NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.Your medical information is personal, and Internal Medicine Specialists, owned and operated by Terrebonne General Medical Center (TGMC) is committed to keeping this information confidential. This notice applies only to protected health information created or obtained in connection with medical care provided to you in this physician office. It does not apply to care provided to you at any other healthcare provider. When this notice refers to “we” or “us,” it is referring to Terrebonne General Medical Center, the members of its Medical Staff (including your physician(s), and other healthcare providers affiliated with the Organization).
This notice describes how we will use and disclose your health information in the Organization. The policies outlined in this notice apply to all of your health information generated by us in the Organization, whether recorded in your medical record, invoices, payment forms, electronic videos or other ways. Similarly, these policies apply to the health information gathered from other organizations by any healthcare professional, employee or volunteer who participates in your care.
USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
In some circumstances we are permitted or required to use or disclose your health information without obtaining your prior authorization and without offering you the opportunity to object. These circumstances include:
- Uses or disclosures for purposes relating to treatment, payment and healthcare operations:
- We may use or disclose your health information for the purpose of providing, or allowing others to provide, treatment to you or any other individual. An example would be if your primary care physician discloses your health information to another doctor for the purposes of a consultation. Also, we may contact you with appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
- We may use and/or disclose 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, we may inform your health insurance company of your diagnosis and treatment in order to assist the insurer in processing our claim for the healthcare services provided to you.
- Healthcare Operations. We may use and/or disclose your information for the purposes of our day-to-day operations and functions. We may also disclose your information to another covered entity to allow it to perform its day-to-day functions, but only to the extent that we both have a relationship with you. For example, we may compile your health information, along with that of other patients, in order to allow a team of our healthcare professionals to review that information and make suggestions concerning how to improve the quality of care provided at this facility. Also, we may contact you as part of our fundraising efforts for this organization. All fundraising communications will include information about how you may opt-out of future fundraising communications.
- Business Associates. Our organization may use and disclose your medical information to business associates who perform services on our behalf. The business associate must agree in writing to protect the confidentiality of the information. For example, we may share your health information with a company that bills for the services we provide.
- Health-related Benefits and Services. TGMC may use and disclose your medical information to tell you about health-related benefits or services that may be of interest to you.
We have agreed, as permitted by law, to share your protected health information among ourselves for purposes of treatment, payment or health care operations. This enables us to better address your healthcare needs.
- When required by law;
- For public health purposes;
- To disclose information about victims of abuse, neglect, or domestic violence;
- For health oversight activities, such as audits or civil, administrative or criminal investigations;
- For judicial or administrative proceedings;
- For law enforcement purposes;
- To assist coroners, medical examiners or funeral directors with their official duties;
- To facilitate organ, eye or tissue donation;
- For certain research projects that have been evaluated and approved through a research approval process that takes into account patients’ need for privacy;
- To avert a serious threat to health or safety;
- For specialized governmental functions, such as military and veterans, national security, criminal corrections, medical suitability determinations or public benefit purposes; and
- For workers’ compensation purposes, as permitted by law.
We may also use or disclose health information created or obtained in connection with your care in the Organization in the following circumstances. However, except in emergency situations, we will inform you of our intended action prior to making any such uses and disclosures and will, at that time, offer you the opportunity to object.
- In the Organization, we may maintain a directory of patients that includes your name and location within the facility, your religious designation, and information about your condition in general terms that will not communicate specific medical information about you. Except for your religion, we may disclose this information to any person who asks for you by name. We may disclose all directory information to members of the clergy.
- We may disclose to your relatives or close personal friends any health information that is directly related to that person’s involvement in the provision of, or payment for, your care. We may also use and disclose your health information for the purpose of locating and notifying your relatives or close personal friends of your location and general condition or death, and to organizations that are involved in those tasks during disaster situations.
Except as described above, disclosures of your health information will be made only with your written authorization. You may revoke your authorization at any time, in writing, unless we have taken action in reliance upon your prior authorization, or if you signed the authorization as a condition or obtaining insurance coverage.
TGMC requires your written authorization for the following:
- Disclosure of Psychotherapy Notes.Disclosure of Psychotherapy Notes will be done in accordance with Louisiana state law. In most cases this will require an authorization signed by you.
- Sale of PHI. TGMC does not sell protected health information.
- TGMC may ask you to sign an authorization to use or disclose protected health information as part of a marketing effort. The authorization will state if TGMC is receiving any direct or indirect financial remuneration for the marketing. The authorization is not necessary for face-to-face communications about a product or service and/or communications made:
- To describe health-related products or services that are provided by TGMC ;
- For your treatment; or
- For case management or care coordination, or to direct or recommend alternative treatments, therapies, providers or settings of care.
