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Notice of Privacy

Lawrence Memorial Hospital and Lawrence Hall Nursing Center

Notice of Privacy Practices

Effective September 23, 2013



If you have any questions about this notice, please contact the Privacy  Officer (see the bottom of this Notice for contact details  of the Privacy Officer).


This notice will tell you how we may use and disclose protected health  information about you. Protected health information means individually identifiable health information, 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, and includes information of  persons living or deceased.  In this notice, we refer to the protected  health information as “medical information.”


This notice will also tell you about your rights and our duties with  respect to medical information about you. In addition, it will describe  how you can file a complaint if you believe we have violated your privacy rights.


This Notice of Privacy Practices describes the practices of Lawrence  Memorial Hospital (“Hospital”) and that of:

  • Any health care professional authorized to   enter information into your medical chart at the Hospital.
  • All departments and units of the Hospital.
  • Any member of a volunteer group we allow to help   you while you are in the Hospital.
  • All employees, staff and other Hospital personnel.
  • All Hospital remote sites and locations.


We all will follow the terms of this notice. In addition, we may share medical information with each other  for treatment, payment or health operations purposes described in this  notice.



We understand that medical information about you and your health is personal  and we are committed to protecting it. Your medical information consists  of records of the care and services you receive at the Hospital. We  need this record to provide you with quality care and to comply with  certain legal requirements. This notice applies to all medical information,  whether created by Hospital 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.


We are required by law to:

• make sure that medical information that identifies you is kept private;

• give you this notice of our legal duties and privacy practices with  respect to medical information about you; and

• follow the terms of the notice that is currently in effect.


How we may use and  disclose medical information about you:

We will share your medical information as necessary to carry out treatment,  payment, or our health care operations. The following categories describe  different ways that we use and disclose medical information. For each  category of uses or disclosures, we will explain what we mean and try  to give some examples. Not every use or disclosure in a category will  be listed. However, all of the ways we are permitted to use and disclose  information will fall within one of the categories.


For Treatment. We may use medical information about you to provide you with medical  treatment or services. We may disclose medical information about you  to doctors, nurses, technicians, medical students, or other Hospital  personnel who are involved in taking care of you at the Hospital. For  example, a doctor treating you for a broken leg may need to know if  you have diabetes because diabetes may slow the healing process. Different  departments of the Hospital also may share medical information about  you in order to coordinate the different things you need, such as prescriptions,  lab work, and x-rays. We may consult or refer you to other health care  providers and share your medical information with them. We also may  disclose medical information about you to people outside the Hospital  who may be involved in your medical care after you leave the Hospital,  such as family members, or others we use to provide services that are  part of your care.


For Payment. We may use and disclose medical information about you so that the  treatment services you receive at the Hospital may be billed to and  payment may be collected from you, an insurance company, or a third  party. We also may need to provide your insurance company or a government  program, such as Medicare or Medicaid, with information about your medical  condition and the health care you need to receive, to obtain prior approval  or to determine whether your plan will cover the treatment.


For Health Care Operations. We may use and disclose medical information about you for Hospital  operations. These uses and disclosures are necessary to run the Hospital  and make sure that all of our patients receive quality care. For example,  we may use medical information to review our treatment and services  and to evaluate the performance of our employees in caring for you.

disclosures to which you have  the opportunity to object or agree:

Hospital Directory. We will include your name, location in the Hospital, condition described  in general terms (e.g., fair, stable, etc.) on our facility census sheet  while you are a patient at the Hospital. This information may be released  to people who ask for you by name. Your religious affiliation may be  given to members of the clergy, even if they don’t ask for you by  name. This is so your family, friends and clergy can visit you in the  Hospital and generally know how you are doing.  If you do not want this  information released you must notify the Privacy Officer or Administration  (870-886-1265) of the Hospital of your objection.


