Notice of Privacy Practices

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

Effective Date: April 14, 2003

WHO WILL FOLLOW THIS NOTICE

This Notice describes Mercy Medical practices at all of its locations (Daphne - main campus facilities, Catherine Place, and John McClure Snook Regional Center; Fairhope - Baldwin County Home Care, The Hamlet and Carroll Place; and, Mobile - Mobile County Home Care, Mercy Medical Mobile, Portier Place, and McAuley Place) and that of any independent healthcare professional who treats or cares for patients/residents at Mercy Medical and is authorized to enter information into your medical record including Mercy Medical’s Medical Director.

• Any healthcare professional authorized to enter information into your medical record.
• All departments and units of Mercy Medical.
• Any member of a volunteer group or student Mercy Medical allows to help you while you are in a Mercy Medical facility or program.
• All staff members including Mercy Medical administrative staff and other medical staff members.
• Any vendors or independent contractors who have access to the protected health information of Mercy Medical patients or residents.
• All the above listed persons, entities, sites, and locations follow the terms of this Notice. In addition, these persons, entities, sites, and locations may share protected health information with each other for your treatment or Mercy Medical operational purposes and the purposes described in this Notice. The independent healthcare professionals, who provide care at Mercy Medical and have agreed to follow the terms of this Notice, are not staff members or agents of Mercy Medical and Mercy Medical is not responsible for how they fulfill their professional responsibilities.

THE PROTECTED HEALTH INFORMATION TO WHICH THIS NOTICE APPLIES

"Protected health information" is individually identifiable health information. This information includes demographics, for example, age, address, e-mail address, and relates to your past, present, or future physical or mental health or condition and related healthcare services.

This Notice applies to all of the records of your care and billing for care that are created at Mercy Medical, whether made by Mercy Medical personnel, your independent personal doctor or other independent healthcare personnel, who are responsible for their own actions. These medical records are the property of Mercy Medical. Your personal doctor or other independent healthcare personnel treating you may have different policies regarding confidentiality and disclosure of your protected health information that is created in their offices or locations other than Mercy Medical.

WHAT THIS NOTICE DOES

This Notice will tell you about the ways in which the people listed above may use and disclose protected health information about you at Mercy Medical. We also describe your rights and certain obligations we have regarding the use and disclosure of protected health information at Mercy Medical.

• Make sure that protected health information that identifies you is kept private;
• Give you this Notice of our legal duties and privacy practices with respect to protected health information about you; and
• Follow the terms of the Notice that is currently in effect.

We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for protected health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice throughout Mercy Medical facilities/locations. The Notice will remain in effect for each subsequent visit unless changed. If the Notice changes, a copy will be made available to you upon request.

HOW MERCY MEDICAL MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU

The following categories describe different ways that Mercy Medical may use and disclose protected health information. For each category of uses or disclosures, we will explain what Mercy Medical means and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways Mercy Medical is permitted to use and disclose information will fall within one of these categories.

• For Treatment. Mercy Medical may use your protected health information to provide you with medical treatment or services. For example, information obtained by the Mercy Medical treatment team such as physicians, nurses, pastoral care staff members, and other clinicians providing health services to you, will record information in your record that is related to your treatment. This information is necessary for Mercy Medical to determine what treatment you should receive. The Mercy Medical treatment team will also record actions taken by us in the course of your treatment, and note how you respond to the actions.
  
  
• For Payment. Mercy Medical may need to use and disclose protected health information about you so that the treatment and services you receive at Mercy Medical or as given by other providers may be billed to and payment may be collected from you, Medicare and Medicaid, an insurance company/health plan, or a third party. For example, we may need to give Medicare or Medicaid information about lab work or therapy you received at Mercy Medical so Medicare or Medicaid will pay us or reimburse you for the lab work or therapy. We are permitted by law to disclose the amount of protected health information necessary for us to obtain payment for the care and services provided to you. Our disclosure of protected health information for the purpose of obtaining payment for the care and services provided to you may also include our giving information to your family members who are involved in your care, and to named insureds on your policy who help pay for your care.
  
  
• For Healthcare Operations. Mercy Medical may use and disclose protected health information about you for Mercy Medical operations. These uses and disclosures are necessary to run Mercy Medical and to make sure that all of our patients receive quality care. For example, Mercy Medical may use protected health information to review our treatment and services and to evaluate the performance of our staff in caring for you. Mercy Medical may also combine protected health information about many patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. Mercy Medical may also disclose information to nurses, technicians, pastoral care staff, independent doctors and other independent healthcare professionals who are involved in the treatment of patients at Mercy Medical, or medical students participating in clinical rotations at Mercy Medical, for review and learning purposes.

