FORREST GENERAL HOSPITAL
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Forrest General Hospital is dedicated to protecting your medical information. We are required by law to maintain the privacy of your medical information and to provide you with this notice of our legal duties and privacy practices with respect to your medical information. Forrest General Hospital is required by law to abide by the terms of this notice.
HOW YOUR MEDICAL INFORMATION WILL BE USED AND DISCLOSED:
We will use and disclose your medical information as part of rendering patient care for treatment, payment or health care operations purposes. For example, your medical information may be used by the doctor or nurse treating you, by the business office to process your payment for the services rendered and by administrative personnel reviewing the quality of the care you receive.
Forrest General Hospital participates in an electronic network for exchanging health and patient information among providers. Your health information will be included in this electronic network unless you object.
We may also use and/or disclose your medical information in accordance with federal and state laws for the following purposes:
Appointment Reminders:
- We may contact you to provide appointment reminders.
Treatment Information:
- We may contact you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Fund Raising:
- We may contact you to raise funds for the Forrest General Healthcare Foundation.
Disclosure to Department of Health and Human Services:
- We may disclose your medical information when required by the United States Department of Health and Human Services as part of an investigation or determination of our compliance with relevant laws.
Facility Directory:
- Unless you object, and with the exception of behavioral health patients, we will include your name, location in the hospital, your condition described in general terms and your religious affiliation in our directory of individuals. The directory information, except for your religious affiliation, will be released to people who ask for you by name. Your religious affiliation may be given to members of the clergy, even if they do not ask for you by name, unless you object.
Family and Friends:
- Unless you object, we may disclose your medical information to family members, other relatives or close personal friends when the medical information is directly relevant to that person’s involvement with your care.
Notification:
- Unless you object, we may use or disclose your medical information to notify a family member, a personal representative or another person responsible for your care, general condition or death.
Disaster Relief:
- We may disclose your medical information to a public or private entity, such as the American Red Cross, for the purpose of coordinating with that entity to assist in disaster relief efforts.
Public Health Activities:
- We may use or disclose your medical information for public health activities, including the reporting of disease, injury, vital events and the conduct of public health surveillance, investigation and/or intervention.
Health Oversight Activities:
- We may disclose your medical information to a health oversight agency for oversight activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions, administrative and/or legal proceedings.
Abuse or Neglect:
- We may disclose your medical information when it concerns abuse, neglect or violence to you in accordance with federal and state law.
Legal Proceedings:
- We may disclose your medical information in the course of certain judicial or administrative proceedings.
Law Enforcement:
- We may disclose your medical information for law enforcement purposes or to law enforcement officials under certain circumstances.
Coroners, Medical Examiners and Funeral Directors:
- We may disclose your medical information to a coroner, medical examiner or a funeral director.
Organ Donation:
- We may disclose your medical information to an organ procurement organization.
Research:
- We may use or disclose your medical information for certain research purposes if an Institutional Review Board or a privacy board has altered or waived individual authorization, the review is preparatory to research or the research is only on decedent’s information.
Public Safety:
- We may use or disclose your medical information to prevent or lessen a serious threat to the health or safety of another person or to the public.
Specialized Goverment Functions:
- We may disclose medical information of Armed Forces personnel to military authorities under certain circumstances. If medical information is required for lawful intelligence, counterintelligence or other national security activities, or for the provision of protective services to the President of the United States or a foreign head of state, we may disclose it to authorized federal officials.
Workers’ Compensation:
- We may disclose your medical information as authorized by laws relating to workers’ compensation or similar programs.
Business Associates:
- We may disclose your medical information to a business associate with whom we contract to provide services on our behalf. To protect your medical information, we require our business associates to appropriately safeguard the medical information of our patients.
AUTHORIZATIONS:
We will not use or disclose your medical information for any other purpose without your written authorization except as otherwise permitted or required by law. Once given, you may revoke your authorization in writing at any time except to the extent that Forrest General Hospital has taken an action in reliance on the use or disclosure as indicated in the authorization. To request a Revocation of Authorization form, you may contact: Forrest General Hospital, Health Information Management Department, P.O. Box 16389, Hattiesburg, MS, 39404 or 601-288-2900.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION:
You have the following rights with respect to your medical information:
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You may ask us to restrict certain uses and disclosures of your medical information. In most cases we are not required to agree to your request, but if we do, we will honor it. We are required to comply with requests to restrict uses and disclosures of your medical information to a health plan if the purpose for the disclosure is not related to treatment and the health care services to which the medical information applies have been paid out-of-pocket in full.
- You have the right to receive communications from us in a confidential manner.
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Generally, you may inspect and copy your medical information. This right is subject to certain specific exceptions, and you may be charged a reasonable fee for any copies of your medical information.
- You may ask us to amend your medical information. We may deny your request for certain specific reasons. If we deny your request, we will provide you with a written explanation for the denial and information regarding further rights you may have at that point.
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You have the right to receive an accounting of the disclosures of your medical information made by Forrest General Hospital during the last six years (or following April 14, 2003), except for disclosures for treatment, payment or healthcare operations, disclosures which you authorized and certain other specific disclosure types. The right to receive this information is subject to certain exceptions, restrictions and limitations.
- You may request a paper copy of this Notice of Privacy Practices.
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You have the right to complain to us and/or to the Secretary of the United States Department of Health and Human Services if you believe that we have violated your privacy rights. If you choose to file a complaint, you will not be retaliated against in any way. If you believe your privacy rights have been violated or if you would like further information regarding your rights or regarding the uses and disclosures of your medical information, please contact: Forrest General Hospital, Privacy Officer, P.O. Box 16389, Hattiesburg, MS, 39404 or 601-288-2810.
THIS NOTICE IS EFFECTIVE AS OF JULY 1, 2001.
REVISION OF NOTICE OF PRIVACY PRACTICES:
We reserve the right to change the terms of this notice, making any revision applicable to all the protected health information we maintain. If we revise the terms of this notice, we will post a revised notice at Forrest General Hospital and will make paper copies of the revised Notice of Privacy Practices available upon request.
Revised February 15, 2010
Patient Rights & Responsibilities (PDF)
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