Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please read it carefully.
WHO WILL FOLLOW THIS NOTICE
This notice describes the practices of our employees and staff as well as:
Physicians, billing companies, insurance companies, laboratories, radiologists, pathologist, and any other person, group, entity, site or location doing business with GSMC will follow this Notice. All of the individuals, entities, sites and locations may share medical information with each other for the treatment or payment of health care operations purposes described in this notice.
INFORMATION COLLECTED ABOUT YOU
In the ordinary course of receiving treatment and health care services from us, you will be providing us with personal information such as:
- Your name, address and telephone number;
- Information related to your medical history;
- Your employer, insurance information and coverage;
- Information concerning your doctor, nurse, or other medical providers;
In addition, we will gather certain medical information about you and will create a record of the care provided to you. Some information also may be provided to us by other individuals or organizations that are part of your “circle of care” such as the referring physician, your other doctors, your health plan, employer and close friends or family members.
HOW WE MAY USE AND DISCLOSE INFORMATION ABOUT YOU
We may use and disclose personal and identifiable health information about you in different ways. All of the ways in which we may use and disclose information will fall within one of the following categories but not every use or disclosure in a category will be listed.
For Treatment – We will use health information about you to furnish services and supplied to you, in accordance with our policies and procedures. For example, we will use your medical history, such as any presence or absence of heart disease, to assess your health and perform requested ultrasound or other diagnostic services.
For Payment – We will use and disclose health information about you to bill for our services and to collect payment from you or your insurance company. For example, we may need to give a payer information about your current medical condition so that it will pay us for examinations or other services that we have furnished to you. We may also need to inform your payer of the test that you are going to receive in order to obtain prior approval or to determine whether the services is covered.
For Health Care Operation – We may use and disclose information about you for the general operation of our business. For example, we sometime arrange for accreditation organizations, auditors or other consultants to review our policies and practices, evaluate our operations, and tell us how to improve our services. We may contact you to provide appointment reminders, gather pre-admission information, or provide you with information about treatment alternatives or other health related benefits and services that may be of interest to you.
For Fundraising – We my use certain information including, but not limited to: your name, address, telephone number, age, gender, insurance status, spouse name, date(s) of service or employer; to contact you in the future to raise money for Good Shepherd Medical Center. We may also provide this information to the Good Shepherd Foundation for the same purpose. The money raised will be used to expand and improve the services and programs we provide to the community.
Opt Out Clause – We protect your personal information and adhere to all legislative requirements with respect to protecting your privacy. We do not sell, trade or otherwise share our mailing lists. However, if at any time you wish to be removed from our records, simply contact us by phone at (903) 315-5294 or regular mail at the address below. Please allow 15 business days to update our records accordingly.
Public Policy Uses and Disclosures – There are a number of public policy reasons why we may disclose information about you:
- We may disclose health information about you when we are required to do so by federal, state or local law.
- We may disclose protected health information about you in connection with certain public health reporting activities. Public health authorities include state health department, the Center of Disease Control, the Food and Drug Administration, the Occupational Safety and Health Administration and the Environmental Protection Agency, to name a few.
- We are permitted to disclose protected health information to a public health authority or other government authority authorized by law to receive reports of child abuse or neglect. Additionally, we may disclose protected health information to a person subject to the Food and Drug Administration’s power of the following activities: to report adverse events, product defects or problems, or biological product deviations, to track products, to enable product recalls, repairs or replacements, or to conduct post marketing surveillance.
- We may disclose your protected health information in situations or domestic abuse or elder abuse.
- We may disclose protected health information in connection with certain health oversight activities of licensing and other agencies. Health oversight activities include audit, investigation, inspection, licensure or disciplinary actions, and civil, criminal or administrative proceedings or action or any other activity necessary for the oversight of: 1.) the health care system; 2.) governmental benefit programs for which health information is relevant to determining beneficiary eligibility; 3.) entities subject to governmental regulatory programs for which health information is necessary for determining compliance with program standards, or 4.) entities subject to civil rights laws for which health information is necessary for determining compliance.
