Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review the information in this notice carefully.

This notice provides you with information to protect the privacy of your confidential health care information, hereafter referred to as protected health information (PHI). The notice also describes the privacy rights you have and how you can exercise those rights. This notice serves as a joint notice from Dardanelle Regional Medical Center and members of the Dardanelle Regional medical staff through an organized health care arrangement.

The law requires that we have privacy protections for PHI and to give you notice of our legal responsibilities to individuals. We are required to follow the terms and conditions contained in this Notice of Privacy Practices, but we reserve the right to change the privacy practices described in it. A current version of this notice is posted on our website and in prominent areas of our facilities. We are also required to notify you if a breach of your health information occurs.

Uses and Disclosures of Your Health Care Information

Treatment Purposes: Your PHI may be used by and disclosed to other health care professionals for the purpose of providing you with health care services. This may also include the need for us to obtain PHI from your current or previous health care providers. For example, information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your medical record and used to determine the course of treatment that should work best for you.

Payment Purposes: Your PHI may be used by and provided to your health plan or insurance provider for the purpose of receiving payment for health care services. Your insurer also has a right to access your health care information for payment determinations or for conducting quality activities. PHI may also be disclosed to comply with workers compensation laws and similar programs. Your PHI may be shared with other health care providers, if necessary, for payment purposes.

Health Care Operations: Your PHI may be used or disclosed for health care operations. Our staff members and independent contractors may be required to access PHI for certain business operations and for quality improvement purposes. These uses and disclosures are necessary to operate Dardanelle Regional Medical Center to help ensure that all of our patients receive quality care. For example, we may use PHI about your health care condition to evaluate the performance of our staff in caring for you.

Business Associates: There are some services in our organization that are provided through contract with business associates and subcontractors of business associates. Your health care information may be used by or disclosed to our business associate(s) to provide and bill for services. These business associates will sign an agreement that requires them to have procedures in place to protect the privacy of your PHI. Business associates are also required to be compliant with the HIPAA regulations.

Patient Directory: Your PHI will be used to maintain a listing of the names, locations, general condition, and religious affiliation of patients in our facilities. The information may be disclosed to members of the clergy and to others who specifically request the information by identifying the patient by name. You may inform our admissions staff or a caregiver if you choose to object to this use or disclosure.

Notification of and Communication with Family: Your PHI may be used, or disclosed, to notify, or assist in notifying, a family member, personal representative, or another person responsible for your care, location, and general condition. Health professionals, using their judgment, may disclose to a family member or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.

Fundraising: We may contact you as part of a fundraising effort for the hospital. In addition to utilizing contact information such as your name, address, telephone number and potentially the date(s) you received services from our organization, we may use and or disclose the department of service, treating physician, outcome information, and health insurance information. If you do not want to be contacted for fundraising efforts, you may opt out of receiving these communications. Please contact the Conway Regional Health Foundation.

Contacts: We may contact you to provide appointment reminders or to tell you about new treatments or services.

As Required by Law: Your PHI will be used or disclosed when we are legally required to do so. If this occurs, we will limit the PHI used or disclosed to the minimum necessary to comply with the law.

Inmates: If you are an inmate, your PHI may be used or disclosed to the correctional institution or agents thereof when necessary for your health and the health and safety of others.

Emergencies: Your PHI may be used or disclosed in an emergency treatment situation. Your acknowledgement will be obtained as soon as possible following the emergency.

Workers’ Compensation: We may disclose PHI to file workers’ compensation claims.

To Avert a Serious Threat to Health or Safety: We may use and disclose PHI about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Organ Procurement Organizations: Consistent with applicable law, we may disclose PHI to organ procurement organizations for the purpose of organ and tissue donation and transplant.

Military: If you are or have been a member of the armed forces, we may release PHI about you as required by military command authorities.

Research: We may disclose PHI about you for research purposes when the research has been approved by an institutional review board and privacy protocols have been established. Your research-related treatment may be conditioned on signing an authorization to use and disclose your PHI in the research. You may also be asked to sign an authorization that would allow your PHI to be used in future research studies.

