Understanding Your Health Record/Information

Each time you visit North Metro Medical Center, Inc., a record of your visit is made. Typically this record contains your symptoms, examination and test results, diagnosis, 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 document describing the care you received
• Means by which you or a third-party payer can verify that services billed were actually provided
• A tool for educating health professionals
• A source of data for medical research
• A source of information for public health officials who oversee the delivery of health care in the United States
• A source of data for facility planning and operations
• A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

• Ensure its accuracy
• Better understand who, what, when and where, and why others may access your health information
• Make more informed decisions when authorizing disclosures to others.

North Metro Medical Center, Inc. Employees, Volunteers and Medical Staff are 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 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 will not use or disclose your health information without your authorization, except as described in this notice.

How We Will Use or Disclose Your Health Information

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 will fall within one of the categories.

1. Treatment. We will use your health information for treatment. For example, information obtained by a nurse, physician, or other member of your healthcare 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 healthcare team. Members of your healthcare 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 healthcare provider with copies of various reports that should assist him or her in treating you once you have been discharged from North Metro Medical Center, Inc.
2. Payment. We will use your health information for payment. 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. We may also tell your third party payer about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
3. Healthcare Operations We will use your health information for regular health operations. For example, members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use your 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 healthcare and service we provide by providing information to healthcare regulation organizations such as Joint Commission on Accreditation of Healthcare Organizations.
4. Business Associates There are some services provided in our organization through contracts with business associates. Examples include our accountants, consultants and attorneys. When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we have asked them to do. To protect your health information, however, we require the business associates to appropriately safeguard your information.
5. Directory Unless you notify us that you object, we may use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name. We also may use your name on a nameplate next to or on your door in order to identify your room, unless you notify us that you object.
6. Notification We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, of your location, and general condition. If we are unable to reach your family member or personal representative, then, we may leave a message for them at the phone number that they have provided us, e.g. on an answering machine.
7. Communication With Family 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.
8. 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.
9. 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.
10. Community Contact 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.
11. 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.
12. Worker’s Compensation We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.
13. Public Health As required by law, we may disclose our health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
14. 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.
15. Law Enforcement We may release medical 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, we are unable to obtain the person’s agreement; about a death we 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.
16. Reports 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.
17. Military and Veterans If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
18. Lawsuits and Disputes If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We 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, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
19. Coroners, Medical Examiners and Funeral Directors We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.
20. National Security and Intelligence Activities We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
21. To Avert a Serious Threat to Health or Safety We may use and disclose medical 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.

Your Health Information Rights

Although your health record is the physical property of North Metro Medical Center, Inc., the information in your health record belongs to you. You have the following rights:

1. You may request that we not use or disclose your health information for a particular reason related to treatment, payment, the Facility’s general health care operations, and/or to a particular family member, other relative or close personal friend. We ask that such request be made in writing on a form provided by our facility. Although we will consider your request, please be aware that we are under no obligation to accept it or to abide by it. For more information about this, see 45 Code of Federal Regulations (C.F.R.) 164.5229 (a).
2. If you are dissatisfied with the manner in which or the location where you are receiving communications from us that are related to your health information, you may required that we provide you with such information by alternative means or at alternative locations. Such a request must be made in writing, and submitted to:

Privacy Officer
North Metro Medical Center
1400 Braden Street
Jacksonville, AR 72076

3. You may request to inspect and/or obtain copies of health information about you, which will be provided to you in the time frames established by law. If you request copies, we will charge you a reasonable fee. For more information about his right, see 45 C.F.R. 164.524.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the 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.
4. If you believe that any health information in your record is incorrect, or if you believe that important information is missing, you may request that we correct the existing information or add the missing information. Such requests must be made in writing, and must provide a reason to support the amendment. We ask that you use the form provided by our facility to make such requests. For a request form, please contact the
Privacy Officer
North Metro Medical Center
1400 Braden Street
Jacksonville, AR 72076

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:

(a) Was not created by us, unless the person or entity that created the information is no longer available to make the amendment; (b) Is not part of the medical information kept by or for the hospital; (c) Is not part of the information which you would be permitted to inspect and copy; or (d) Is accurate and complete.


For more information about this right, see 45 C.F.R. 164.526

5. You may request that we provide you with a written accounting of all disclosures made by us during the time period for which you request (not to exceed 6 years). We ask that such requests be made in writing on a form provided by our facility. Please note that an accounting will not apply to any of the following types of disclosures:

a. Disclosures made for reasons of treatment, payment or healthcare operations
b. Disclosures made to you or your legal representative, or any other individual involved with your care
c. Disclosures to correctional institutions or law enforcement officials
d. Disclosures for national security purposes.
6. You will not be charged for your first accounting request in any twelve month period. However, for any requests that you make thereafter, you will be charged a reasonable, cost-based fee. For more information about this right, see 45 C.F.R. 164.528.

7. You have the right to obtain a paper copy of our Notice of Information Practices upon request from North Metro Medical Center, Inc.

8. You may revoke an authorization to use of disclose health information, except to the extent that action has already been taken. Such a request must be made in writing to North Metro Medical Center, Inc. Health Information Management Department, 1400 Braden Street, Jacksonville, Arkansas 72076

Privacy Officer

North Metro Medical Center
1400 Braden Street
Jacksonville, AR 72076

If you believe that your privacy rights have been violated, you may file a complaint with us. These complaints must be filed in writing on a form provided by North Metro Medical Center, Inc. The complaint form may be obtained from North Metro Medical Center, Inc., and when completed, should be returned to the Privacy Officer at North Metro Medical Center, Inc. You may also file a compliant with the Secretary of the Federal Department of Health and Human Services. There will be no retaliation for filing a complaint.

Revised 03/19/03