Notice of Privacy Practices

HOSPITAL AUTHORITY OF VALDOSTA-LOWNDES COUNTY
d.b.a. South Georgia Medical Center (SGMC)
Notice of Privacy Practices
Effective Date: 02/18/2010

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

This notice describes SGMC's practices regarding the uses and disclosures of medical information about you and your rights and obligations regarding your medical information.  SGMC participates in an organized health care arrangement which allows the sharing of your medical information among SGMC physicians that need to access your information.  This notice also applies to services provided by SGMC physicians.  This notice shall apply for all sites of SGMC.

We are required by law to:

• maintain the privacy or your health information;
• provide this notice of our legal duties and privacy practices with respect to medical information; and
• follow the terms of the notice that is currently in effect.

We are allowed under law to change or amend our practices and we reserve the right to do so.  Our current Notice of Privacy Practices is posted on our website, www.sgmc.org.  You may receive the most current copy from the website, e-mailed to you or request a paper copy from the Admissions Department.

We may use and disclose medical information about you in the following ways:

• For Treatment. We may use your medical information to provide you with medical treatment or services.  We may disclose medical information about you to doctors, nurses, technicians, or others who are involved your care.  For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process.  In addition, the doctor may need to tell the dietitian you have diabetes so that we can arrange for appropriate meals.
• For Payment.  We may use and disclose your medical information so that the treatment and services you receive at the hospital may be billed to and payment may be collected from you, an insurance company or third party.  For example, we may need to give your health plan information about surgery you received at the hospital so your health plan will pay us or reimburse you for the surgery.  Your insurance company may require validation for an extended length of stay and may send a representative to review your medical records.
• For Health Care Operations.  We may use and disclose your medical information for health care operations.  These uses and disclosures are necessary to ensure that all of our patients receive quality care.  For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff.   We may also disclose information to doctors, nurses, and other hospital personnel for review and education purposes.
• As Required By Law. We may use or disclose your medical information when required to do so by federal, state, local law or by a valid order from any appropriate judicial or administrative entity.
• Public Health Risks (Health and Safety to you and/or others).  We may disclose medical information about you for public health activities.  We may use and disclose medical information about you to agencies when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Examples of these activities may include reporting child abuse or neglect, preventing or controlling disease, injury or disability; reporting reactions to medications or problems with medical products.
• Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law or FDA regulated products.  These oversight activities may include audits, investigations, inspections, and licensure.
• Plan Sponsor Activities. We may use and disclose medical information to your plan sponsor for plan administration functions.
• Appointment Reminders. We may use and disclose medical information to remind you of an appointment for treatment or medical care.
• Treatment Alternatives. We may use and disclose medical information to inform you about or recommend possible treatment options or alternatives that may be of interest to you.
• Health-Related Benefits and Services. We may use and disclose medical information to educate you about health-related benefits, services, or medical education classes that may be of interest to you.
• Marketing Activities - Presently we do not use your patient information for marketing activities.  If we think you will benefit from our services or products, we will get your authorization before we contact you with marketing material.
• Fundraising Activities. -  Presently we do not use your information for fundraising activities.  We may, in the future, use or disclose your patient information for fundraising efforts unless you choose to opt out.  You can make your request to opt out by writing to SGMC Foundation, 2501 N. Patterson St., Valdosta, GA  31602
• Hospital Directory. We may include certain limited information about you in the patient directory.  You have a right to request that your name be removed from the directory or the clergy report at time of admission. If you are included in the directory, your name will be posted on floor "White Boards".
• Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to your caregiver.  We may also give information to someone who helps pay for your care.  We may also share information with your designee.
• Other uses may include: We may disclose medical information about you for workers' compensation, law enforcement purposes, coroners, funeral directors, organ donations, research, military and national security.  We may disclose medical information to prevent a serious threat to your safety or the safety of others.  We may release your information to employers relating to medical surveillance of the workplace and work-related illnesses or injury.  In some circumstances, we may forward your information to your physician of record or primary physician for continuum of care and/or billing purposes.  You must let us know if you would like your information to go to other health care providers involved in your care.

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

Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care.  To inspect and/or copy your medical information, contact the Medical Records Department for an appointment.  You may request an electronic copy of your record.  We have 30 days to meet your request.. If you request a copy of the information, we will charge a fee for costs.  We may deny your request to inspect and copy in certain circumstances.  If you are denied access to medical information, you may request that the denial be reviewed.

Right to Amend.  If you feel that the medical information about you is incorrect or incomplete, you have the right to request an amendment for as long as the information is kept by or for SGMC.  Your request for amendment must be made using SGMC's amendment form and submitted to the Director of Medical Records.  We may deny your request for an amendment.

Right to an Accounting of Disclosures.  You have the right to request an "accounting of disclosures".  This is a list of the disclosures we made about you for purposes other than treatment, payment and operations identified above or if we have a signed authorization from you.  We are not required to track those disclosures made from the hospital registry if you have elected to be on the patient registry.  To request this list of accountings, contact the Director of Medical Records.  Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003.

Right to Request Restrictions.  You have the right to request a restriction or limit medical information we use or disclose about your for treatment, payment or health care operations.  You also have the right to request a limit on the medical 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.  You should make your request known to the custodian of your record.  You have a right to request restrictions of your health information to your payer if you pay for your hospital bill when presented.

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.

Right to 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 can ask that we only contact you at work or by mail.  To request confidential communications, you must make your request known at registration or admission time and specify how or where you wish to be contacted.  We will not ask you the reason for your request.  We will accommodate all reasonable requests.

PRIVACY COMPLAINTS

If you believe your privacy rights have been violated while at SGMC, you may contact or submit your complaint in writing to the Patient Relations Department, (229) 259-4414.  Questions related to the physician's privacy practices should be directed to your physician.  If we cannot resolve your concern, you also have the right to file a written complaint with the Secretary of the Department of Health and Human Services.

The quality or your care will not be jeopardized nor will you be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission.  If you authorize us to use or disclose medical information about you, you may revoke that permission, in writing to the Medical Records Department, at any time.  If you revoke your permission, we will no longer use or disclose medical 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 permission, and that we are required to retain our records of the care that we provided to you.