East Mississippi State Hospital(EMSH), EMSH Division of Community Services, and Division of Nursing Home Services are dedicated to protecting your medical information. East Mississippi State Hospital and its facilities are required by law to maintain the privacy of your protected health information and to provide you with this Notice of our legal duties and privacy practices with respect to protected health information. East Mississippi State Hospital, EMSH Division of Community Services, and/or Division of Nursing Home Services collects information from you and stores it in a chart and on a computer. This is your health record. The health record is the property of East Mississippi State Hospital, EMSH Division of Community Services, and/or the Division of Nursing Home Services, but the information in the record belongs to you. If you have any questions about any part of this Notice or if you want more information about the privacy practices at East Mississippi State Hospital, EMSH Division of Community Services, or the Division of Nursing Home Services please contact:
Privacy Officer
East Mississippi State Hospital
P.O. Box 4128- West Station
Meridian, MS 39304-4128
Telephone #: 601-581-7600, ext. 17573
Effective Date of this Notice: October 25, 2013
East Mississippi State Hospital, EMSH Division of Community Services, and the Division of Nursing Home Services are required to abide by the terms of the Notice currently in effect.
Changes to the Notice: East Mississippi State Hospital, EMSH Division of Community Services, and the Division of Nursing Home Services reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all protected health information that we maintain. If East Mississippi State Hospital, EMSH Division of Community Services, and the Division of Nursing Home Services make a material change in this Notice, we will post the revised Notice at the hospital/facility and will make a copy of the revised Notice available to you upon request.
The law permits East Mississippi State Hospital, EMSH Division of Community Services, and/or the Division of Nursing Home Services to use or disclose your health information without your consent or authorization for the following purposes:
Treatment: We may use health information about you to provide treatment and services. We may disclose your health information to doctors, nurses, technicians, or other staff at East Mississippi State Hospital, EMSH Division of Community Services, and/or the Division of Nursing Home Services who are involved in taking care of you or when we refer you to another health care provider for treatment or services.
Examples: Your physician may ask a nurse to give you certain medications or information related to your condition or treatment. Another example is that if you had a heart problem that required us to consult with a heart specialist (cardiologist) outside of the hospital, your doctor at the hospital/facility may refer you to a cardiologist in the community for your care. We may also release your information to another treatment facility for your continued care after your discharge from this facility.
Payment: We may use and disclose your health information to third party payers, such as insurance companies, Medicaid, or Medicare, when needed to determine your eligibility for benefits, for reimbursement or for other requirements related to payment for treatment or services.
Examples: Information on or accompanying a bill to your insurance company or a claim form to the Division of Medicaid may include information, such as your diagnosis, the dates you received the services for which payment is requested or claimed, and the procedures or services you received. Information may be disclosed and used as part of utilization review activities, such as pre-certification and preauthorization of services and concurrent and retrospective review of services.
Healthcare Operations: We may use your health information for the purposes of East Mississippi State Hospital, EMSH Division of Community Services, and the Division of Nursing Home Services operations. These uses and disclosures are necessary to run or operate the hospital/facility and to make sure that all individuals we serve receive quality care.
Examples: Your records may be copied by a medical records employee to send them to another healthcare provider for your continued treatment. Members of the medical/nursing staff and other staff at the hospital may review your health information to assess the care, outcomes and quality of services you and others at the hospital receive.
1. We may contact you to provide or remind you of an appointment, information about treatment alternatives, or other health related benefits and services that may be of interest to you. Examples of how we may contact you include:
2. We may disclose your health information to you or your authorized personal representative, except as restricted under applicable laws and regulations
3. Information may be released about you for public health activities, such as:
4. Information may be released to health oversight agencies for activities authorized by law. These activities may include investigations, inspections and licensure, and other lawful activities. These activities may also include providing access to your health information on a need-to-know basis by members of the Humans Rights Advocacy Committee for approved activities. All specific information gained by the Human Rights Advocacy Committee shall remain confidential.
