Joint Notice of Privacy Practices

Arkansas Children's Hospital
University of Arkansas for Medical Sciences
ACH Medical Staff

En Espaņol

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.

This Notice is provided on behalf of Arkansas Children’s Hospital (ACH) and the University of Arkansas Medical Sciences (UAMS) and the members of the ACH Medical Staff.

We understand that medical information about you and your health is personal, and we are committed to protecting medical information about you. We create a record of the care and services you receive at ACH hospital and clinics. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we may use and disclose protected health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of protected health information.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes permitted or required by law. “Protected health information” is information about you or your minor child, including demographic data such as name, address, phone numbers, etc., that may identify you and that relates to your past, present or future physical or mental health and related health care services.

We are required to give you this notice and to maintain the privacy of protected health information. We must abide by this Notice, but we reserve the right to change the privacy practices described in it. This Notice may be accessed on the ACH web page. Revised Notices will be posted in waiting rooms. You may receive a revised copy by sending a written request to the ACH Privacy Officer, Department of Regulatory Affairs, Arkansas Children's Hospital, 800 Marshall Street, Little Rock, AR 72202.

You may complain to us or to the U.S. Secretary of Health and Human Services if you believe your privacy rights have been violated. To file a complaint with us, you must send a letter describing the violation to the ACH Privacy Officer. There will be no retaliation for filing a complaint.

If you have questions or need more information, contact the ACH Privacy Officer at 501-364-4368.

This Notice applies at all ACH clinics, departments and units.

WHO WILL FOLLOW THIS NOTICE? This Notice describes the practices of:

ACH healthcare professionals authorized to enter information into your records.

ACH employees, ACH medical staff, volunteers and other ACH or clinic personnel.

UAMS doctors, UAMS nurses, and other UAMS employees who work or provide healthcare services on the ACH campus.

Students-in-training on the ACH campus.

Your Rights. You have the following rights relating to your protected health information.

You May:

• Request a restriction on certain uses and disclosures of your information, but we are not required to agree to your restrictions. Your restriction request must be in writing.
• Obtain a paper copy of this Notice.
• Inspect and get a copy of records used to make decisions about you. You will be charged a fee for the cost of copying, mailing or other supplies. In some situations, we are allowed to deny this request. In some situations you may ask for a review of this denial by a licensed healthcare professional who was not involved in the denial decision. We will comply with the outcome of this review.
  
• Request that we amend your record if you feel the information is incomplete or incorrect; however, we are allowed to deny this request in certain circumstances. We may ask you to put these requests for amendments in writing and provide a reason that supports your request.
  
• Obtain a record of certain disclosures of your protected health information.
  
• Make a reasonable request to receive confidential communications of your protected health information from us by alternative means or at alternative locations.
• Revoke your authorization to use or disclose protected health information except to the extent that action has already been taken.

To inspect or obtain a copy of your records, send a written request to the Director of the ACH Medical Records Department. All other requests must be sent to the ACH Privacy Officer, Department of Regulatory Affairs.

Our Responsibilities. We are required to protect the privacy of your protected health information, abide by the terms of this Notice, make this Notice available to you, and notify you if we are unable to agree to a requested restriction or an alternative means of communicating.

Examples of Uses & Disclosures

We will use your protected health information for treatment. Information obtained by a nurse, doctor, etc. will be put into the record and used to plan and manage your treatment. They will record their actions and their observations so they will know how you are responding to treatment. We may provide reports or other information to your physician or others who will be involved in your care when you leave ACH.

We will use your protected health information for payment. A bill will be sent to you and/or your insurance company with information about your diagnosis, procedures and supplies used.

We will use your protected health information for regular healthcare operations. The Medical Staff and other healthcare workers may use your protected health information to check on the care you received, how you responded to it, and for other business purposes related to operating the hospital or clinic. Also, we will share your protected health information as may be necessary to carry out the routine business functions.

Business Associates. We may share some of your protected health information with outside people or companies who provide services for us, such as typing physician reports.

Directory: We will use and disclose your name, location in the facility, general condition and religious affiliation (shared only with the clergy) in a directory unless you tell us not to include you. All of this information, except religious affiliation, will only be given out to people that ask for the patient by name.

Notification. We may use or disclose protected health information to notify a family member or other person involved in your care your location and general condition unless you tell us not to do so.

Communication with family: A doctor, nurse or other healthcare worker may share protected health information with a family member, a close personal friend, or a person that you identify, if they are involved in your care or in payment for your care, unless you tell us not to do so.

Research. Our researchers may use your protected health information after they receive approval from our special review board whose members review and approve the research project.

Coroners, Medical Examiners, Funeral Directors. The law allows us to disclose protected health information to these people so that they may carry out their duties.

Organ Donor Organizations. If you are an organ donor, we must share your protected health information with the organ donation agency for the purpose of tissue or organ donation or as we are required to do so.

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

Fundraising: Our Foundation may contact you.

Food and Drug Administration (FDA): We may share your protected health information with certain government agencies like the FDA so they can recall drugs or equipment.

Workers Compensation: We may disclose your protected health information for workers' compensation claims.

Public Health: We may give your protected health information to public health agencies who are charged with preventing or controlling disease, injury or disability or as required by law.

Communicable Disease: We may disclose protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Correctional Institution: If you are an inmate of a correctional institution, we may disclose protected health information needed for your health or the health and safety of others.

Law Enforcement: We may disclose protected health information for law enforcement purposes as required by law.

As Required by Law: We must disclose protected health information about you when required by federal, state or local law.

Health Oversight: We must disclose information to a health oversight agency for activities authorized by law, for example investigations and inspections. Oversight agencies are those that oversee the health care system, government benefit programs, such as Medicaid, and other government regulatory programs.

Abuse or Neglect: We must disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect.

Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to a court order, if authorized, and in certain conditions in response to a subpoena, discovery request or other lawful process.

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

To Avoid Harm: We may use and disclose information about you when necessary to prevent a serious threat to your health or safety of the health or safety of the public or another person.

For Specific Government Functions: In certain situations, we may disclose protected health information of military personnel and veterans. We may disclose protected health information for national security activities required by law.

OTHER USES OF MEDICAL INFORMATION

Use and sharing of medical information not covered by this Notice or the laws that apply to use will be made only with your written permission. At any time you may cancel this permission, but you must put this in writing. If you cancel this permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization unless we are required to do so by law. We are unable to take back any disclosures we have already made.

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