Privacy Policy

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.

Understanding Your Health Record/Information

Each time you visit a hospital, physician, or other health care provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

  • basis for planning your care and treatment

  • means of communication among the many health professionals who contribute to your care

  • legal documentation describing the care you received

  • means by which you or a third-party payer can verify that services billed were actually provided

  • tool in educating health professionals

  • source of data for medical research

  • source of information for public health officials charged with improving the health of the nation

  • source of data for facility planning and marketing

  • tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

  • Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

When this Notice refers to "we" or "us," it is referring to KDMC, the members of its medical staff (including your physician(s)), other health care providers affiliated with KDMC. This Notice applies only to protected health information created or obtained in connection with medical care provided to you in this facility. It does not apply to care provided to you in your physician's office or in the office of any other health care provider. If you have not previously visited your physician's office, upon your next visit you should receive that physician's Notice of Privacy Practices as it relates to his or her own office practice.

This Notice describes how we will use and disclose your health information in the facility. The policies outlined in this Notice apply to all of your health information generated by us in the facility, whether recorded in your medical record, invoices, payment forms, videotapes or other ways. Similarly, these policies apply to the health information gathered from other organizations by any health care professional, employee or volunteer who participates in your care.

Our Responsibilities

This organization is required by law to:

  • maintain the privacy of your health information

  • provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you

  • abide by the terms of this notice

  • notify you if we are unable to agree to a requested restriction

  • accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Any changes to this Notice will be posted on our website and at our facility, and will be available from us upon request. We will not use or disclose your health information without your written authorization, except as described in this Notice.

Your Health Information Rights

Although your health record is the physical property of the facility that compiled it, the information belongs to you. You have the right to:

  • request that we not use or disclose your health information for a particular reason related to treatment, payment or KDMC's general health care operations and/or to a particular family member, other relative or close personal friend. We are not required to agree to your request. If we do agree to a restriction, we will abide by that restriction unless you are in need of emergency treatment and the restricted information is needed to provide that emergency treatment. To request a restriction, submit a written request to the Privacy Officer listed on the final page of this Notice.

  • obtain a paper copy of the "Privacy Notice" upon request.

  • inspect and obtain a copy of your health record. To arrange for access to your records, or to receive a copy of your records, you should submit a written request to the Privacy Officer listed on the last page of this Notice. (If you request copies, we will charge you a reasonable fee for copying and mailing the requested information.)
    amend your health record if you believe that any health information in your record is incorrect or if you believe that important information is missing. Please use the form provided by our facility to make such requests. For a request form, please contact the Privacy Officer.

  • obtain an accounting of disclosures of your health information made by KDMC during the time period for which you request (not to exceed 6 years). To request an accounting of disclosures, submit a written request to the Privacy Officer listed on the final page of this Notice, using the form provided by our facility to make such requests. The following disclosures will not be accounted for: (i) disclosures made for the purpose of carrying out treatment, payment or health care operations, (ii) disclosures made to you, (iii) disclosures of information maintained in our patient directory, or disclosures made to persons involved in your care, or for the purpose of notifying your family or friends about your whereabouts, (iv) disclosures for national security or intelligence purposes, (v) disclosures to correctional institutions or law enforcement officials who had you in custody at the time of disclosure, (vi) disclosures that occurred prior to April 14, 2003, (vii) disclosures made pursuant to an authorization signed by you, (viii) disclosures that are part of a limited data set, (ix) disclosures that are incidental to another permissible use or disclosure, or (x) disclosures made to a health oversight agency or law enforcement official, but only if the agency or official asks us not to account to you for such disclosures and only for the limited period of time covered by that request. The accounting will include the date of each disclosure, the name of the entity or person who received the information and that person's address (if known), and a brief description of the information disclosed and the purpose of the disclosure. You will not be charged for your first accounting request in any 12 month period; however, for any requests that you make thereafter, you will be charged a reasonable fee.

  • receive confidential communications of your health information by alternative means or at alternative locations upon request. This means that you may, for example, designate that we contact you at work rather than home. To request communications via alternative means or at alternative locations, you must submit a written request to the Privacy Officer listed on the final page of this Notice. All reasonable requests will be granted.

  • revoke your authorization to use or disclose health information except to the extent that action has already been taken in reliance on your prior authorization (such a request must be made in writing to the Privacy Officer).

