Understanding Your Health Record/Information:  Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made.  Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment.  It may also contain correspondence and other administrative documents.  All of this information, often referred to as your health or medical record, serves as a:

• basis for planning your care and treatment
• means of communication among the many health professionals who contribute to your care
• legal document describing the care you received
• 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 charged with improving the health of the nation
• a source of data for facility planning and marketing
• a tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

Your Health Information Rights:  Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you.  You have the right to:

• inspect and obtain a printed or electronic copy of your health record as contained in the designated record set as provided in R.S. 40:1299.96 and 45 CFR 164.524. To do that, you must present your request in writing to Specialists Hospital Shreveport, Attn: SHS HIM director, 1400 Line AVE Shreveport, LA 71101, or him@spechosp.com.   Exceptions include psychotherapy notes or certain other information that may be contained in the designated record set. This organization may deny a request under certain circumstances.
• request that your health information be amended when you believe it is incorrect or incomplete as provided in 45 CFR 164.528. To do that, you must present your request in writing to Specialists Hospital Shreveport, Attn: SHS HIM director, 1400 Line AVE Shreveport, LA 71101, or him@spechosp.com. “Amend” is defined as the patient’s right to add to (or append) information with which he/she disagrees and does not include deleting or removing or otherwise changing the content of the record. This organization may deny a patient’s request for amendment under certain circumstances.
• request a restriction on certain uses and disclosures of your information as provided in 45 CFR 164.522. In addition, you have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. To do that, ask the front office receptionist for a form to complete at the time of your office visit and return it to them or mail your written request to Specialists Hospital Shreveport, Attn: SHS HIM director, 1400 Line AVE, Shreveport, LA 71101, or him@spechosp.com.   All requests must be in writing. We are not required to agree to those restrictions.
• be notified following a breach of unsecured protected health information in the event that you are affected.
• restrict certain disclosures of protected health information to a health plan where the individual pays out of pocket in full for the health care item or service.
• opt out of receiving such communications, if a covered entity intends to contact an individual to raise funds for the covered entity.
• obtain a paper copy of the Notice of Privacy Practices upon request. This notice will be available at the registration desk.  This notice will also be maintained on our website.
• obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528. To do that, you must present your request in writing to, Specialists Hospital Shreveport, Attn: SHS HIM director, 1400 Line AVE Shreveport, LA 71101 or him@spechosp.com .
• request communications of your health information by alternative means or at alternative locations as provided in 45 CFR 164.522. To do that, ask the front office receptionist for a form to complete at the time of your office visit and return it to them or mail your written request to Specialists Hospital Shreveport, Attn: HIM director,1400 Line AVE Shreveport, LA 71101 or him@spechosp.com. This organization will want to receive a request for confidential communications that is reasonable for alternative means of communication.
• revoke your authorization to use or disclose health information except to the extent that action has already been taken. To do that, you must present your request in writing to Specialists Hospital Shreveport, Attn: SHS HIM director, 1400 Line AVE Shreveport, LA 71101 or him@spechosp.com. An authorization may be revoked at any time.

Our Responsibilities:  This organization 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 are required to notify you if your protected health information has been breached.  A breach occurs when there has been an unauthorized use or disclosure under HIPAA that compromises the privacy or security of protected health information.  The notification requirements under this section apply unless we can demonstrate that there is a low probability that your protected health information has been compromised.  The notice will contain the following information: (1) a brief description of what happened, including the date of the breach and the date of the discovery of the breach; (2) the steps you should take to protect yourself from potential harm resulting from the breach; and (3) a brief description of what we are doing to investigate the breach, mitigate losses, and to protect against further breaches. Not every impermissible use or disclosure of protected health information constitutes a reportable breach. The determination of whether an impermissible breach is reportable hinges on whether there is more than a low probability that your protected health information has been compromised.

We will not use or disclose your health information without your consent or authorization except as provided by law or described in this notice.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain.  Should our information practices change, we will make the new version available to you upon request.

For More Information or to Report a Problem:  You may call our Privacy Officer at (318) 213-3749 or write to Specialists Hospital Shreveport, Attn:  HIM director, 1400 Line AVE Shreveport, LA 71101 or him@spechosp.com.   If you believe your privacy rights have been violated, you can file a complaint with the Practice Administrator or with the Secretary of Health and Human Services.  There will be no retaliation for filing a complaint.

Examples of Disclosures for Treatment, Payment and Health Operations:  Pursuant to law and the consent form which you have signed:

We will use your health information for treatment.  For example: Information obtained by a nurse, physician, or other 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 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 in treating you once you have been discharged.

We will use your health information for payment.  For example: A bill may be sent to you or a third-party payer.  The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.  In the event that payment is not made, we may also provide limited information to collection agencies, attorneys, credit reporting agencies and other organizations as are necessary to collect for services rendered.

We will use your health information for regular health operations.  For example: Members of the medical staff and practice management 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.

Other permitted uses and disclosures:

Required by law:  As required by law, we may use and disclose your health information.

With your authorization:  We can release your health information to anyone who has your written permission.

Business associates:  There are some services provided in our organization through contracts with business associates.  Examples include diagnostical testing, certain laboratory tests, collection agencies, and a copy service we use when making copies of your health record.  When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we have asked them to do and bill you or your third-party payer for services rendered.  To protect your health information, however, we require the business associate to appropriately safeguard your information.

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 general condition.

Communication with family:  Health professionals, using their best judgment, may disclose to a family member, other 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 insure the privacy of your health information.

Judicial and administrative proceedings:  We may disclose your health information in the course of any administrative or judicial proceeding.

Deceased person information:  We may disclose your health information to coroners, medical examiners and funeral directors.

Public safety:  We may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.

Specialized government functions:  We may disclose your health information for military, national security, and protective services purposes.

Organ procurement organizations:  Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Other healthcare services:  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.

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, or replacement.

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.

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 certain health information for law enforcement purposes as required by law or in response to a valid subpoena.

Change of ownership:  In the event that this organization is sold or merged with another organization, your health information will become the property of the new owner.

Other disclosures:  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 workforce 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.

Fundraising Activities:  We may use health information about you to contact you in an effort to raise money as part of a fundraising effort. We may disclose health information to a foundation related to the Facility so that the foundation may contact you in raising money for the Facility.

Marketing:  We may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

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

Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of federal privacy and security regulations.

Disclosures Requiring Your Authorization:

Uses and disclosures of your protected health information, other than those set forth above, will be made only with your written authorization, unless otherwise permitted or required by law as described in this Notice. You may revoke this authorization, at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.  The types of disclosures which require your authorization include: 1) release of psychotherapy notes except for treatment, payment or healthcare operations purposes; 2) marketing activities that are subsidized or for which we receive any remuneration; and, 3) sale of protected health information.

Eff: 8/2013; Rev 12/2016, 11/2017