Individuals Involved in Your Care or Payment for Your Care. We may  disclose medical information about you to family members, other relatives,  a close personal friend, or any other person identified by you who is  involved in your medical care or payment related to your care. We may  also give information to someone who helps pay for your care. If there  is a family member, other relative, or close personal friend that you  do not want to disclose medical information about you, please notify  the Privacy Officer/Medical Records Department of the Hospital, or tell  our staff member who is providing care to you.


Fundraising Activities.  We may use or disclose medical information for the purpose  of contacting you in an effort to raise money for the Hospital.   We would only use your contact information, such as your name, address,  phone number, and the dates you received treatment or services.   If you do not want to be contacted for fundraising efforts, you   must notify Administration at 870-886-1265 or email ajones@lawrencehealth.net.


Uses and disclosures that  may be made without your authorization or opportunity to object:

Disaster Relief. We may use or disclose medical information about you to an entity  assisting in a disaster relief effort so that your family member, other  relative, or close personal friend can be notified about your condition,  status, and location.


As Required by Law.  We may use or disclose medical information about you when we are required  to do so by federal, state, or local law.


Public Health Activities. We may disclose medical information about you for public health activities  and purposes. These activities generally include the following:

• to prevent or control disease, injury or disability;

• to report births and deaths;

• to report child abuse or neglect;

• to report reactions to medications or problems with products;

• to notify people of recalls of products they may be using;

• to notify a person who  may have been exposed to a disease or may be at risk for contracting  or spreading a disease or condition.


Reporting Victims of Abuse, Neglect or Domestic Violence. We may disclose medical information about you to notify an appropriate  government authority if we believe you are a victim of abuse, neglect,  or domestic violence. We will only make this disclosure if you agree  or when required or authorized by law.


Health Oversight Activities. We may disclose medical information to a health oversight agency for  activities authorized by law. These oversight activities include, for  example, audits, investigations, inspections, licensure or disciplinary  actions. These activities are necessary for the government to monitor  the health care system, government programs, and compliance with civil  rights laws.


Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical  information about you in response to a court or administrative order.  We may also disclose medical information about you in response to a  subpoena, discovery request, or other lawful process by someone else  involved in the dispute, but only if efforts have been made to tell  you about the request or to obtain an order protecting the information  requested.


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 an actual or suspected victim of a crime and that person agrees to   the disclosure. If we are unable to obtain that person’s agreement, in limited circumstances, the information may still be   disclosed.
  • About a death we believe may be the result   of criminal conduct;
  • About criminal conduct at the Hospital; and
  • In emergency circumstances   to report a crime; the location of the crime or victims; or the identity,   description, or location    of the person who committed   the crime.


Coroners, Medical Examiners, and Funeral Directors. We may release medical information to a coroner or medical examiner.  This may be necessary, for example, to identify a deceased person or  determine the cause of death. We may also release medical information  about patients of the Hospital to funeral directors as necessary to  carry out their duties.


Organ, Eye or Tissue Donation. If you are an organ donor, we may release medical information to organizations  that handle organ procurement or organ, eye or tissue transplantation  or to an organ donation bank, as necessary to facilitate organ or tissue  donation and transplantation.


To Avert Serious Threat to Health or Safety. We may use and disclose medical information 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. Any disclosure, however,  would only be to someone able to help prevent the threat.


Military. If you are a member of 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.


National Security and Intelligence. We may release medical information about you to authorized federal  officials for the conduct of intelligence, counter-intelligence, and  other national security activities authorized by law.


Protective Services for the President and Others. We may disclose medical information about you to authorized federal  officials to provide protection to the President of the United States,  certain other federal officials, or foreign heads of state.


Security Clearances. We may use your medical information to make decisions regarding your  medical suitability for a security clearance or service abroad. We may  also release your medical suitability determination to the officials  in the Department of State who need access to that information for these  purposes


Inmates, Persons in Custody.  If you are an inmate of a correctional institution or under  the custody of a law enforcement official, we may release medical information  about you to the correctional institution or law enforcement official.  This release would be necessary (1) for the institution to provide you  with health care; (2) to protect your health and safety or the health  and safety of others, or (3) for the safety and security of the correctional  institution.