Examples of How We May Use or Disclose Your Health Information

In some circumstances we are permitted or required to use or disclose your health information without obtaining your prior authorization and, except as noted below, without offering you the opportunity to object. These circumstances include:

  • Treatment: We will use your health information for the purpose of providing, or allowing others to provide, treatment to you or any other individual. For example: information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health care team. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. We will also provide your physician or a subsequent health care provider with copies of various reports that should assist him or her in treating you once you're discharged from this hospital.

  • Payment: We will use your health information for the purpose of allowing us, as well as other entities, to secure payment for the health care services provided to you. For example: A bill may be sent to you or a third-party payer, including Medicare or Medicaid. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

  • Health care operations: We will use and/or disclose your health information for regular health operations and may also disclose your information to another organization to allow it to perform its operations, but only to the extent that we both have a relationship with you. For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.

  • We have agreed, as permitted by law, to share your health information among ourselves for purposes of treatment, payment or health care operations. This enables us to better address your health care needs.

  • Business associates: There are some services provided in our organization through contacts with business associates. Examples include physician services in the emergency department and radiology, certain laboratory tests, and a copy service we use when making copies of your health record. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

  • Directory: Unless you notify us that you object, we will use your name, location in the facility, your condition in general terms that will not communicate specific medical information about you, and religious affiliation for directory purposes. This patient directory information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.

  • Notification: Unless you notify us that you object, we may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition or death and to organizations involved in these tasks during disaster situations. In emergencies, we may disclose this information without giving you an opportunity to object.

  • Communication with family: Unless you notify us that you object, health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information that is directly related to that person's involvement in your care or payment related to your care. In emergencies, we may disclose this information without giving you an opportunity to object.

  • 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.

  • Coroners, medical examiners, funeral directors: We may disclose health information to coroners, medical examiners or funeral directors consistent with applicable law to carry out their official 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 organs for the purpose of tissue donation and transplant.

  • Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may use your patient questionnaire information to improve the quality of our services.

  • Fund raising: We may contact you as part of a fund-raising effort.

  • 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.

  • Workers' compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
    Public health risks and purposes: As required by law, we may disclose your health information to public health or legal authorities for purposes related to: prevention or controlling disease, injury or disability; reporting of births, deaths, child abuse, neglect, exploitation of vulnerable adults, domestic violence, disease or infection exposure, and we may disclose your health information to a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.

  • Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.
    Required by law and law enforcement: We may disclose health information to a law enforcement official for purposes such as complying with a court order or a valid subpoena or in the course of any judicial or administrative proceeding.

  • Reporting: Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

  • Health oversight activities: We may disclose medical information to a health agencies for activities authorized by law, including audits, inspections, licensure or civil, administrative or criminal investigations.

  • Public safety: We may disclose medical information about you to appropriate persons when necessary to prevent or lessen a serious threat to your health or safety or the health and safety of the general public or another person.

  • Specialized governmental functions: When appropriate conditions apply, we may release medical information for military, national security, intelligence activities, criminal corrections, or public benefit purposes.

For More Information or to Report a Problem

To obtain a paper copy of this notice or if you have questions and would like additional information about our privacy policies, you may contact the Privacy Officer at (601) 835-9281.

If you believe your privacy rights have been violated, you can file a written complaint with the Privacy Officer or by mail, fax, or e-mail with the Office for Civil Rights (OCR), Region IV, United States Department of Health and Human Services, Atlanta Federal Center, Suite 3B70, 61 Forsyth Street, SW., Atlanta, GA 30303-8909. Voice Phone (404) 562-7886. FAX (404) 562-7881. TDD (404) 331-2867. For all complaints filed by e-mail send to:

OCRComplaint@hhs.gov
Individuals may, but are not required to, use OCR's Health Information Privacy Complaint Form. To obtain a copy of this form, or for more information about the Privacy Rule or how to file a complaint with OCR, contact any OCR office or go to www.hhs.gov/ocr/hipaa/.
You will not be penalized for filing a complaint.
Effective Date: 4-14-03

Providing quality health and wellness in a Christian environment.

King's Daughters Medical Center

601.833.6011  |  427 Highway 51 North, Brookhaven, MS 39601

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