the hospital may contact you to raise money for the hospital or its operations. We only would release contact information, such as your name, address and phone number, and the dates you received treatment or services at the hospital. If you do not want the hospital to contact yon for fundraising efforts, you must notify the Administrator in writing.
  

• Patient Information. Unless yon object, we will release your room number and condition (fair, stable, etc.) to family or friends who ask for you by name. Your religions affiliation will be given to members of the clergy, even if they do not ask for you by name, unless you object.
  

• Individuals Involved in Your Care or Payment for Your Care. Unless you object, we will release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care.
  

• Disaster Relief. We may disclose medical 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.
  

• Research. We may use and disclose medical information about yon for research purposes. All research projects, however, are subject to a special approval process. We shall attempt to ask for your specific permission if the researcher will have access to your name, address and other information that reveals who you are, or will be involved in your care at the hospital.
  

• As Required By Law. We will disclose medical information when required by federal, state, or local law.
  

• To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about yon to prevent a serious threat to your health and safety or the health and safety of the public or another person.
  

• Organ and Tissue Donation. Consistent with applicable law, we may disclose health information to organ procurement organizations as necessary to facilitate organ or tissue donation or transplantation.
  

• Military and Veterans. If you are a member of the armed forces we may release medical information about you as required by military command authorities.
  

• Workers’ Compensation. We may release medical information about you for workers’ compensation or similar programs.
  

• Public Health Risks. We may disclose medical information about you for public health activities including the reporting of diseases and vital events. We may also disclose information to report reactions to medications or problems with products; to notify of recalls of products they are using; to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease; to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.
  

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

• Lawsuits and Disputes. If you are involved in a lawsuit, we may disclose medical information about you in response to a court or administrative order. 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 to obtain an order protecting the information requested.
  

• Law Enforcement. We may release medical information if asked to do so by law enforcement official. These activities could be in response to a court order, subpoena, warrant, summons, or similar process. Also medical information may be disclosed if it is relevant to a legitimate law enforcement inquiry, such as investigation of a crime.
  

• Coroners, Medical Examiners, and Funeral Directors. We may release medical information to a coroner, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors as necessary to cam’ out their duties.
  

• 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.
  

• 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.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding medical information we maintain about you:

• Right to Inspect and Copy. You have the right to inspect and copy medical information that includes medical and billing records. You must submit your request in writing to the Health Information Department. If you request a copy of the information, we may charge a fee for die costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain circumstances, if you are denied access to medical information, you may request that the denial be reviewed.
  

• Right to Amend, if you feel the medical information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, your request must be made in writing and submitted to the Health Information Department. We may deny your request for certain specific reasons, and if denied, will provide you with a written explanation and information regarding further rights you have at that point.
  

• 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 medical information about you. Not all disclosures require an accounting.
  
  To request this, you must submit your request in writing to the Health Information Department. The first list you request within a 12-month period will be free. There will be a charge for additional lists.
  

• Right to Request Restrictions. 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. 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. To request restrictions, you must make your request in writing to the Health Information Department.
  

• 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. To request confidential communications, you must make your request in writing to the Health Information Department. We will accommodate all reasonable requests.

Right to a Paper Copy of This Notice.  To obtain a paper copy of this notice, contact the Admissions Office or call (662) 773-6211 and request a copy be mailed to you.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint.  To file a complaint with the hospital, contact:

Health Information Department
(662) 773-6211 Ext. 1436

All complaints must be submitted in writing. Complaints may be mailed to:

Office of Civil Rights
U. S. Department of Health and Human Services 
61 Forsyth St, SW, Ste 3B70
Atlanta, GA 30323

You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

We will not use or disclose your medical information for any other purpose without your written permission. You may revoke that permission, in writing, at any time. You 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.