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Hemphill County Hospital District Privacy Statement

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Hemphill County Hospital District Notice of Health Information Privacy Statement


If you have any questions about this notice, please contact the Hemphill County Hospital Privacy Officer by dialing the main hospital telephone number (806-323-6422) during normal business hours.

Each time you visit Hemphill County Hospital, a record of your visit is made. This record may contain your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and billing-related information. This notice applies to all of the records of your care generated by Hemphill County Hospital, whether made by hospital personnel, agents of Hemphill County Hospital, or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your health information created in the doctor’s office or clinic.

We are required by law to maintain the privacy of your health information and provide you a description of our privacy practices. We will abide by the terms of this notice.

How We May Use and Disclose Health Information About You:
The following categories describe examples of the way we use and disclose health information:

· For Treatment: We may use health information about you to provide you with treatment or services. We may disclose health information about you to doctors, nurses, technicians, medical or nursing students, other hospital personnel or other healthcare providers who are involved in taking care of you at Hemphill County Hospital. For example: a doctor treating you for a broken leg may need to know if you have another medical condition that may affect the healing process. Different departments of Hemphill County Hospital also may share prescriptions, lab work, meals and x-rays.

· For Payment: We may use and disclose health information about your treatment and services to bill and collect payment from you, your insurance company, or a third party payer. For example; we may need to give your insurance company information about your surgery so they will pay us or reimburse you for the treatment. We may also tell your health plan about treatment you are going to receive to determine if it is a covered benefit.

For Healthcare Operations: Members of the medical staff and/or performance improvement team may use information in your health record to assess the care and outcomes in your case and others like it. The result will then be used to continually improve the quality of care for all patients we serve. For example; we may combine health information about many patients to evaluate the need for new services or treatment. We may disclose information to doctors, nurses and other students for educational purposes. And we may combine health information we have with that of other hospitals to see where we can make improvements. We may remove information that identifies you from this set of health information to protect your privacy.

We may also use and disclose health information:
-To business associates we have contracted with to perform a service and billing for it;
-To remind you that you have an appointment for medical care;
-To assess your satisfaction with our services;
-To tell you about possible treatment alternatives;
-To tell you about health-related benefits or services;
-For population based activities relating to improving health or reducing healthcare costs; and
-For conducting training programs or reviewing competence of healthcare professionals.

When disclosing information, primarily appointment reminders and billing/collections efforts, we may leave messages on your answering machines/voice mail.

Business Associates: There are some services provided in our organization through contracts with business associates. Examples include physician services in the emergency department and radiology and certain laboratory tests. When these services are contracted, we may disclose your health information to our business associates 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: We may include certain limited information about you in the hospital directory while you are a patient at Hemphill County Hospital. The information may include your name, location in Hemphill County Hospital, your general condition (e.g., good, fair), and your religious affiliation, to other people who ask for you by name. If you would like to opt out of being in the facility directory and/or clergy directory, please notify the admissions staff.

Individuals Involved in Your Care or Payment for Your Care: We may release health information about you to a friend or family member who is involved in your medical care or who helps pay for your care. In addition, we may disclose 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.

Future Communications: We may communicate to you via newsletters, direct mail, or other means regarding treatment options, health related information, disease-management programs, wellness programs or other community based initiatives or activities our facility is participating in.

Organized Healthcare Arrangement: Hemphill County Hospital, its medical staff members and other healthcare providers who participate in your care at Hemphill County Hospital have organized and are presenting you this document as a joint notice. Information will be shared as necessary to carry out treatment, payment and healthcare operations. Physicians and caregivers may have access to protect health information in their offices to assist in reviewing past treatment as it may affect treatment at the time of your visit in their office.

As Required by Law: We may also use and disclose health information for the following types of entities, including, but not limited to:

-Food and Drug Administration
-Public Health or Legal Authorities charged with preventing or controlling disease, injury to disability
-Correctional Institutions
-Workers Compensation Agents
-Organ and Tissue Donation Organizations
-Military Command Authorities
-Health Oversight Agencies
-Funeral Directors, Coroners and Medical Directors
-National Security and Intelligence Agencies
-Protective Services for the President and Others
Law Enforcement/Legal Proceedings: We may disclose health information for law enforcement purposes as required by law in response to a valid subpoena.

