HMH Notice of Health Information Practices
Trusted Healthcare Service from Huntsville Memorial Hospital
Please review the following notice carefully as it provides information
on how your personal health information may be used, disclosed and accessed.
Understanding Your Health Record/Information
This Notice describes the practices of Huntsville Memorial Hospital and
that of any physicians* with staff privileges with respect to your protected
health information created while you are a patient at this hospital. Huntsville
Memorial Hospital, physicians with staff privileges, and personnel authorized
to have access to your medical chart are subject to this notice. In addition,
Huntsville Memorial Hospital and physicians with staff privileges may
share medical information with each other for treatment, payment, or health
care operations described in this notice. Each time you visit HMH we create
a record of the care and services you receive. Typically, this record
contains your symptoms, examination and test results, diagnosis, 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
- A means of communicating among the many health professionals who contribute
to your care
- A legal document describing the care you received
- A means by which you or a third-party payer can verify that services billed
were actually provided
- A tool in educating health professionals
- A source of data for medical research
- A source of information for public health officials who oversee the delivery
of health care in Texas
- A source of data for facility planning and marketing
- A tool with which we can assess and continually work to improve the outcomes
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 access your health information and make more informed
decisions when authorizing disclosure to others.
Our hospital 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 practices change, we will
make available to you a revised notice during your next visit to our hospital
after a revision is made. We will not use or disclose your health information
without your authorization except as described in this notice
How We Will Use or Disclose Your Health Information
Treatment: We will use your health information for treatment. For example, information
obtained by a nurse, physician, or another 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 physician will document in your record
his or her expectations of the members of your healthcare team. Members
of your healthcare 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 healthcare
provider with copies of various reports that should assist him or her
in treating you once you're discharged from our hospital.
Payment: We will use your health information for payment. For example, a bill
may be sent to you or a third-party payer, including Medicare or Medicaid.
The information on or accompanying the bill may include information that
identifies you, as well as your diagnosis, procedures, and supplies used
Health care operations: We will use your health information for regular health operations. For
example, members of the medical staff, the risk or quality improvement
manager, or members of the quality improvement 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 healthcare and service we provide.
Business associates: There are some services provided in our organization through contacts
with business associates. Examples include our accountants, consultants,
and attorneys. When these services are contracted, we may disclose your
health information to our business associates so that they can perform
the job we've asked them to do. To protect your health information,
however, we require the business associates to appropriately safeguard
Directory: Unless you notify us that you object, we may 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.
We may also use your name on a nameplate next to or on your door in order
to identify your room unless you notify us that you object.
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, of your location and general condition. If we are unable
to reach your family member or personal representative, then we may leave
a message for them at the phone number that they have provided us, e.g.,
on an answering machine.
Communication with family: Health professionals, using their best judgment, may disclose to a family
member, another relative, close personal friend or any other person you
identify, health information relevant to that person's involvement
in your care or payment related to your care.
Research: We may disclose information to researchers when their research has been
approved by an institutional review board that has reviewed the research
proposal and established protocols to ensure the privacy of your health
Funeral directors: We may disclose information to funeral directors and coroners to carry
out their duties consistent with applicable law.
Organ procurement organizations: Consistent with applicable law, we may disclose health information to
organ procurement organizations or other entities engaged in the procurement
of organs for the purpose of tissue donation and transplant.
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.
Fundraising: We may contact you as part of a fundraising effort.
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,
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.
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.
Abuse, neglect, or domestic violence: As required by law we may disclose health information to a governmental
authority authorized by law to receive reports of abuse, neglect, or domestic violence.
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 disclose health information for law enforcement purposes as required
by law or in response to a valid subpoena.
Reports: 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.
Your Health Information Rights
Although your health record is the physical property of the hospital, the
information in your health record belongs to you.
You have the following rights:
You may request that we not use or disclose your health information for
a particular reason related to treatment, payment, the hospital's
general health care operations, and/or to a particular family member,
other relative or close personal friend. We ask that such requests be
made in writing on a form provided by our hospital. Although we will consider
your request, please be aware that we are not obligated to accept it or
to abide by it.
If you are dissatisfied with the manner in which or the location where
you are receiving communications from us that are related to your health
information, you may request that we provide you with such information
by alternative means or at alternative locations. Such a request must
be made in writing and submitted to the Medical Records Department. We
will attempt to accommodate all reasonable requests.
You may request to inspect and/or obtain copies of health information about
you, which will be provided to you in the time frames established by law.
If you request copies, we will charge you a reasonable fee.
If you believe that any health information in your record is incorrect
or if you believe that important information is missing, you may request
that we correct the existing information or add the missing information.
Such requests must be made in writing and must provide a reason to support
the amendment. We ask that you use the form provided by our hospital to
make such requests. For a request form, please contact the Medical Records
You may request that we provide you with a written accounting of all disclosures
made by us during the time period for which you request (not to exceed
six years). We ask that such requests be made in writing on a form provided
by our hospital. Please note that an accounting will not apply to any
of the following types of disclosures:
- (a) disclosures made for reasons of treatment, payment, or health care
- (b) disclosures made to you or your legal representative or any other individual
involved with your care.
- (c) disclosures to correctional institutions or law enforcement officials.
- (d) disclosures for national security purposes.
You will not be charged for your first accounting request in any 12-month
period. However, for any requests that you make thereafter, you will be
charged a reasonable, cost-based fee.
You have the right to obtain a paper copy of the Notice of Health Information
You may revoke an authorization to use or disclose health information except
to the extent that action has already been taken. Such a request must
be made in writing.
For More Information or To Report a Problem
If you have questions and would like additional information, you may contact
our hospital's Privacy Officer, Sue Swinner at (936) 291-4595. If
you believe that your privacy rights have been violated, you may file
a complaint with us. These complaints must be filed in writing on a form
provided by our hospital.
The complaint form may be obtained from the Medical Records Department,
and when completed should be returned to the Hospital's Legal Compliance
Officer in administration.
You may also e-mail us with compliance related questions at email@example.com
or at firstname.lastname@example.org.
You may also file a complaint with the secretary of the federal Department
of Health and Human Services. There will be no retaliation for filing
* The physicians participating in your care at HMH, including the physicians
in the Emergency Department, are not employees or agents of HMH and are
not acting for or on behalf of HMH. They are independent physicians who
have been granted privileges to use this facility for the care of their
patients. All medical decisions regarding your care and treatment at HMH
are made by the physicians and not by HMH.
Reviewed: January 2009
Effective Date: 04/14/03