Public Health Authorities: As required by law, we may disclose your PHI to the public health or legal authorities charged with preventing or controlling disease, injury, or disability. For example, reporting births and deaths, reporting suspected abuse or neglect, and reporting communicable disease information as required by public health authorities.

Health Oversight Activities: We may disclose PHI to a health oversight agency for activities authorized by law, including, audits, investigations, inspections, medical device reporting and licensure.

Legal Proceedings: We may disclose your PHI in the course of any judicial or administrative proceeding or in response to a court order, subpoena, discovery request, or other lawful process, as allowed by law.

Law Enforcement Officials: We may release PHI for law enforcement purposes as required by law such as to identify or locate a suspect, fugitive, material witness, or missing person; about the victim of a crime if, under certain circumstances, we are unable to obtain the person’s agreement; about a death we believe may be the result of criminal conduct; about criminal conduct at or during services being provided by Dardanelle Regional Medical Center; and in emergency circumstances to report a crime, the location of the crime or victim(s), or the identity, description, or location of the person who committed the crime.

Coroners, Medical Examiners, and Funeral Directors: We may disclose PHI to coroners, medical examiners or funeral directors consistent with applicable law to allow these individuals to carry out their duties.

National Security and Intelligence Activities: We may release PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Sale of Information: Dardanelle Regional Medical Center will not sell your information without your prior authorization or as otherwise allowed by law.

Required Uses and Disclosures: Dardanelle Regional Medical Center must make disclosures when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the HIPAA Privacy Regulations.

Your PHI may be used or disclosed for other purposes not identified above based on your signing of a specific authorization form. You can revoke this authorization at any time provided you submit the revocation in writing to the Dardanelle Regional Medical Center Privacy Officer. However, Dardanelle Regional Medical Center is unable to “take back” any uses or disclosures that were made pursuant to the authorization prior to its revocation.

Your Health Information Rights

Right to Request a Restriction of Uses and Disclosures: You have the right to request in writing a restriction on certain uses and disclosures of your PHI. We are not required to agree to the requested restrictions, unless you are requesting to restrict certain information from your health plan and you have paid Conway Regional Health System for those services in full prior to receiving those services.

Right to Request Confidential Communications: You have the right to request that we communicate with you about your PHI in a certain way or at a certain location to protect the confidentiality of the information.

Right to Inspect and Copy: You have the right to request to inspect or obtain a copy of your PHI in paper or electronic form. There are a few exceptions to this right such as psychotherapy notes. For copies of your PHI, we may charge a reasonable fee for copying, postage (if mailed) and other costs associated with your request.

Right to Amend: You have the right to request that we amend your PHI that we created if you feel that the information is incorrect or incomplete. To request an amendment, you must submit the request in writing to our Privacy Officer. You must also provide reasoning to support your request. In addition, we may deny your request if you ask us to amend information that (1) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; (2) is not part of the information kept by or for us; (3) is not part of the information which you would be permitted to inspect or copy; or (4) is accurate and complete.

Right to Receive an Accounting of Disclosures: You have the right to request a record of certain disclosures of your PHI.

Right to Receive a Paper Copy of this Notice: You have a right to receive a paper copy of our Notice of Privacy Practices. You may request a copy of this notice from the Admissions desk.

Right to File a Complaint: You have the right to file a complaint if you believe we are not in compliance with our Notice of Privacy Practices and the Healthcare Information Portability and Accountability Act (HIPAA) or if you believe your privacy rights have been violated. Your complaint can be submitted to our Privacy Officer via phone, writing, or in person. We value your opinion and we will not retaliate against you in any manner for filing a complaint. You also have a right to file a complaint with the Secretary of the Department of Health and Human Services.