State-Specific Requirements: Texas has some reporting requirements including population-based activities relating to improving health or reducing healthcare costs. Some Texas privacy laws apply additional legal requirements. If the state privacy laws are more stringent than federal privacy laws, the state law preempts the federal law.

YOUR HEALTH INFORMATION RIGHTS – Although your health record itself is in the physical property of Hemphill County Hospital, the protected health information in the record belongs to you. You have the right to:

Inspect and Copy: You have the right to inspect and obtain a copy of the health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. We may be allowed to charge you for the cost of making the copy according to Texas Department of Health guidelines. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. Another licensed healthcare professional chosen by Hemphill County Hospital will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Amend: If you feel that the 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 Hemphill County Hospital. We may deny your request for an amendment and if this occurs, you will be notified of the reason for the denial.

An Accounting of Disclosures
: You have the right to request an accounting of disclosures. This list of certain disclosures we make of your health information for purposes other than treatment, payment or healthcare operations where an authorization was not required.

Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example; you could ask that we not use or disclose information about a surgery you had. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example; you may ask that we contact you at work instead of your home. The facility will grant reasonable requests for confidential communications at alternative locations and/or via alternative means only if the request is submitted in writing and the written request includes a mailing address where the individual will receive bills for services rendered by the facility and related correspondence regarding payment for services. Please realize that we reserve the right to contact you by other means and at other locations if you fail to respond to any communication from us that requires a response. We will notify you in accordance with your original request prior to attempting to contact you by other means or at another location.

A Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. You may print or view a copy of the notice by clicking the Privacy link on Hemphill County Hospital’s website at www.hchdst.org.

To exercise your rights, please obtain the required forms from the Privacy Officer and submit your request in writing.

CHANGES TO THIS NOTICE – We reserve the right to change this notice and the revised or changed noticed will be effective for information we already have about you as well as nay information we receive in the future. The current notice will be posted in Hemphill County Hospital and include the effective date. In addition, each time you register at or are admitted to Hemphill County Hospital for treatment or healthcare services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.

COMPLAINTS – You will not be penalized for filing a complaint. If you believe your privacy rights have been violated, you may file a complaint with either the Hemphill County Hospital Privacy Officer or you may call the Privacy Officer and request a complaint form. Hemphill County Hospital requests that you attempt to resolve your complaint the Privacy Office via these complaint procedures since Hemphill County Hospital is in the best position to respond to your complaint. However, you may also file a complaint with the Office of Civil Rights (“OCR”). Contact information to follow:

Covered Entity:
Hemphill County Hospital
Attn: Privacy Officer
1020 S. 4th Street
Canadian, TX 79014

Medical Privacy Complaint Division
Office of Civil Rights
United States Department of Health and Human Services
200 Independence Avenue, S.W., Room 509F
HHH Building
Washington, DC 20201
Voice Hotline Number: 800-368-1019
Internet Address: www.hhs.gov/ocr
OTHER — USES OF HEALTH INFORMATION: – Other uses and disclosures of your protected health information, not covered by this notice or the law, will be made only with your written permission. If you provide us permission to use or disclose health 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 health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permissions, and that we are required to retain our records of the care that we provided to you.


Neither the Director to Physicians nor the Durable Power of Attorney for Healthcare needs to be notarized in order to be a legally valid expression of your desires.

Neither this hospital nor your physician may require you to execute a Directive to Physicians under the Texas Natural Death Act or a Durable Power of Attorney for Healthcare as a condition for admittance or receiving treatment in this or any other hospital.

The fact that you have executed a Directive to Physicians or a Durable Power of Attorney for Healthcare does not change any provision in any insurance policy you may have.


Formal policies have been adopted to assure that your rights to make medical treatment decisions will be honored to the extent permitted by law. This hospital has adopted policies relating to informed consent, implementation of Directives to Physicians under the Texas Natural Death Act and implementation of treatment decisions made by agents appointed under a Durable Power of Attorney for Healthcare. If you desire further information about any of these policies, you may contact your nurse or physician.