DESOTO REGIONAL HEALTH SYSTEM NOTICE OF HEALTH INFORMATION POLICIES

This notice explains your rights regarding access and release of medical information regarding your care and treatment at DeSoto Regional Health System (DRHS). 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.

Understanding Your 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 and treatment

• Legal document describing the care provided and needed in the future

• Source of information required for use by public health officials to assess the effectiveness of health care policies and providers in the State

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.

Your Health Information Rights

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:

• 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 professional disagrees 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 would identify you by name, although DRHS may not be legally required to agree with such restrictions. To make such a request. You may complete and sign a "Request for Additional Privacy Protection" form.

• Obtain a copy of this "Notice of Health Information Policies" statement.

• 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" form.

• 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.

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.

DeSoto Regional Health System Responsibilities

DRHS is required by law to:

• Maintain the privacy of your health information

• Provide you with notice of its legal duties and obligations regarding information collected and maintained 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 alternative locations

• 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 upon request.

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 complaint.

Disclosures of Treatment Payment and Health Operations

DRHS is required to provide you with examples of how your health information is typically used in accordance with your standard consent for treatment:

1. Use 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 hospital. Your physician will establish a plan of care for use by your healthcare team composed of hospital staff, and consulting physicians and specialists.

2. For 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.

3. Use 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 parties.

Notice and 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:

Directories: Unless you specifically notify us that you object, we will allow your name, religious affiliation, general condition and location in the facility for our hospital directory.

Business Associates: Some of the patient care services provided in DRHS are performed through contracts with outside parties and business associates. Examples include physician coverage in the Emergency Department, hospital-based radiologists and nurse anesthetists, specialized laboratory tests and collection agencies. When these services are contracted out, DRHS may disclose your health information on a need-to-know basis so they can accomplish the tasks they've been contracted to perform. In such circumstances, the business associates are required to maintain full confidentiality of your records under DRHS policies. Information may also be disclosed to emergency medical transport organizations in the event you may require such 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.

Deaths   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 patients in other health care facilities.

Public Safety 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 inmates.

Other Disclosures 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 public.