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.
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal. At the hospital, we are committed to protecting your medical information. We create a record of the care and services you receive at our 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. Your personal doctor may have different policies or notices regarding his or her use and disclosure of your medical information created in the office or clinic. We are required by law to:
WHO WILL FOLLOW THIS NOTICE?
This notice describes our Hospital’s practices and that of:
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 of uses or disclosures, we will briefly explain what we mean and try to give you some examples. Not every use or disclosure in a category will be listed, but all of the ways we are allowed to use and disclose information will fall within one of the categories.
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
GENERAL USES AND DISCLOSURES OF HEALTH INFORMATION
USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION FOR RELEASE
USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION FOR RELEASE
OTHER USES OF MEDICAL INFORMATION.
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to the use and disclosure of your medical information 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. We cannot, however, take back any disclosures we have already made with your permission.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
CHANGES TO THIS NOTICE
We reserve the right to change the information in this Notice. Any changes we make will remain consistent with applicable federal and state laws protecting patient information. We will post a copy of the current notice in the Hospital. Each time you register at or are admitted to the Hospital for treatment or health care services as a patient, we will offer you a copy of the current Notice in effect. You may also request a copy of the current Notice by calling or writing the Privacy Officer for the hospital.
If you have a question or would like to file a complaint with us, contact the Privacy Officer as listed below. If you believe your privacy rights have been violated, you may file a written complaint with us or the Secretary of the Department of Health and Human Services and/or the Office of Civil Rights, DHHS. You will not be penalized for filing a complaint.
Hospital Privacy Officer
1240 South Germantown Road
Germantown, TN 38138
All complaints will be acted upon. You will be notified of the results of the review in a reasonable amount of time, generally within 30 days or less. If for any reason you are not satisfied with the results or information received, please feel free to contact the Chief Executive Officer of the Hospital at 901-275-3300.