Notice of Privacy Practices for Substance Use Disorder Treatment Information

Conway Regional Health System

This Notice is provided by Conway Regional Health System (CRHS) and describes:

• HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
• YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
• HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF PRIVACY OR SECURITY OF YOUR HEALTH INFORMATION, OR OF YOUR RIGHTS CONCERNING YOUR INFORMATION
• YOUR RIGHT TO RECEIVE A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC FORM) AND TO DISCUSS IT WITH CRHS STAFF. YOU MAY ALSO CONTACT THE PRIVACY OFFICER AT 501 513 5469.

  The confidentiality of records for patients seeking care for substance use disorder maintained by this program is protected by Federal law and regulations. We will make uses and disclosures not described in this notice only with your written consent. You may revoke any previously provided written consent by contacting the Privacy Officer at 501 513 5469.

  With your consent, we may use or share your health information in the following ways:

• To treat you. Example: Sharing with your doctor who is treating you for a chronic condition and asks about your health condition and medications you are taking in order to avoid complications.
• To run our organization. Example: We use health information about you to manage our treatment program and services.
• To bill for your services: Example: We will provide information about you to your health insurance plan to pay for your services.

   

  Your Rights. With respect to your records, you have the following rights:

• Ask us to amend your medical record.
• The right to provide a single consent for all future uses or disclosures of your information for treatment, payment, and health care operations purposes.
  • If you decide to do so, records disclosed to a Part 2 program or HIPAA covered entity or business associate may be further disclosed by that Part 2 program, covered entity, or business associate without your written consent, to the extent the HIPAA regulations allow for such disclosure.
  • If you decide not to do so, your records will remain confidential and not be shared with other providers or third parties for your care or health care operations purposes without your consent, except as outlined below in the section entitled: Our Uses and Disclosures.
• The right to request restrictions on certain uses and disclosures of your records made with prior consent for the purposes of treatment, payment, and health care operations.
• If you pay for a service or health care item out-of-pocket and in full prior to care, you can ask us not to share that information with your health insurer if it is for a payment or operations purpose. The request must be in writing, and we will approve your request unless we are required by law to share that information.
• Get a list of those with whom we’ve shared your electronic records.
• Get a list of health care providers who have received your information through certain third parties.
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.  We will provide you with a copy.

  Our Uses and Disclosures. CRHS is prohibited from disclosing to a person outside our program that a patient attends a drug and alcohol program or any information identifying a patient as a patient of CRHS, except in the following circumstances:

• You consent in writing.
•  In case of a medical emergency.
• To qualified personnel for audit or program evaluation.
• To communicate within our program and with contractors who help us run our program.
• To conduct or help with scientific research or share information about a deceased patient as required or allowed by laws that collect information relating to cause of death.
• You commit, or threaten to commit, a crime either on CRHS premises or against any person who works for CRHS.
• To report suspected child abuse or neglect.
• For legal proceedings and court orders.
  • We will not use or share your information or provide testimony about your information in any civil, administrative, criminal, or legislative proceedings against you without your written consent or a court order.
  • We will only respond to a court order to use or share your health information if it is accompanied by a subpoena or other similar legal mandate requiring us to comply.
  • We will only use or share your information in proceedings against you based on a court order after we have received notice and an opportunity to be heard or you tell us that you have received notice.
  • We may use or share your information to respond to legal proceedings against our program based on a court order and you may not be notified in advance. You have the right to seek to overturn or change the court order after you learn about it.

    Our Responsibilities

    We are required by law to maintain the privacy and security of your records, provide you with notice of our legal duties and privacy practices with respect to your records, and notify you if you are affected by a breach of your unsecured records.

    We are required to abide by the terms of this notice currently in effect. We reserve the right to change the terms of this notice at any time and make the new notice provisions effective for records that we maintain.

    Patients will be notified promptly of any changes to this notice. The new notice will be available on request and on our website.

    If you believe your privacy rights have been violated, you may file a complaint by contacting us or the Federal government using the information below. We will not retaliate against you for filing a complaint.

• CRHS Privacy Officer at 501 513 5469 or [email protected].
• U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD).

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For More Information

If you have any questions or would like further information about this Notice, please contact our Privacy Officer:
               Dardanelle Regional Medical Center
               200 N 3rd St.
               Dardanelle, AR 72834