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 information
is provided in accordance with new Federal regulations described in R.S.
40:1299.96,45 CFR 164.524 and 45 CFR 164.528.
If you have any questions about this Notice, please
contact our Privacy Officer, Suzonne
Bourque, at 318-871-3106, or by email at email@example.com.
Health Records and Information
Every time you visit a hospital, physician or other health care
provider, a record of your visit is made containing essential information regarding
your care and treatment. Typically, these records contain the reasons for your
visit, examination and test results, your medical history, diagnoses,
treatments, your plan of care and the ultimate disposition of your case. All of
this information is usually referred to as your "Medical Records". Your Medical Records essentially serve as a:
- Basis for
planning your care and treatment
- Means of
communication to the many health care professionals involved in your care
- Legal document
describing the care provided and needed in the future
- Source of
information required for use by public health officials to assess the
health care policies and providers in the State
- Source of data
for internal use and planning for the hospital to assess its performance
planning for future services needs
- Source of data
and statistics for use in medical research
Ownership of Medical
By law, hospitals, physicians and
health care providers own the medical records they create and are held
responsible for their storage and safekeeping in accordance with applicable
State laws. While you have specific rights to the access and release of
information concerning your personal medical records, you do not own them.
While your actual medical record is the physical property of the
facility or practitioner who created the record, you have rights to the access
and release of such information as follows:
- To inspect and
obtain a personal copy of your health record. To do so, you will be
required to complete and sign an " Authorization to Release Medical
Information" form and pay the cost of copying or sending the records
- Request that your health records be amended when you
believe the information contained therein is incorrect or incomplete. Again, to do so you must complete and sign a
"Request to Amend or Correct
a Medical Record" form. Please note that if your physician or health care
with your request, they are not required to comply, but you may have your own statement
included as a part of the record.
Request a restriction on certain uses and disclosures of
information in your medical record that
identify you by name, although DRHS may not be legally required to agree with
To make such a request. You may complete and sign a "Request for
Obtain a copy of this "Notice of Health Information
Obtain a an accounting of disclosures of you health
information. To do so, you are required to
complete and sign a "Request for Disclosures of Health Information"
Request that copies of your medical records be sent to
another health care provider. To do so,
you must complete and sign an
"Authorization to Release Medical Information" form, specifying the
name of the health care facility or practitioner. Customarily, there is no
charge for complying with such requests, but DRHS reserves the right to assess
a charge in specific cases.
- Revoke your authorization to release medical
information or copies of records, to the extent that
DRHS has not already complied with the original authorization. To do so,
you must complete
and sign a "Revocation of Consent to Release Health Information"
form specifying the nature
and extent of the revocation.
and Powers of Attorney
DRHS will release
health information and/on minors to parents and legal guardians only. DRHS will
also honor requests for information from third parties who may be authorized by
a properly executed Power of Attorney or from legal guardians duly appointed a
court of competent jurisdiction.
Health System Responsibilities
DRHS is required by
- Maintain the privacy of your health
- Provide you with notice of its legal
duties and obligations regarding information collected and
about you and abide by the terms of this notice
- Notify you if we are unable to comply
with or agree to a requested restriction
- Accommodate reasonable requests to
communicate health information by alternative means or to
DRHS will not use or
disclose health information identifying you personally except as provided by
law or as described in this notice.
DRHS reserves the right to amend or revoke its policies and practices as
necessary to better effect its health information release or accommodate new
regulations and legal opinions. Copies of the amended policies will be provided
Information and Problem Reporting
If you have any questions regarding health
information policies and practices or you would like to report a problem, you
may contact our Health Information Officer at (318)872-4610. If you believe
your privacy rights have been violated, you can file a written complaint with
the Health Information Officer at DRHS, or directly with the Secretary
of Health and Human Services. There will be no retaliation for filing a
Disclosures of Treatment Payment and Health
DRHS is required to provide you with examples of how your health information
is typically used in accordance with your standard consent for treatment:
of Medical Information for Treatment
all medical and health information obtained by nurses, physicians and
other health care professionals will be recorded in your personal medical
record and used to diagnose your illness or injury, determine a course of
treatment, provide necessary and appropriate care and determine an appropriate
setting to continue your treatment and care following release from the
physician will establish a plan of care for use by your healthcare team
composed of hospital staff, and consulting physicians and specialists.
