MID-SOUTH HEALTH SYSTEMS, INC.
NOTICE OF PRIVACY PRACTICES
NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED, DISCLOSED AND HOW YOU
CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW CAREFULLY.
purposes of this Notice, the following definitions apply:
HIPAA means Health Insurance Portability and
Accountability Act of 1996
Community Mental Health
Center (CMHC) means, for purposes of
Ø All departments or units of the CMHC.
Ø Any member of a volunteer group we allow to help
you while you are being treated at any of our CMHC locations.
Ø All employees, staff, and other CMHC personnel.
Ø Any health care professional authorized to enter
information into your CMHC chart.
Ø All CMHC remote sites and locations.
Information (PHI) means individually
identifiable health information, as defined by HIPAA, that is created or received
by the Hospital as it relates to the past, present or future physical or mental
health or condition of an individual; the provision of health care to an
individual; or the past, present or future payment for the provision of health
care to an individual; and that identifies the individual or for which there is
a reasonable basis to believe information can be used to identify the individual.
PHI includes information of persons living or deceased.
OUR PLEDGE REGARDING MEDICAL
We understand that medical information about you
and your health is personal. We are committed to protecting your PHI. We create
a record of the care and services you receive at the Community Mental Health
Center (CMHC). We need this record to provide you with quality care and to
comply with certain legal requirements. This notice applies to all PHI
generated by the Hospital, whether made by the CMHC personnel or your personal
doctor. Your personal doctor may have different policies or notices regarding
the doctor’s use and disclosure of your medical information created in the
doctor’s office or clinic. This notice will tell you about the ways in which we
may use and disclose your PHI. We also describe your rights and certain
obligations we have regarding the use and disclosure of your PHI.
YOUR HEALTH RECORD/INFORMATION
Each time you receive health care services from the
agency a record of your service is made.
Typically, this record contains your symptoms, examination, test
results, diagnoses, treatment and a plan for further 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 are actually provided
§ A tool in educating health professionals, clinical
and support staff
§ A source of information for public health officials
charged with improving the health of the nation (communicable diseases)
A source of data for facility planning
§ A tool with which we can assess and continually work
to improve the care we render and outcomes we achieve
Understanding what is in your record and how your
health information is used helps you to:
§ Ensure its accuracy
§ Better understand who, what, when, where, and why
others may access your health information
§ Make more informed decisions when authorizing
disclosure to others
HEALTH INFORMATION RIGHTS
Although your health record is the physical property
of this agency or the facility that compiled it, the information belongs to
you. You have the right to:
Inspect/ Obtain a paper or electronic copy of your medical record: You can ask to see or get an
electronic or paper copy of your medical record and other health information we
have about you. Ask us how to do this. We will provide a copy or summary of your
health information, usually within 30 days of your request. There will be a
reasonable, cost-based fee.
- Amend your medical record:
You can ask us to correct health information
about you that you think is incorrect or incomplete. Ask us how to do
this. We may say “no” to your request, but we will tell you in writing
within 60 days.
- An Accounting of
Disclosures: You can ask for a
list (accounting) of the times that we have shared your PHI with and why
for up to six years prior to the date of your request.
- Request Restrictions or
ask us to limit what we share: You
can ask us not to share certain health information for treatment,
payment or our operations.
ü Keep in mind that we are not required to agree with
your request, and we may say “no” if it would affect your care.
you pay for a service or health care item out-of-pocket in full, then you can
ask us not to share that information for the purpose of our operations
with your health insurer.
ü We will say “yes” to this request unless the law
requires us to share that information.
- Request Confidential
Communications: You can
ask us to contact you in a specific way (for example, home or office
phone) or to send mail via alternate means (E.g., fax) or to a different
address such as a P.O. Box, etc. We will say “yes” to all reasonable
- Receive Notice of a Breach:
We will notify you if your unsecured PHI has
been breached, unless there is a low probability that the PHI has been
compromised based upon a risk assessment.
- Receive a Paper Copy of
This Notice. You have a right to
ask us for a copy of this notice at any time, even if you have agreed to
receive the notice electronically. At the time of request, we will provide
you with a paper copy promptly.
- Choose or appoint someone
to act on your behalf: If you
have given someone medical power of attorney or if someone is your legal
guardian, that person can exercise your rights and make choices about your
health information. We will make sure that the person has this authority
and can act on your behalf before we take any action.
a complaint: You can complain if you feel we have violated your
rights by following the steps outlined below in the “Complaints” section of
We are required to:
§ Maintain policies and practices that
protect the security and privacy of
your protected health information
§ Secure your electronic records from premature
destruction and unauthorized disclosure
§ Promptly notify you if a breach occurs that may have
compromised the privacy or security of your information
§ Provide you with this notice of our legal duties and privacy practices with
respect to information we collect and maintain about you
§ Abide by the terms of this notice, until such time
as our privacy practices or the law changes
§ Notify you if we are unable to agree to a requested
amendment pertaining to your health information
§ Accommodate reasonable request you may have to
communicate health information by alternative means or at alternative locations
§ Provide examples of our practices to help you better
understand how your health information will be used and disclosed
§ Not use or share your PHI other than as described in
this notice unless you tell us we can in writing. Even then, you still have the
right to change your mind at any time by letting us know in writing.
