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Notice of Privacy Practices

Your Rights Regarding Medical Information About You

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You have the following rights regarding medical information we maintain about you:

Right to Inspect and Copy
You have the right to inspect and receive a copy of medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.

To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Director of Health Information Management/Chief Privacy Officer.  If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances.  If you are denied access to medical information, you may request that the denial be reviewed.  Another licensed health care professional chosen by the hospital will review your request and the denial.  The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

Right to Amend.
If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the hospital.

To request an amendment, your request must be made in writing and submitted to the Director of Health Information Management/Chief Privacy Officer. In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
Is not part of the medical information kept by or for the hospital;
Is not part of the information which you would be permitted to inspect and copy;
Is accurate and complete.

Right to an Accounting of Disclosures.
You have the right to request an “accounting of disclosures.” This is a list of the individuals and/or institutions to which we have released your private medical information.

To request this list or accounting of disclosures, you must submit your request in writing to the Director of Health Information/ Privacy Officer.  Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003.  Your request should indicate in what form you want the list (for example, on paper, electronically).  The first list you request within a 12-month period will be free.  For additional lists, we may charge you for the costs of providing the list.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions.
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations.

To request restrictions, you must make your request in writing to the Director of Health Information Management/Chief Privacy Officer. In your request, you must tell us:
(1) what information you want to limit;
(2) whether you want to limit our use, disclosure or both;
(3) to whom you want the limits to apply, for example, disclosures to your spouse

All requests will receive review for consideration of acceptance, therefore you will not receive immediate response to your request. Every effort will be made to provide you response to your request within thirty (30) days.

We are not required to agree to your request
If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

Right to Request Confidential Communications.
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

To request confidential communications, you must make your request in writing to the Director of Health Information Management/ Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice.
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

Personal Representative. 
Your “personal representative” may exercise the rights listed above on your behalf, if under applicable law, that person has legal authority to act on your behalf in making decisions related to health care. If you live in Tennessee and do not have a “personal representative” you may wish to create a legal document called Durable Power of Attorney for Health Care. This may be extremely beneficial in the unfortunate situation where you are unable to make a decision for yourself and wish for someone to act upon your behalf.

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