- We may disclose information in repose to warrant, subpoena, or other order of a court or administrative hearing body, and in connection with certain government investigations and law enforcement activities.
- We may release personal health information to a coroner or medical examiner to identify a deceased person or determine the cause of death. We also may release personal health information to organ procurement organizations, transplant centers, and eye or tissue banks.
- We may release your personal health information to workers’ compensation or similar programs.
- Information about you also will be disclosed when certain personal health information about your condition and treatment for research purposes where an Institutional Review Board or a similar body referred to as a Privacy Board determines that your privacy interest will be adequately protected in the study. We may also use and disclose your protected health information to prepare or analyze a research protocol and for other research purposes.
- If you are a member of the Armed Forces, we may release personal health information about you required by military command authorities. We also may release personal health information about foreign military personnel to the appropriate foreign military authority.
- We may disclose your protected health information for legal or administrative proceedings that involve. You. We may release such information upon order of a court or administrative tribunal. We may also release protected health information in the absence of such an order and in response to a discovery or other lawful request, if efforts have been made to notify you or secure a protective order.
- If you are an inmate, we may release protected health information about you to a correctional institution where you are incarcerated or to law enforcement officials.
- Finally, we may disclose protected health information for national security and intelligence activities and for the provision of protective services to the President of the United States and other officials or foreign heads of state.
Our Business Associates – We sometimes work with outside individuals and businesses that help us operate successfully. We may disclose your health information to these business associates so that they can perform the tasks we hire them to do. Our business associates must guarantee to us that they will respect the confidentiality of your personal and identifiable health information.
Individuals Involved in Your Care or Payment for Your Care – We may disclose information to individuals involved in your care or in the payment for your care, but we will obtain your agreement before doing so. This includes people and organizations who are part of your “circle of care” such as your spouse, your other doctors, or an aide who may be providing services to you. Although we must be able to speak with your other physicians or health care providers, you can let us know if we should not speak with other individuals, such as your spouse or family.
Other Uses and Disclosures of Personal Information – We are required to obtain written authorization from you for any other uses and disclosures of medical information other than those described above. If you provide us with such permission, you may revoke that permission, in writing, at any time.
You have the right to ask for restrictions on the way in which we use and disclose your medical information beyond those imposed by law. We will consider your request, but we are not required to accept it.
You have the right to request that you receive communications containing your protected health information from us by alternative means or at alternative locations. For example, you may ask that we only contact you at home or by mail.
Except under certain circumstances, you have the right to inspect and request a copy of medical and billing records about your. If you ask for copies of this information, we may charge you a fee for copying and mailing.
If you believe that information in your record is incorrect or incomplete, you have the right to ask us to correct the existing information or correct the missing information. Under certain circumstances, we may deny your request.
You have the right to ask for a list of instances when we have used or disclosed your medical information for reasons other than your treatment, payment for services furnished to you, our health care operations, or disclosures you give us authorization to make. If you request this information more than once every twelve months, we may charge you a fee.
You have the fight to a copy of this Notice in paper form. You may ask us for a copy at any time. You may also obtain a copy of this form at our website located at www.gsmc.org.
To exercise any of your rights, please contact us in writing at:
Good Shepherd Medical Center
ATTN: Privacy Officer
Health Information Management
700 East Marshall Avenue
Longview, TX 75601
CHANGES TO THIS NOTICE
We reserve the right to make changes to this notice at any time. We reserve the right to make the revised notice effective for personal health information we have about your as well as any information we received in the future. In the event there is a material change to this Notice, the revised Notice will be posted. In addition, you may request a copy of the revised Notice at any time.
You have the right to voice complaints regarding the quality of care and services you receive and you are assured that the presentation of a complaint will in no way compromise your access to care. Whenever you are admitted to the hospital, you will be informed of your rights, including the right to state complaints. You may voice your complaints to any staff member of by calling the Guest Relations Specialist at (903) 315-2630.
