This notice describes how medical information about you may be used and disclosed and how you can get access to this information. It has been developed to protect patient’s rights under the Health Insurance Portability & Accountability Act (HIPAA). Please view it carefully.

This notice describes our hospital’s practice and that of:

• any healthcare professional authorized to enter information into your hospital chart
• 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

Our Pledge Regarding Medical Information:

We understand that medical information about you and health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the hospital. We need this record to provide you with quality care and comply with certain legal requirements. This notice applies to all of the records of your care generated by the hospital, whether made by the hospital personnel or your personal doctor or other practitioners involved in your care. 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.

This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and obligations we have regarding the use and disclosure of medical information.
 

We are required by law to:

• make sure the medical information that identifies you is kept private;
• give you this notice for 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

The following categories describe the different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try and 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, healthcare students, clergy, or others who are involved in your care. 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. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. 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 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 or others we or your physician uses to provide services that are part of your care.
• For Payment. We may use and disclose medical information about you so that the treatment and services you receive at the hospital may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about the therapy you received at the hospital so your health plan will pay us or reimburse you for the therapy. We may also tell your health plan about a treatment you are going 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 staff in caring for you. We may also combine medical information about many hospital patients to decide what additional services the hospital should offer, what services are not needed, and whether certain treatments are effective. We may also disclose information to doctors, nurses, technicians, healthcare students, and other hospital personnel for review and learning purposes.
• Appointment Reminder- We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the hospital.
• Treatment Alternatives- We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
• Health Related Benefits and Services- We may use and disclose medical information to tell you about health related benefits, services, or medical education classes that may be of interest to you.
• Individuals Involved In Your Care or Payment For Your Care- We may release medical information about you to a caregiver who may be a friend or family member. We may also give information to someone who helps pay for your care.
• Facility Directory. We may use or disclose limited information about you in our hospital directory while you are a patient at our facility. This information may include your name, your assigned patient unit and room number, your religious affiliation, and a general description of your condition. Your religious affiliation may be given to a member of the clergy. The directory information, except for religious affiliation, may be given to people who ask for you by name.
• Organ and 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 tissue donation and transplantation.
• Research- Under certain circumstances, we may use and disclose medical information about you 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. We will 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 the hospital.
• To Avert A Serious Threat to Health or Safety. We may use or 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.
• 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 medical facility to funeral directors as necessary to carry out their duties.
• 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 the victim of a crime if, under limited circumstances, we are unable to obtain the person’s agreement;
• About a death we believe may be the result of criminal conduct;
• About criminal conduct at the medical center;
• 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.

• As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law.
• Marketing and Fundraising. We may contact you to raise money for the hospital. We may disclose your name, address, phone number, next of kin, and dates for which you received hospital services to a foundation, which is working for the hospital, so the foundation may contact you on behalf of the hospital.
• 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, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights.
   

You have the following rights regarding medical information 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.

To inspect and copy medical information that may be used to make decisions about you, you may submit your request in writing to Mends Medical Record Department or call +234 8033112061, 8054483201.

We may deny your request to inspect and copy in certain and very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. The person conducting the review will not be the person who denied the request.

Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask to amend the information.

To request an amendment, your request must be made in writing. Submit your request in writing to Mends Medical Record Department or call +234 8033112061, 8054483201. 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 the reasons to support the request. In addition, we may deny your request if you ask 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; or
• is accurate and complete.

Right To An Accounting Of Disclosure. You have the right to request an accounting of disclosure. This is a list of the disclosures we made of medical information about you.

To request this list or accounting of disclosures, you may submit your request in writing to Mends Medical Record Department or call +234 8033112061, 8054483201. Your request must state a time period which may not be longer than six years.

Right to Request Restrictions. You have the right to request a restriction on or limitation on the medical information that we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment of your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.

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.

To request restrictions, you must make your request in writing to Mends Medical Record Department or call +234 8033112061, 8054483201. We will not ask you for the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Changes to This Notice. 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. The effective date of the notice will be indicated on the first page of the notice. In addition, each time you register or are readmitted to the hospital for treatment or health care services as inpatient or outpatient, we will offer you a copy of the current notice in effect.

Complaints. If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with the hospital, contact Mends Privacy Officer or call +234 8033112061, 8054483201. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Other Uses of Medical Information. Other uses and disclosure of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke that permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care we provide to you.

If you have any questions about this notice, please contact us at +234 8033112061, 8054483201.