Payment by Third Party Payers
Health information required to pay for your hospital bills and charges
will be sent to third party payers and insurance carriers identified by you at
the time of admission or thereafter including Medicare or Medicaid. Such
information typically includes your personal identification, dates of admission and
discharge, diagnoses, treatment provided, procedures performed and supplies
used. This information may be
transmitted electronically, by fax or communicated verbally in order to obtain prior
authorization for admission or testing as may be required under your health
plan or insurance policy. In the event that payment is not made, DRHS may also
provided limited information to credit agencies, collection agencies and/or
attorneys to collect for services rendered.
of Information for Internal Operations
DRHS and its medical staff and its internal staff professionals serving
on a quality improvement team, may utilize information in your medical records
to generate data and statistics to assess the overall quality and
appropriateness of the care rendered at the hospital, review outcomes of
treatments, utilization of hospital resources and other programs related to the
continuous improvement of the quality and effectiveness of services provided in
our institution. Such information is protected from disclosure to any outside
Disclosure of Health Information Practices
As authorized in accordance with existing laws and regulations, DRHS
may use and disclose your health information as may be needed as follows:
Unless you specifically notify us that you object, we will allow your
religious affiliation, general condition and location in the facility
for our hospital directory.
Some of the patient care services provided in DRHS are performed
contracts with outside parties and business associates. Examples include
in the Emergency Department, hospital-based radiologists and nurse
laboratory tests and collection agencies. When these services are contracted
may disclose your health information on a need-to-know basis so they can
they've been contracted to perform. In such circumstances, the business
to maintain full confidentiality of your records under DRHS policies.
also be disclosed to emergency medical transport organizations in the event you
services during your stay at DRHS.
Information Requests and Notifications DRHS may disclose your name, location and
general condition to your families, friends and personal agents during your
hospital stay. Government and Regulatory Inquiries DRHS may disclose appropriate information
to State and Federal health care agencies in the course of audits,
investigations, inspections, licensure or related inquiries.
Judicial and Legal Proceedings Information may be disclosed to a court,
investigating agency or administrative organization in connection with a
judicial or legal proceeding, or in response to a valid subpoena.
Information may be disclosed to coroners or medical examiners on
deceased persons, or to funeral directors selected by you or your families.
Also, consistent with applicable State and Federal laws, pertinent medical
information will be disclosed to organizations engaged in the procurement,
banking or transplantation of organs or tissue for potential use by eligible
other health care facilities.
DRHS may disclose pertinent information to public safety officials
including the FDA and CDC in response to appropriate requests, in order to
prevent or lessen the effect of real or imminent threats or endangerment to the
safety of another person or the general public, initiate product recalls or
track possible contagious diseases. Moreover, information may be disclosed as deemed necessary in
response to a military or national emergency. Health Activities Unless you object, DRHS may occasionally
contact you to provide appointment reminders, follow-up on treatments performed
at our facility or notify you of health-related benefits and services that may be of
interest to you from time-to-time. Workers Compensation To the extent authorized and necessary,
information may be disclosed to agencies responsible for enforcing Workers Compensation
laws or similar programs involving reimbursement for health care services.
Law Enforcement information may
also be disclosed to appropriate law enforcement officials and agencies or in
response to a valid subpoena to cooperate with investigations into patient or
provider fraud, allegations of criminal activities or other matters involving
their areas of jurisdiction.
Changes of Ownership
In the event of a sale or merger of DRHS to another entity, ownership of your health
information will be transferred to the new owner.
Correctional Institutions Health information may be provided to
corrective institutions responsible for the care and treatment of prisoners and
Federal law makers also allow for your health information to be released
to an appropriate oversight agency, public health authority or attorney,
provided that a facility representative or business associate believes in good
faith that they are potentially engaged in unlawful conduct or in violation of
professional or clinical standards that could endanger patients, workers or the