5. Information may be disclosed in the course of any administrative or judicial proceeding:
6. Information may be disclosed for law enforcement purposes under certain circumstances, such as reporting of certain types of physical injuries, locating persons and reporting and investigating crimes.
7. Information may be disclosed to a coroner, medical examiner, or funeral directors, consistent with applicable law.
8. If you are an organ, eye or tissue donor, your health information may be disclosed to organizations involved in procurement, banking or transplantation to facilitate organ, eye or tissue donation or transplantation.
9. Information may be disclosed for public safety reasons to appropriate persons in order to prevent or lessen a serious and/or imminent threat to the health or safety of a particular person or the general public.
10. Information may be disclosed as necessary to comply with Workers Compensation laws.
11. Information may be disclosed for research purposes, only as approved by the facility's research committee that serves as an Institutional Review Board and/or privacy board.
12. We may disclose your health information for other purposes, only as required or permitted by law.
13. We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.
14. We may share information for special government functions such as military, national security and presidential protective services.
Except as provided in this Notice of Privacy Practices, East Mississippi State Hospital, EMSH Division of Community Services, and the Division of Nursing Home Services will not disclose your health information, including, except under certain conditions, psychotherapy notes, without your written authorization. If you do not authorize the hospital/facility to use or disclose your information for purposes other than as provided in this Notice, you may revoke your authorization in writing at any time.
Note:
Release of information and/or other health information rights relating to substance treatment/services and to nursing home services are
also subject to rights and/or restrictions set out in other federal law and regulations.
You have the following rights with respect to your Protected Health Information (PHI):
1. The right to request restrictions on certain uses or disclosures of protected health information. East Mississippi State Hospital, EMSH Division of Community Services, and/or the Division of Nursing Home Services is not required to agree to your requested restriction. If the hospital/facility does agree to your requested restriction, we will comply with your request, unless the information is needed to provide you with emergency treatment. If you pay for a service or health care item out-of-pocket in full, you have the right to ask that your Protected Health Information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request unless the law requires us to share that information.
2. The right to receive confidential communication of protected health information. You have the right to request in writing to the Privacy Officer that the hospital/facility only communicate to you in a certain format (for example, in writing) and/or location (for example, only at your work address). We will accommodate all reasonable requests.
3. The right to inspect and copy protected health information, subject to certain restrictions as provided by law. You may be charged a fee for copying and/or postage.
4. The right to amend protected health information. You have a right to request that East Mississippi State Hospital, EMSH Division of Community Services, and/or the Division of Nursing Home Services amend or change your health information. East Mississippi State Hospital, EMSH Division of Community Services, and/or the Division of Nursing Homes Services is not required to change your health information under certain conditions. You must make requests for amendments in writing and include the reason(s) for your request.
5. The right to receive an accounting of disclosures of protected health information. You have a right to receive an accounting of disclosures of your protected health information made by the hospital/facility, except for disclosures such as treatment, payment, healthcare operations, and certain other disclosures as provided by law.
6. The right to receive notice of a privacy breach. You have the right to receive written notice of a breach of unsecured protected health information involving your health information. Breach means the unauthorized acquisition, access, use, or disclosure of protected health information which compromises the security or privacy of the information.
7. The right to receive a paper copy of this Notice of Privacy Practices. If you agreed to receive this Notice electronically, you also have the right to request a paper copy.
You may exercise one or more of the rights described in this Notice or receive additional information by contacting:
Privacy Officer
601-581-7600, ext. 17573
East Mississippi State Hospital
P.O. Box 4128 - West Station
Meridian, MS 39304-4128
Or, you may contact:
OCR Regional Manager
Office of Civil Rights
U.S. Department of Health and Human Services
Sam Nunn Atlanta Federal Center, Suite 16T70
61 Forsyth Street, S.W.
Atlanta, GA 30303-8909
or
Office of Civil Rights
U.S. Department of Health and Human Service
200 Independence Avenue, S.W.
Room 515F HHH Building
Washington, DC 20201
or
Calling 1-800-368-1019
or
Visiting www.hhs.gov/ocr/privacy/hipaa/complaints/
© 2014 East Mississippi State Hospital