Workers Compensation. We may release medical information about you for workers’ compensation  or similar programs. These programs provide benefits for work-related  injuries or illness.


Business Associates. Certain aspects and components of our services are performed through  contracts with outside persons or organizations. At times it may be  necessary for us to provide certain elements of your medical information  to one or more of these outside persons or organizations.


Research. Under certain circumstances, we may use and disclose your medical  information 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.  All research projects, however, are subject to a special approval process.  This process evaluates a proposed research project and its use of medical  information, trying to balance the research needs with patients’ need  for privacy of their medical information. Before we use or disclose  medical information for research, the project will have been approved  through this research approval process, but we may, however, disclose  your medical information to people preparing to conduct a research project,  for example, to help them look for patients with specific medical needs,  so long as the medical information review is not removed from the Hospital.  We will almost always ask for your specific permission if the researcher  will have access to your name, address, or other information that reveals  who you are, or will be involved in your care at Hospital.


Health Related Benefits and Services. We may use and disclose medical information about you to tell you  about health-related benefits and services that may be of interest to  you.

Other Uses and Disclosures  based upon youR authorization:

Disclosures will be made only with your written authorization such  as marketing, sale of medical information, psychotherapy notes, and  other uses and disclosures not described in the Notice of Privacy Practices.  You may revoke such an authorization at any time by notifying the Privacy  Officer of the Hospital (see last page for contact details of the Privacy  Officer), in writing of your desire to revoke it. However, if you revoke  such an authorization, it will not have any affect on actions taken  by us in reliance on it.


How We Will Contact You:

Unless you tell us otherwise in writing, we may contact you by either  telephone or by mail at either your home or your office. At either location,  we may leave messages for you on the answering machine or voice mail.  If you want to request that we communicate to you in a certain way or at a certain location, see “Right  to Request Confidential Communications” section of this Notice.



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


Right to Inspect and Copy. You have the right to inspect and copy 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, you must submit your request in writing  to the Privacy Officer of the Hospital). If you request a copy of the  information, there will be a reasonable fee for the costs of copying  and other supplies associated with your request.


We will act on your request  within thirty (30) days after we receive your request. If we grant your  request, in whole or in part, we will inform you of our acceptance of  your request and provide access and copying. Upon completion of transfer to an electronic health  record system at Lawrence Memorial Hospital, an individual can request  to receive medical information in an electronic format.


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 an Electronic Copy of Electronic Medical Records. If your medical information is maintained in an electronic format  (known as an electronic medical record or an electronic health record),  you have the right to request that an electronic copy of your record  be given to you or transmitted to another individual or entity. We will  make every effort to provide access to your medical information in the  form or format you request, if it is readily producible in such form  or format. If the medical information is not readily producible in the  form or format you request, your record will be provided in either our  standard electronic format; or if you do not want this form or format,  a readable hard copy form. We may charge you a reasonable, cost−based  fee for the labor associated with transmitting the electronic medical  record.



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 this  right for so long as we maintain the medical information. To request  an amendment, your request must be made in writing and submitted to  the Privacy Officer of the Hospital. Your request must state the amendment  desired and provide a reason in support of that amendment.


We will act on your request within thirty (30) days after we receive  your request. If we grant the request, we will make the appropriate  amendment to the medical information by appending or otherwise providing  a link to the amendment. We will also inform the entities authorized by  you to receive a copy of the amendment.


We may deny your request for an amendment if it is not in writing  or does not include a reason to support the request. If we deny your request for this or other reasons, we will inform  you of the basis for the denial. You will have the right to submit a  statement of disagreement with our denial. We may prepare a rebuttal  to that statement. All of this will then be included with any subsequent  disclosure of the information, or, at our election, we may include a  summary of any of that information.