Business Associates

Mercy Medical may contract with individuals and entities (known as “business associates”) to perform various functions on our behalf or to provide certain types of services. Some of the functions they may provide are utilization management services, legal, and administrative services. Mercy Medical requires the business associates to agree in writing to contract terms designed to appropriately safeguard your information, prior to the performing of these functions or services.

• Treatment Alternatives. Mercy Medical may use and disclose protected health information to tell you about or recommend different ways to treat you.
  
  
• Health-Related Benefits and Services. Mercy Medical may use and disclose protected health information to tell you about health-related benefits or services that may be of interest to you. For example, Mercy Medical may inform a patient about our assisted living facilities
  
  
• Fundraising Activities. We will not share information about you with people or organizations that are involved in general fund-raising activities. We may contact you, using demographic information, i.e., name, address and phone number, to share information about Mercy Medical’s fund-raising needs. All Mercy Medical fundraising material distributed to a patient using demographic information, will include instructions of how the patient may choose not to receive any further fund-raising communications
  
  
• Individuals Involved in Your Care or Payment for Your Care. Except as explained below concerning information furnished in connection with Mercy Medical’s Patient/ Resident directory, we may disclose protected health information about you to a friend or family member who is involved in your medical care, unless you are able to and do object. In addition, Mercy Medical may disclose protected health 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. You can object to these disclosures by telling us that you do not wish any or all individuals involved in your care to receive this information. If you cannot agree or object, Mercy Medical will use professional judgment to decide whether it is in your best interest to disclose relevant information to someone who is involved in your care or to an entity assisting in a disaster relief effort.
  
  
• Mercy Medical’s Patient/Resident Directories. Unless you tell us otherwise, we will include certain limited information about you in Mercy Medical’s Patient Directory while you are an inpatient at Mercy Medical. This information may include your name, room number and religious affiliation. This directory information, except for your religious affiliation, may be released to people who ask for you by name. This is so your family, friends and clergy can visit you at Mercy Medical. If you choose not to be listed in the directory, then we may not be able to acknowledge that you are in Mercy Medical to your family, friends, clergy or delivery people. If you do not want anyone to know this information about you, if you want to limit the amount of information that is disclosed, or if you want to limit who gets this information, you must notify the Admitting Office staff at the facility where you are an inpatient in writing or by indicating your choice on the form that will be provided to you by the staff member admitting you.

  In an assisted living facility, please notify the Facility Director if you do not want information pertaining to your residence at that facility given out in response to inquiries at the Front Desk or through incoming telephone calls.

  If you are a home care patient, please notify the Director of the Home Care office from which you receive services (Mobile County or Baldwin County) if you do not want it disclosed that you are a patient in the home care program. If you desire to limit the amount of information that is disclosed or if you want to limit who gets this information, you must also notify the Director of the home care office in writing or by indicating your choice on a form that can be provided to you by the staff member admitting you.

• Research. Occasionally, Mercy Medical may use and disclose protected health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another for the same condition. All research projects, however, will require your written consent if the researchers will know who you are. Protected health information about you that has had identifying information removed may be used for research without your consent.
  
  
• As Required By Law. Mercy Medical will disclose protected health information about you when required to do so by federal, state, or local law.

To Avert a Serious Threat to Health or Safety. Mercy Medical may use and disclose protected health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

SPECIAL SITUATIONS

• Body Organ and Tissue Donation. If you are an organ donor, Mercy Medical may release protected health information to organizations that handle organ procurement or organ, eye, or tissue transplantation, or to a body organ donation bank as necessary to facilitate organ or tissue donation and transplantation.
  
  
• Military and Veterans. If you are a member of the armed forces, Mercy Medical may release protected health information about you as required by military command authorities. Mercy Medical may also release protected health information about foreign military personnel to the appropriate foreign military authority. Mercy Medical may use and disclose to components of the Department of Veterans Affairs protected health information about you to determine whether you are eligible for certain benefits.
  
  
• Workers’ Compensation. Mercy Medical may release protected health information about you for Workers’ Compensation or similar programs. These programs provide benefits for work-related injuries or illness.
  
  
• Public Health Risks. Mercy Medical may disclose protected health information about you for public health activities. These activities generally include the following:
  • To prevent or control disease, injury, or disability;
  • To report deaths;
  • To report reactions to medications or problems with products; to notify people of recalls of products they may be using;
  • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and
  • To notify the appropriate government authority if Mercy Medical suspects a patient has been the victim of abuse, neglect, or domestic violence. Mercy Medical will only make this disclosure if you agree or when required or authorized by law.
    
    
• Health Oversight Activities. Mercy Medical may disclose protected health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.
  
  
• Lawsuits and Disputes. If you a re involved in a lawsuit or a dispute, Mercy Medical may disclose protected health information about you in response to a court or administrative order. Mercy Medical 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, by furnishing your medical records, as required by law.
  