You have a right to file a complaint with the Texas Department of State Health Services, 1100 West 49th Street, Austin, TX 78756-3199, Toll free 1-888-963-7111; (512) 458-7111 or contact DSHS HIPAA Project Office via Email: email@example.com regardless of whether you have first used the hospital complaint process.
If at any time during your care at Good Shepherd Medical Center you disagree with the quality of care you are receiving or disagree with premature discharge of your care, you may immediately request a Medicare beneficiary initiated Peer Review of the facts in your case. You may make this request through the hospital, or by calling 1-800-MEDICARE (1-800-633-4227) and ask for the Quality Improvement Organization (QIO) to file a complaint, or contact the Texas Medical Foundation (TMF) Health Quality Institute Helpline at 1-800-725-8315.
The Joint Commission on Accreditation of Healthcare Organizations is an independent, not for profit national body that oversees the safety and quality of healthcare and other services provided in accredited organizations. Concerns about accredited organizations may be provided directly to the Joint commission at 1-800-994-6610.
Concerns regarding accreditation and the accreditation performance on individual organizations can be obtained through the Joint Commission website at www.jointcommission.org.
PATIENT RIGHTS AND RESPONSIBILITIES
At Good Shepherd Medical Center, we respect your rights as a patient and recognize that you are an individual with unique healthcare needs. We want you to know what your rights are as a patient, as well as what your obligations are to yourself, to other patients, to your physician and to the Medical Center.
At Good Shepherd Medical Center, we encourage a partnership between you and your healthcare team. Your role as a member of this team is to exercise your rights and to take responsibility by asking for clarification of things you do not understand.
As a patient of the Medical Center, you retain all rights of Citizenship of the State of Texas and the Untied States of America, including registration and voting privileges.
You have the right to:
- Considerate and Respectful Care
- Information About Treatment
- Participate in Decisions About Your Care
- Informed Consent – You have the right to decide what may be done to your body during the course of medical treatment.
- Surrogate Decision-Maker – If you become unable to make your own health care decisions and do not have a legal guardian or someone designated under a Medical Power of Attorney, then certain family members and others can make medical treatment decisions on your behalf.
- Advance Directives
- Directive to Physicians – Also known as a living will, allows you to tell your physician not to use artificial methods to prolong the process of dying if you are terminally ill. A directive does not become effective until you have been diagnosed with a terminal or irreversible condition.
- Medical Power of Attorney – Allows you to designate someone you trust – an agent to make health care decisions on your behalf should you become unable to make these decisions yourself.
- Out-of-Hospital Do-Not-Resuscitate Order – (DNR) allows you to refuse certain life-sustaining treatments in any setting outside of a hospital. This advance directive must be issued in conjunction with your attending physician.
- Declaration of Mental health Treatment – Deals with mental health treatment issued only. It allows you to tell health care providers your choices for mental health treatment in the event you become incapacitated.
- Make an individual decision based on your personal beliefs and values as well as on the available medical information
- Privacy, and to be informed of a consent to GSMC’s Privacy Practice under HIPAA
- Continuity of Care
- If dying, you have the right to comfort and dignity, treatment of primary and secondary symptoms; effective pain management; and response to patient/family psychosocial, spiritual and cultural needs.
You, in turn, have the responsibility to:
- Provide complete medical information
- Ask for clear explanations
- Make informed decisions
- Understand your health problems if your treatment plan is to succeed
- Report changes in your health
- Follow hospital rule and regulations
If you would like more detailed information about your Rights as a Patient at Good Shepherd Medical Center, please ask a nurse, a social worker, or a registration staff member.
Hospital Policies for Implementing Patients’ Rights
Formal policies have been adopted to assure that your right to make medical treatment decisions will be honored to the extent permitted by law. This hospital has adopted policies relating to informed consent and implementation and treatment decisions under the Directive to Physicians, the Medical Power of Attorney, the Out-of-Hospital Do-Not-Resuscitate Order, and the Declaration for mental health Treatment.
Complaints concerning advance directive requirement may be filed by calling the Texas Department of State health Services 1-800-973-0022. Prepared by the Texas Hospital Association.