If you do not submit a statement of disagreement, you may ask that  we include your request for amendment and our denial with any future  disclosures of the information. We will include your request for amendment and our denial  (or a summary of that information) with any subsequent disclosure of  the medical information involved. You also will have the right to complain  about our denial of your request.


Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures”,  that is, the disclosures we made of medical information about you. The  accounting may be for up to six (6) years prior to the date on which  you request the accounting. Under certain circumstances your right to  an accounting of disclosures may be suspended for disclosures to a health  oversight agency or law enforcement official.


To request an accounting of disclosures, you must submit your request  in writing to the Privacy Officer of the Hospital. Usually, we will act on your request  within sixty (60) days after we receive your request. Within that time,  we will either provide the accounting of disclosures to you or give  you a written statement of when we will provide the accounting and why  the delay is necessary.


The first list you request  within a twelve (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 the 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. You also have the right to request that we restrict  the uses or disclosures we make to: (a) a family member, other relative,  a close personal friend or any other person identified by you; or, (b)  to public or private entities for disaster relief efforts. For example,  you could ask that we not use or disclose information about a surgery  you had to your brother or sister.


To request restrictions, you must make your request in writing to  the Privacy Officer of the Hospital. 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; and (3) to whom you want the limits to  apply, for example, disclosures to your spouse.


We are not required to agree to any such requested restriction. However, if we do agree, we will follow that restriction unless the  information is needed to provide emergency treatment. Even if we agree  to a restriction, either you or we can later terminate the restriction.


Out-of-Pocket Payments.  If you paid out−of−pocket (or in other words, you have  requested that we not bill your health plan) in full for a specific  item or service, you have the right to ask that your medical information  with respect to that item or service not be disclosed to a health plan  for purposes of payment or health care operations, and we will honor  that request, unless we are required by law to make the disclosure.


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. If you want to request  confidential communication, you must do so in writing to the Privacy  Officer of the Hospital. Your request must state how or where you wish  to be contacted. We will accommodate all reasonable requests.


Right to Notification in the Event of a Breach.  You will be contacted in writing in the event a breach of  your medical information occurs, unless there is a low probability that  the medical information has been compromised based upon a risk assessment.


Right to a Paper Copy of This Notice. You have the right to a paper copy of our Notice of Privacy Practices.  To obtain a paper copy of this notice, contact the Privacy Officer.


You may also obtain a copy of this notice at our website, www.lawrencehealth.net.


Our Right to Change Notice of Privacy Practices. We reserve the right to change this notice. We reserve the right to  make the revised or changed notice effective for medical information  we already have about you as well as any information we receive in the  future. We will post a copy of the current notice in the Hospital. .  In addition, each time you register at or are admitted to the Hospital  for treatment or health care services as an inpatient or outpatient,  we will make available upon request a copy of the current Notice in  effect.


Complaints. You may complain to us and to the Secretary of Health and Human Services  if you believe your privacy rights have been violated by us. You may  submit a complaint to us, in writing, to Darlene Glass, RHIT, Health  Information Management Director, (870) 886-1243, (870) 886-5534 (fax),  1309 West Main, PO Box 839, Walnut Ridge, AR 72476.


To file a complaint with the Secretary of Health and Human Services, send your complaint  to him or her in care of: Office for Civil Rights, U.S. Department of  Health and Human Services, 200 Independence Avenue SW, Washington, D.C.  20201.

You will not be penalized for filing a complaint.


Questions and Information. If you have any questions or want more information concerning this  Notice of Privacy Practices, please contact the Privacy Officer.

Contact details of the  Privacy Officer

Darlene Glass, RHIT, Health Information Management Director, (870) 886-1243, (870)  886-5534 (fax), 1309 West Main, PO Box 839, Walnut Ridge, AR 72476.

Contact details of the  Health Information Management Department

Health Information Management, (870) 886-1243, (870) 886-5534 (fax), 1309 West Main, PO Box 839, Walnut Ridge,  AR 72476.

Lawrence Memorial Hospital and Lawrence Hall Nursing Center