COVINGTON COUNTY HOSPITAL NOTICE OF PRIVACY


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

Effective September 23, 2013


The following is the privacy policy of Covington County Hospital as described in the Health Insurance Portability and Accountability act of 1996 and the Omnibus Addendum of 2013. HIPAA requires that by law Covington County Hospital maintain the privacy of your personal health information and to provide you with notice of Covington County Hospital's legal duties and privacy policies with respect to your personal health information. We are required by law to abide by the terms of this Privacy Notice.

YOUR PERSONAL HEALTH INFORMATION

We collect personal health information from you through treatment, payment and related healthcare operations, the application and enrollment process, and/or healthcare providers or health plans, or through other means as applicable. Your personal health information that is protected by law broadly includes any information, oral, written or recorded, that is created or received by certain healthcare entities, including healthcare providers, such as physicians and hospitals, as well as health insurance companies or plans. The law specifically protects health information that contains data, such as your name, address, social security number and other information that could be used to identify you as the patient associated with that information.

USES OR DISCLOSURES OF YOUR PERSONAL HEALTH INFORMATION

Generally, we may not use or disclose your personal health information without your permission. Further, once your permission has been obtained we must use or disclose your personal health information in accordance with the specific terms of that permission. The following are the circumstances under which we are permitted by law to disclose your personal health information:
Without your consent: Without your consent we may use or disclose your personal health information in order to provide you with services and the treatment you require or request, or to collect payment for those services, and to conduct other related healthcare operations otherwise permitted or required by law. Also, we are permitted to disclose your personal health information within and among our workforce in order to accomplish these same purposes. However, even with your permission we are still required to limit such disclosures to the minimal amount of personal health information that is required to provide those services. Other uses and disclosures not described in the Notice of Privacy will be made only with the authorization of the individual.

RIGHT TO RESTRICT DISCLOSURE

A patient who pays out of pocket in full for a healthcare treatment, procedure or consultation and has no balance with the healthcare provider has the right to request restriction of the release of patient health information for operational or payment reasons but not for treatment. Any person wanting to do this must sign a statement to that effect and it will be filed in the patient's medical record.

DISCLOSURE OF RECORDS FOR MARKETING, SALES AND RESEARCH

The disclosure of psychotherapy notes, uses and disclosures of protected health information for marketing purposes, and disclosures that constitute a sale of protected health information require an authorization.

DISCLOSURE OF STUDENT IMMUNIZATIONS TO SCHOOLS

Covington County Hospital may disclose proof of immunization to a school where State or other law requires the school to have such information prior to admitting the student. Written authorization is no longer required to permit disclosure. Covington County Hospital still must obtain agreement, which may be oral, from a parent, guardian or other person acting in loco parentis for the individual, or from the individual themselves, if the individual is an adult or emancipated minor. There must be written documentation that this oral agreement occurred and this documentation will be kept in the patient's medical record.

BREACH NOTIFICATION

A breach is an unauthorized release of your personal healthcare information. It may be intentional or accidental. If a breach of your personal information occurs that could potentially cause financial, reputational or other harm, you will be notified in writing within 60 days of the discovery of the breach.

RIGHT TO RECEIVE AN ACCOUNTING OF DISCLOSURE OF YOUR PERSONAL HEALTH INFORMATION

You have a right to receive a written accounting of all disclosures of your personal health information that we have made within the six(6) year period immediately preceding the date on which the accounting is requested. Such accounting will include the date of each disclosure, the name and address of the entity or person who received the information, a brief description of the information disclosed and a brief statement of the purpose and basis of the disclosure or, in lieu of such a statement, a copy of your written authorization or written request for disclosure pertaining to such information. We are not required to provide accounting of disclosures for the following purposes: (a) treatment, payment and healthcare operations, (b) disclosures pursuant to your authorization, (c) disclosures to you, (d) for a facility directory or to a person involved in your care, (e) for national security or intelligence purposes, and (f) to correctional institutions. We reserve the right to temporarily suspend your right to receive an accounting to health oversight agencies or law enforcement officials, as required by law. We will provide the first accounting to you in any twelve (12) month period without charge, but will impose a reasonable cost-based fee for responding to each subsequent request for accounting within that same twelve (12) month period. All requests for accounting will be sent to Covington County Hospital, 701 S.Holly Ave., Collins, MS., 39428.

COMPLAINTS

You may file a complaint with us and with the Secretary of DHHS if you believe that your privacy rights have been violated. You may submit your complaint in writing by mail to our privacy officer, Ann Howell, at Covington County Hospital, 701 S.Holly Ave, Collins, MS., 39428. A complaint must name the entity that is the subject of the complaint and describe the acts or omissions believed to be in violation of the applicable requirements of HIPAA or this Privacy Policy.

ON-GOING ACCESS TO PRIVACY POLICY

We will provide you with a copy of the most recent version of this Privacy Policy at any time upon your written request sent to Covington County Hospital, 701 S.Holly Ave., Collins, MS., 39428. For any other requests or for further information regarding the privacy of your personal health information and for the information regarding the filing of a complaint with us, please contact our privacy officer, Ann Howell, or our Chief Compliance Officer, Jon Calhoun, at 601-765-6711.