Effective Date: 01/01/03

Muskogee Women's Clinic

Notice of Health Information Practices

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

Understanding Your Health Record/Information

Each time you visit a hospital, physician, or other health care provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future 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 were actually provided

· A tool in educating heath professionals

· A source of data for medical research

· A source of information for public health officials charged with improving the health of the nation

· A source of data for facility planning and marketing

· A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

· 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

Your Health Information Rights

Although your health record is the physical property of the health care practitioner or facility that compiled it, the information belongs to you. You have the right to:

· Request a restriction on certain uses and disclosures of your health information as provided by 45 CFR 164.522

· Obtain a paper copy of the notice of health information practices upon request

· Inspect and obtain a copy of your health record as provided for in 45 CFR 164.524

· Amend your health record as provided in 45 CFR 164.528

· Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528

· Request communications of your health information by alternative means or at alternative locations

· Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Our Responsibilities:

Muskogee Women's Clinic is required to:

· Maintain the privacy of your health information

· Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you

· Abide by the terms of this notice

· Notify you if we are unable to agree to a requested restriction

· Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you’ve supplied us.

We will not use or disclose your health information without your authorization, except as described in this notice.

For More Information or to Report a Problem

If have questions and would like additional information, you may contact the Privacy Officer at 918-687-5477.

If you believe your privacy rights have been violated, you can file a complaint with the Director of Health Information Management or with the Secretary of The U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint. The Department of Health and Human Services, Office Of Civil Rights, Herbert H. Humphrey Building, Room 509F, 200 Independence Avenue, S.W., Washington, D.C. 20201.

Examples of Disclosures for Treatment, Payment and Health Operations

We will use your health information for treatment.

For example: Information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.

We will also provide your physician or a subsequent health care provider with copies of various reports that should assist him or her in treating you once you’re discharged from this facility.

We will use your health information for payment.

For example: 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.

We will use your health information for regular health operations.

For example: Members of the medical staff, management, or members of our team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.

Business associates: There are some services provided in our organization through contacts with business associates. Examples include attorney services, consulting firms, and collection agencies. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Directory: Unless you notify us that you object, we will use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.

Emergencies: We may use or disclose your protected health information in an emergency treatment situation. If this happens, your physician will try to obtain your consent as soon as reasonably practical after the delivery of treatment. If your physician or another physician in the practice is required by law to treat you and the physician has attempted to obtain your consent but is unable to obtain your consent, he or she may still use or disclose your protected health information in order to treat you.

Communication with family: Health professionals, using their best judgement, may disclose to a family member, other relative, or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.

Research: Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. We will do our best to protect your identity, but we may not be able to do so in all instances.

Funeral directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.

Lawsuits & Disputes: If you are involved in a lawsuit in Oklahoma in which you have placed your medical condition at issue, we will likely have to release your medical records if requested to do so under Oklahoma law [ Title 76 of the Oklahoma Statutes, Section 19].

Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Fund raising: We may contact you as part of a fund-raising effort.

Change of Ownership: In the event this medical practice is sold or merged with another organization, your medical information will become the property of the new owner, although you will maintain the right to request that copies of your medical information be transferred to another physician or medical practice.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Workers’ compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Military & Veterans: If you are a member or the Armed Forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority. We may use and disclose to the Department of Veterans Affairs medical information about you to determine whether you are eligible for certain benefits.

Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.

Law enforcement: We may release medical information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons, or similar process; to identify or locate a suspect, fugitive, material witness or missing person; about a death we believe may be the result of criminal conduct; and in potential cases of abuse and neglect.

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

Effective Date

This notice was published and becomes effective on January 1, 2003.