IN OUR PRIVACY PRACTICES
We reserve the right to change the practices
described in this notice and to make the new provisions effective for all PHI
we maintain, including any information compiled before the change. Should our privacy practices change, we will
make a copy available at your next scheduled visit. We will also post the revised notice in
prominent public access locations throughout our facility and on our website at
If you have questions and/or believe your privacy
rights have been violated, you may file a complaint/appeal with Mid-South
Health Systems (MSHS) or with the Secretary of the Department of Health and
Human Services. To file a complaint with MSHS, contact the Corporate Privacy
Officer, 2707 Browns Lane, Jonesboro, AR 72401; (870) 972−4046. All
complaints must be submitted in writing. You will not be penalized for
filing a complaint.
FOR TREATMENT, PAYMENT AND HEALTH OPERATIONS (TPO)
We will use and disclose your information for your
treatment, payment for services rendered, and health care operations of the
agency. Examples are included for
information purposes. If you have
questions about these or other permitted uses and disclosures of your health
information, please discuss these with the Privacy Officer at (870) 972-4046.
can use your health information and share it with other professionals who are
treating you. Information obtained by a nurse, physician, mental health professional, 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 healthcare providers will document in
your record the actions they took and their observations. In that way, the treatment team will know how
you are responding to treatment. Example: A doctor such as your primary
care physician (PCP) who is treating you asks another doctor who is also
treating you about your overall health condition or specifics concerning your
health condition. I such cases as these and alike, we will provide subsequent
healthcare providers with copies of certain information necessary for
professionals are trained to identify and respond to emergency situations. When we conclude an emergency exists, our
focus is on immediate intervention and stabilizing the client, not on
privacy. Consequently, we will use and
disclose health information as needed to provide appropriate healthcare
service; even it would conflict with a client’s normal privacy expectations.
We can use and share your health information to bill
and obtain payment from health plans or other entities. A bill may be sent to
you or a third-party payer. The information on or accompanying the bill may
include information that identifies you, as well as your diagnosis, procedures,
and supplies used. Example: We give information about you to your health
insurance plan so that it will pay for your services.
We can use and share your health information to run
our mental health center, improve your care, and contact you when necessary. We
share private health information internally and with selected business
associates in order to continually improve the quality and effectiveness of the
health care and service we provide. Example:
We use health information about you to manage your treatment and services,
assess your care received, and the outcomes of your case.
some services pertaining to treatment, payment or healthcare operations
provided in our organization through contracts with business associates. Examples include, but are not limited to
certain laboratory tests, Patient Assistance Program, and offsite records
storage, etc. When these services are contracted, we may disclose your health
information to our business associate.
To protect your health information, however, we require the business
associate to appropriately apply and uphold the same safeguards as we do.
WITH FAMILY AND OTHERS
Health professionals using their best judgment and
the authority conveyed by the Laws of the State of Arkansas may disclose to a
parent and/or guardian, or other person you identify and authorize to have
access to health information relevant to that person’s involvement in your care
or payment related to your care. We may
use or disclose information to notify and assist in notifying a family member,
personal representation, or another person responsible for your care, your
location, and general condition.
are several situations where we might be required by law, law enforcement,
courts or regulators to release some or all of a client’s protected health
information, whether or not you authorize such a release. Examples include, but are not limited to
certain information we are required to release to the Medical Examiner, Public
Health agencies, Workers Compensation Administrators, Law Enforcement Officers,
Judicial Proceedings, and others.
USES OF PHI / MARKETING
As a part of our healthcare services, we may
recommend or discuss options that relate to your treatment. Other uses and disclosures of PHI not
covered by this Notice or the laws that apply to us (such as marketing or sale
of PHI), will be made only with your written authorization. Additionally,
psychotherapy notes will not be disclosed without your written authorization.
If you provide us authorization to use or disclose your PHI, you may revoke
that permission, in writing, at any time. If you revoke your authorization, we
will no longer use or disclose your PHI 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 authorization, and that we are required to
retain our records of that care that we provided to you. Send all revocation
Mid-South Health Systems, Inc.
Attention: Privacy Officer
2707 Browns Lane
Jonesboro, Arkansas 72401
OF ALCOHOL/SUBSTANCE ABUSE PATIENT RECORDS
The confidentiality of alcohol and drug abuse
patient records maintained by this program is protected by federal law and
regulations. Generally, the program may
not say to a person outside the program that a patient attends the program, or
disclose any information identifying a patient as an alcohol or drug abuser
unless one of the following conditions is met: (1) the patient consents in
writing; (2) the disclosure is allowed by a court order; (3) the disclosure is
made to medical personnel in a medical emergency or to qualified personnel for
research, audit, or program evaluation.
Violation of the federal law and regulations by a
program is a crime. Suspected violations
may be reported to appropriate authorities in accordance with federal
regulations. Federal law and regulations
do not protect any information about a crime committed by a patient either at
the program or against any person who works for the program or about any threat
to commit such a crime. Federal laws and
regulations do not protect any information about suspected child abuse or
neglect from being reported under state law to appropriate state or local
For most other uses and disclosures of information,
we will require a signed authorization by the client before providing a third
party with access to your individually identifiable health information. Most
other uses and disclosures will be made only with the individual’s written
consent or authorization and the individual may revoke such authorization at
Even though we can lawfully use and disclose your
health information under a variety of circumstances, we always try to limit the
information to the minimum necessary.
This sometimes requires the exercise of professional judgment.
Date: September 23, 2013.