  
• Law Enforcement. Mercy Medical may release protected health information if asked to do so by a law enforcement official:
  • In response to a court order, subpoena, warrant, summons, or similar process;
  • To identify or locate a suspect, fugitive, material witness, or missing person;
  • About the victim of a crime if, under certain limited circumstances, Mercy Medical is unable to obtain the person’s agreement;
  • About a death Mercy Medical believe may be the result of criminal conduct;
  • About criminal conduct at the hospital; and
  • In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description, or location of the person who committed the crime.
    
    
• Coroners, Medical Examiners, and Funeral Directors Mercy Medical may release protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. Mercy Medical may also release protected health information about deceased patients of Mercy Medical to funeral directors as necessary to carry out their duties upon the request of the patient’s family.
  
  
• National Security and Intelligence Activities. Mercy Medical may release protected health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
  
  
• Protective Services for the President and Others. Mercy Medical may disclose protected health information about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state, or to conduct special investigations.

YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU

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

• Right to Inspect and Copy. If you are a current patient/resident, you or your representative have the right to inspect your records within 24 hours of your request, excluding weekends and holidays. If you are a current patient/resident, you or your legal representative have a right to purchase copies of your records or any portions of your records on five working days’ advance Notice to Mercy Medical. If you are no longer a current patient/resident at the time of your request to inspect or copy your records, Mercy Medical has a longer time within which to respond to your request up to 60 days from the date of your request.
  
  The request must be submitted in writing, to the Director of the facility/office where you records are housed. If you request a copy of the information, we may charge a fee not to exceed the community standard rate for the costs of copying, mailing, or other supplies associated with your request and may collect the fee before providing the copy to you.
  
  
• Right to Request an Amendment. If you feel that protected health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for Mercy Medical.
  
  To request an amendment, your request must be made in writing and submitted to the Director of the facility/office where your records are housed. In addition, you must provide a reason that supports your request.
  • We may deny your request for an amendment, if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
    • Was created by a provider other than Mercy Medical, unless the provider who created the information is no longer available to consider or make the amendment;
    • Is not part of the protected health information kept by or for Mercy Medical;
    • Is not part of the information that you would be permitted to inspect and copy; or
    • Has been determined to be accurate and complete.
      
      
• Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we have made of protected health information about you.
  
  To request this list or accounting of disclosures, you must submit your request in writing to the Director of the facility/office where your records are housed. Your request must state a time period that may not be longer than six years prior to the request and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, or electronically). The first list you request within a twelve (12) month period will be free. For additional lists, we will charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. We will collect the fee before providing the list to you.
  
  
• Right to Request Restrictions. Except where we are required to disclose the information by law, you have the right to request a restriction or limitation on the protected health information we use or disclose about you. For example, you could ask that we not use or disclose information about a treatment you had to a family member or friend.
  
  We are not required to agree to your request to restrict use or disclosure of your information within Mercy Medical or among the healthcare professionals currently involved in your care at Mercy Medical except with regard to psychotherapy notes. If we do agree, we will comply with your requested restriction unless the information is needed to provide you emergency treatment.
  
  Except as permitted or required by law, we will only disclose your confidential protected health information to persons outside Mercy Medical who are not currently involved in your care at Mercy Medical, in accordance with your written authorization.
  
  To request restrictions, you must make your request in writing to the Director of the facility/office where your records are housed. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
  
  
• Right to Request Alternative Communications. You or your representative has the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by speaking with you in a certain location or contacting your representative at work or at a certain mailing address.
  
  To request communications by certain means, you must make your request in writing to the Director of the facility/office where your records are housed, and specify how or where you wish to be contacted. We will not ask you the reason for your request. To obtain a paper copy of this Notice, contact 251.621.4200.
  
  
• Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice or any revised Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.
  
  You may obtain a copy of this Notice at our website, www.MercyMedical.com.
  
  To obtain a paper copy of this Notice, contact the Admitting Office at 251-621-4000.

OTHER USES OF PROTECTED HEALTH INFORMATION

Other uses and disclosures of protected health information not covered by this Notice will be made only with your written permission or as required by law. If you provide Mercy Medical permission to use or disclose protected health information about you, you may revoke that permission, in writing, at any time. The revocation will be effective for future uses and disclosures of protected health information. However, the revocation will not be effective for information that Mercy Medical has already used or disclosed in reliance on your permission.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with Mercy Medical. To file a complaint with Mercy Medical, contact the Privacy Officer, at 251-621-4496 or place your written concern in the privacy concern drop box, located in every Mercy Medical facility. All complaints must be submitted in writing. If you are not satisfied with the above process, you also have the right to file a complaint with the Secretary of the United States Department of Health and Human Services.

You will not be penalized for filing a complaint.