Understanding Your Health Record/ Information

Purpose: Dewitt Medical District and its professional staff, employees, and volunteers follow the privacy practices described in this Notice. The Facility maintains your medical information in records that will be kept in a confidential manner, as required by law. However, the Facility must use and disclose your medical information to the extent necessary to provide you with quality health care. To do this, the Facility must share your medical information as necessary for treatment, payment and health care operations.

Examples of Treatment, Payment and Health Care Operations:

Treatment: We will use and disclose your health information to provide you with medical treatment or services. For example, we may disclose medical information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you at the Dewitt Medical District facility. We may share medical information about you in order to coordinate different treatments, such as prescriptions, lab work and x-rays. We may also provide your physician or a subsequent health care provider with copies of various reports to assist in treating you once you are discharged from care at Dewitt Medical District.

Payment: We will use and disclose your health information so that the treatment and services you receive at the Facility may be billed to and payment may be collected from you, an insurance company or a third party. A bill may be sent to you or a third party payer. 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 disclose your health information to conduct our standard internal operations, including proper administration of records. Also, we may use the information in your health record to assess the care and outcome 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 services we provide.

Other Uses and Disclosures:

We may use or disclose health information about you for other reasons without your authorization. The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information should fall within one of the categories.

• Required by Law: We may be required by law to report gunshot wounds, suspected abuse or neglect or similar injuries and events.
• Public Health Activities: As required by law, we may disclose vital statistics, diseases, information related to recalls of dangerous products, and similar information to public health authorities.
• Health Oversight: We may be required to disclose information to assist in investigations and audits, eligibility for government programs, and similar activities.
• Judicial and Administrative Proceedings: We may disclose information in response to an appropriate subpoena or court order.
• Law Enforcement Purposes: Subject to certain restrictions, we may disclose information required by law enforcement officials.
• Deaths: We may report information regarding deaths to coroners, medical examiners, funeral directors, and organ donation agencies.
• Serious Threat to Health or Safety: We may use and disclose information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
• Military and Special Government Functions: If you are a member of the armed forces, we may release information as required by military command authorities. We may also disclose information to correctional institutions or for national security purposes.
• Research: We may use or disclose information for approved medical research.
• Organ Procurement Organizations: Consistent with applicable law, we may disclose information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs for the purpose of organ and tissue donation and transplant.
• Workers Compensation: We may release information about you for workers compensation or similar programs providing benefits for work-related injuries or illnesses.
• Appointment Reminders: We may contact you to provide a reminder that you have an appointment for treatment or medical care at the Facility.
• Treatment Alternatives: We may contact you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.
• Fundraising: We (or a foundation related to the hospital) may contact you to raise funds for the hospital and its operations. You may opt out of receiving fundraising communications by submitting a written request to the Privacy Officer at the address listed below.
• Directory: Unless you notify us that you object, we will use your name, location in the facility, general condition and religious affiliation in our patient directory. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name unless you object.
• 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.
• 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 relevant to that person’s involvement in your care or payment related to your care.
• Business Associates: There are some services our organization provides through contracts with business associates. When such 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 payor for services rendered. However, we do require the business associate to appropriately safeguard your information and your rights described below apply to health information maintained by the business associate.

Your Health Information Rights

Although your health record is the physical property of Dewitt Medical District, the information belongs to you. You have the following rights regarding your health information maintained by us:

• You may request a restriction on certain uses and disclosures of your information for treatment, payment, and health care operations. However, we are not required by law to agree to a requested restriction.
• You may obtain a paper copy of this notice of information practices upon request;
• You may inspect and copy your health information maintained by us, except for psychotherapy notes. If you request copies, we may charge a fee for the cost of copying, mailing, or other related supplies. If we deny your request to review or obtain a copy, you may submit a written request for review of that decision.
• If you feel that your health information maintained by us is incorrect or incomplete, you may ask us to amend the information. Your request to amend must include a reason for amendment that supports your request. We may deny your request for an amendment if you ask us to amend information that:
  1. Was not created by us, unless the person/entity that created the information is no longer available to make the amendment;
  2. Is not part of the health information kept by or for us;
  3. Is not part of the information you would be permitted to inspect and copy; or
  4. Is accurate and complete.
• You may obtain an accounting of disclosures of your health information that have been made to persons or entities other than for health care treatment payment or operations in the past six (6) years, but not prior to April 14, 2003. After the first request, there may be a charge for additional requests within the subsequent 12-month period.
• You may request communications of your health information by alternative means or at alternative locations. We will accommodate reasonable requests.
• You may revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Our Responsibilities

In addition to the responsibilities set forth above, we are also required to:

• Maintain the privacy of your health information;
• Provide you with a notice as to our legal duties and privacy practices with respect to information we maintain about you;
• Abide by the terms of this notice; and
• Notify you if we are unable to agree to a requested restriction on certain uses and disclosures;

We will not use or disclose your health information without your written authorization, except as described in this notice.

For More Information or to Report a Problem

If you have questions and would like additional information, you may contact the Risk Manager at 361-275-6191 Ext. 2488,
2550 N. Esplanade,
Cuero, TX 77954.

If you believe your privacy rights have been violated, you can file a complaint with our Risk Manager at 361-275-6191 Ext. 2488, or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

Independent Contractors: Dewitt Medical District and the physicians who practice in its facilities are independent contractors and do not hereby assume any liability for the services or conduct of each other.

Effective Date: The effective date of this Notice is April 14, 2003.