THE FOLLOWING NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW THE FOLLOWING INFORMATION CAREFULLY.

Each time you visit a hospital, physician, or other healthcare provider a record of your visit is made. Typically, this record contains your symptoms, examination and results, diagnoses, treatment, a plan for future care or treatment, and billing-related information. This Notice of Privacy Practices describes how Crittenden Regional Hospital (CRH) or healthcare organizations governed by CRH may use and/or disclose your protected health information (PHI). It also describes your rights to access and control your PHI.

CRH is required to:
Maintain the privacy of your medical information,
Advise you of our privacy practices, and
Abide by the terms of our Notice of Privacy Practices.

In accordance with federal law, CRH is permitted to use or disclose your PHI without your authorization for the following purposes:

Treatment:
CRH may use or disclose, as needed, your PHI to provide, coordinate, or manage your health care and any related services. For example, information obtained by a nurse, physician, or other healthcare provider may be shared or used to determine the best course of treatment for you. In addition, we may also provide your physician or subsequent healthcare provider, such as home health agencies and nursing homes with copies of various reports that will assist them in providing you continued care.

Payment:
CRH may use or disclose your PHI, as needed, to obtain payment for healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services. This includes activities such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your PHI be disclosed to your health plan in order to obtain approval for providing treatment.

Healthcare Operations:
CRH may use or disclose, as needed, your PHI in order to support the business activities of our organization. These activities may include but are not limited to: quality assessment activities, employee review activities, training of medical students, licensing, marketing and fundraising activities, and conducting or arranging for other business activities. For example, we may disclose your PHI to third party “business associates” that perform various activities (e.g. billing or transcription services) on behalf of the organization.

Business Associates:
CRH provides some services through contracts with business associates. Examples of these services include, but are not limited to, physician services in the emergency department and radiology, certain laboratory tests, billing services, and transcription services. When these services are provided by business associates of CRH, we may disclose your PHI to them so that they may perform the job we have contracted with them to do and bill you or your third–party payer for services rendered. To protect your PHI, we require all of our business associates to properly safeguard your information.

Patient Directory:
CRH may include certain limited information about you in our patient directory. This information may include your name, location in the hospital, your general condition (e.g. good, fair, etc.), and your religious affiliation. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name. If you wish to opt out of being listed in our Patient Directory, please inform the registration clerk of your wishes.

Notification and Communication:
CRH may use or disclose your PHI to notify or assist in notifying a family member, personal representative, or other person responsible for your care of your location and general condition. Healthcare professionals, using their best judgment, may disclose to a family member or relative, close personal friend, or any other person you identify, PHI relevant to that person’s involvement in your care.

Funeral Director, Coroner, and Medical Examiner:
Consistent with applicable law, CRH may disclose your PHI to funeral directors, coroners, and medical examiners in order to help them carry out their duties.

Organ Procurement Organizations:
Consistent with applicable law, CRH may disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Fundraising:
CRH may use certain PHI for the purposes of raising funds for the facility and its operations.

Food and Drug Administration (FDA):
CRH may disclose to the FDA PHI relative to adverse events, product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.

Public Health Officials:
As required by law, CRH may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Child Abuse and Neglect:
CRH may disclose PHI to public authorities to report suspected child abuse or neglect.

Victims of Abuse, Neglect, or Domestic Violence:
CRH may disclose to appropriate governmental agencies, such as adult protective or social service agencies, your PHI, if we reasonably believe you are the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Agencies:
CRH will provide PHI to health oversight agencies authorized by law to audit or investigate the operations of our organization.

Court Proceedings:
CRH may release PHI in response to requests made during judicial and administrative proceedings, such as court orders or subpoenas.

Law Enforcement:
CRH may disclose your PHI to law enforcement officials as required by law. This includes but is not limited to situations such as the following: when required by court order, for required reporting of certain types of wounds or injuries, reports of death, reports of crime on our premises, and more.

Inmates:
If you are an inmate of a correctional institute or in the custody of a law enforcement official, CRH may release your PHI to the correctional institute or law enforcement official so that the institution can provide you with healthcare, protect your health and safety as well as the health and safety of others, and for the safety and security of the correctional institution.

Threats to Public Health or Safety:
CRH may disclose your PHI when it is our good faith belief that it is necessary to prevent or lessen a serious and imminent threat or is necessary to identify or apprehend and individual.

Specialized Government Functions:
CRH may disclose your PHI for specialized government functions as authorized by law such as to Armed Forces personnel, for national security purposes, or to public assistance program personnel.

Workers Compensation:
If you are seeking compensation through Workers Compensation, CRH may disclose your PHI to the extent necessary to comply with the laws relating to Workers Compensation.

Other Uses and Disclosures:
Other uses and disclosures besides those identified in this Notice of Privacy Practices will be made only as otherwise authorized by law or with your written authorization.

YOUR HEALTH INFORMATION RIGHTS

The health and billing records we maintain are the physical property of CRH. However, the information contained in the record belongs to you. You have the following rights with respect to your Protected Health Information (PHI).

• You have the right to restrict the use of your protected health information. However, the organization may choose to refuse your restriction if it is in conflict with providing you with quality healthcare or in the event of an emergency situation.
• You have the right to receive confidential communication about your health status.
• You have the right to review and photocopy any/all portions of your health information.
• You have the right to request changes to your health information.
• You have the right to know who has accessed your protected health information and for what purpose.
• You have the right to possess a copy of this Notice of Privacy Practice upon request.
• The organization is required by law to protect the privacy of its patients. It will keep confidential any and all patient health information and will provide patients with a list of duties or practices that protect protected health information.
• The organization will abide by the terms of this notice. The organization reserves the right to make changes to this notice and continue to maintain the confidentiality of all health information. All complaints will be investigated. No personal issue will be raised as a result of filing a complaint with the organization.
• You have the right to complain to the organization if you believe your rights to privacy have been violated. If you feel your privacy rights have been violated, please mail your complaint to the hospital:
  

  ATTN: Quality Management Office
  Crittenden Regional Hospital
  200 Tyler Avenue
  West Memphis, AR 72301

  For further information about this Privacy Notice, please contact:

  Privacy Officer
  Crittenden Regional Hospital
  200 Tyler Avenue
  West Memphis, AR 72301

This notice is effective as of April 14, 2003.