- To Request Restrictions. You have the right to request restrictions on the use and disclosure of your health information for treatment, payment or healthcare operations purposes or notification purposes. 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 restriction information is needed to provide that emergency treatment. To request a restriction, submit a written request to the contact listed on the final page of this notice.
- To Limit Communications. You have the right to receive confidential communications about your own health information by alternative means or at alternative locations. This means that you may, for example, designate that we contact you only via e-mail, or at work rather than home. To request communications via alternative means or at alternative locations, you must submit a written request to the contact listed on the final page of this notice. All reasonable requests will be granted.
- To Access and Copy Health Information. You have the right to inspect and copy any health information about you other than psychotherapy notes, information compiled in anticipation of or for use in civil, criminal or administrative proceedings, or certain information that is governed by the Clinical Laboratory Improvement Act. To arrange for access to your records, or to receive a copy of your records, you should submit a written request to the contact listed on the last page of this notice. If you request copies, you will be charged our regular fee for copying and mailing the requested information.
Despite your general right to access your protected health information, access may be denied in some limited circumstances. For example, access may be denied if you are an inmate at a correctional institution or if you are a participant in a research program that is still in progress. Access may be denied if the federal Privacy Act applies. Access to information that was obtained from someone other than a healthcare provider under a promise of confidentiality can be denied if allowing you access would reasonably be likely to reveal the source of the information. The decision to deny access under these circumstances is final and not subject to review.
In addition, access may be denied if (a) access to the information in question is reasonably likely to endanger the life and physical safety of you or anyone else, (b) the information makes reference to another person and your access would reasonably be likely to cause harm to that person, or (c) you are the personal representative of another individual and a licensed healthcare professional determines that your access to the information would cause substantial harm to the patient or another individual. If access is denied for these reasons, you have the right to have the decision reviewed by a healthcare professional who did not participate in the original decision. If access is ultimately denied, the reasons for that denial will be provided to you in writing.
- To Request Amendment. You may request that your health information be amended. Your request may be denied if the information in question: was not created by us (unless you show that the original source of the information is no longer available to seek amendment from), is not part of our records, is not the type of information that would be available to you for inspection or copying (for example, psychotherapy notes), or is accurate and complete. If your request to amend your health information is denied, you may submit a written statement disagreeing with the denial, which we will keep on file and distribute with all future disclosures of the information to which it relates. Requests to amend health information must be submitted in writing to the contact listed on the final page of this notice.
- To An Accounting of Disclosures. You have the right to an accounting of any disclosures of your health information made during the six-year period preceding the date of your request. However, the following disclosures will not be accounted for:
- disclosures made for the purpose of carrying out treatment, payment or healthcare operations,
- disclosures made to you,
- 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,
- disclosures for national security or intelligence purposes,
- disclosures to correctional institutions or law enforcement officials who had you in custody at the time of disclosure,
- disclosures that occurred prior to April 14, 2003,
- disclosures made pursuant to an authorization signed by you,
- disclosures that are part of a limited data set,
- disclosures that are incidental to another permissible use or disclosure, or;
- disclosures that are 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. To request an accounting of disclosures, submit a written request to the contact listed on the final page of this notice.
- To a Paper Copy of this Notice. You have the right to obtain a paper copy of this notice upon request. You may also view this notice on our website at www.tgmc.com.
- Right to Notification of a Breach of Unsecured Protected Health Information.Under certain circumstances, you have the right to or will receive notifications of breaches of your unsecured protected health information.
- We are required by law to maintain the privacy of your health information and to provide you with this notice of our legal duties and privacy practices.
- We are required to abide by the terms of this notice. We reserve the right to change the terms of this notice and to make those changes applicable to all health information that we maintain. Any changes to this notice will be posted on our website (if applicable) and at our facility, and will be available from us upon request.
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.
COMPLAINTS AND FEEDBACK
If you believe your privacy rights have been violated you may contact the TGMC Privacy/Compliance Officer and/or the Secretary of the Federal Department of Health and Human Services. To lodge a grievance with us, please file a written notice with the contact set forth below. This contact will also provide you with further information about our privacy policies upon request. No action will be taken against you for filing a complaint.
Privacy Officer or Compliance Officer
8166 Main Street / P.O. Box 6037
Houma, LA 70361-6037
Phone: (985) 873-3539
TGMC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
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