Notice of Privacy Practice
This Notice describes how medical information about you may be used and disclosed by Thibodaux Regional Medical Center and how you can get access to this information. Please review it carefully.
Click here to open a PDF copy of this Notice.
Who Will Follow This Notice
This notice describes Thibodaux Regional Medical Center’s practices and that of:
- Any health care professional authorized to enter information into your medical record at Thibodaux Regional Medical Center
- 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
- Paincourtville Clinic and the Pierre Part Clinic.
In addition, these entities, sites and locations may share medical information with each other for treatment, payment or hospital operations purposes described in this Notice.
Understanding Your Health Record/Information
Each time you visit a hospital, physician, or other health care provider, a record of your visit is made. Typically, this record contains identifying information, information about your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, may serve 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 (such as an insurance company) can verify that services billed were actually provided
- Tool in educating health professionals
- Source of data for medical research
- Source of information for public health officials who oversee the delivery of health care in the United States
- Source of data for hospital planning and marketing
- Tool with which Thibodaux Regional Medical Center can assess and continually work to improve the care we render and the outcomes our patients achieve.
Understanding what is in your medical record and how your health information is used helps you to:
- Ensure its accuracy
- Better understand who, what, when, where, and why others may access your health information
- Make more informed decisions when authorizing disclosure of your health information to others.
Your Health Information Rights
Although your medical record is the physical property of Thibodaux Regional Medical Center, the information belongs to you. You have the right to:
Right to Request Restrictions: You have the right to request a restriction on certain uses and disclosures of your information for treatment, payment, or health care operations. You may also request restrictions on information about you that we may disclose to persons involved in your care or in payment for your care, such as family members, close friends or other persons designated by you.
To request restrictions, you must make your request in writing to the Health Information Management Director at the following address: 602 North Acadia Road, Thibodaux, LA 70301. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
Although we will consider your request, please be aware that we are under no obligation to agree to it or to abide by it. In an emergency situation, however, we may use or disclose the restricted information if it is needed to provide care to you.
Right to a Paper Copy of This Notice: You have the right to obtain a paper copy of this Notice of Privacy Practices upon request, even if you have agreed to receive this notice electronically. The request should be in writing and made to the Health Information Management Director.
Right to Inspect and Copy: You have the right of reasonable access to inspect and obtain a copy of your health information. If you provide a written request for a copy of your health information, Thibodaux Regional Medical Center will charge a fee for the costs of copying, mailing and other supplies associated with your request and in most cases, provide you with the copy within 15 days of your request. If you request a summary of your health information, Thibodaux Regional Medical Center may also charge you the cost of preparing the summary.
Thibodaux Regional Medical Center may deny your request to inspect and copy your health information in certain very limited circumstances and for certain types of information, such as psychotherapy notes. If you are denied access to certain types of health information, you may request that the denial be reviewed.
Right to Amend: You have the right to request an amendment to your health information. The request must be made in writing and submitted to the Health Information Management Director. In addition, your written request must provide a reason that supports your request.
Thibodaux Regional Medical Center may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by Thibodaux Regional Medical Center, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the medical record 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 Disclosures: You have the right to request an accounting of disclosures of your health information. An accounting is a list of disclosures we have made of your health information to others.
To request this list or accounting of disclosures, you must submit your request in writing to the Health Information Management Director. Your request must state a time period for the accounting, which may not be longer than six years and may not include dates before April 14, 2003. Please note that we are not required to provide you with an accounting of the following types of disclosures:
- Disclosures made for reasons of treatment, payment or health care operations
- Disclosures made to you or your legal representative, or any other individual involved with your care
- Disclosures made with your authorization
- Disclosures to correctional institutions or law enforcement officials
- Disclosures for national security purposes.
The first accounting you request within a 12-month period will be free. However, for any additional requests, you will be charged for the costs of providing the accounting.
Right to Request Confidential Communications: You have the right to request communications of your health information by alternative means or at alternative locations. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must submit your request in writing to the Health Information Management Director. Your request must specify how or where you wish to be contacted. We will not ask you the reason for the request. We will try to accommodate all reasonable requests.
Right to Revoke an Authorization: You have the right to revoke your authorization to allow us to use or disclose health information (not for treatment, payment, or healthcare operations). Such a request must be made in writing. The revocation will be effective for any future uses or disclosures of your health information, but will not affect any uses or disclosures that we have already made in reliance upon your authorization before it was revoked.
An authorization may not be revoked if it was obtained as a condition of obtaining insurance coverage or a law provides your insurer the right to contest a claim under the policy or contest the policy itself.
Thibodaux Regional Medical Center’s Responsibilities
Thibodaux Regional Medical Center is required to:
- Maintain the privacy of your health information
- Provide you with this Notice of our legal duties and privacy practices with respect to health 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.
- Notify you of any breach of your unsecured PHI.
Thibodaux Regional Medical Center reserves the right to change our privacy practices and to make new provisions effective for all protected health information we maintain. Should our information practices change, we will re-issue another Privacy Notice to you upon your return to Thibodaux Regional Medical Center.
Thibodaux Regional Medical Center will not use or disclose your health information without your authorization, except as described in this Notice.
How We Will Use and Disclose Your Health Information
The following categories describe different ways that we may use and disclose your health information. For each category of uses or disclosures we will explain what we mean and try to 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 will use your health information for treatment or services. We may disclose health information about you to physicians, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you at the hospital or in your future care (discharge planning, placement, etc.). For example, information obtained by a nurse, physician, or other member of Thibodaux Regional Medical Center’s staff will be recorded in your medical record and used to determine the course of treatment that should work best for you. We may also disclose your health information to another health care provider for that provider’s treatment purposes.
For Payment: We will use and disclose health information about you so that the treatment and services you receive at Thibodaux Regional Medical Center may be billed and payment may be collected from you, an insurance company or a third party. 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. We may also disclose your health information to another health care provider for that provider’s payment activities. If you or someone other than your health care plan has paid for your services in full out of pocket, you may request that Thibodaux Regional Medical Center not disclose PHI related solely to those services for payment or health care operation purposes (such as an audit by the health plan).
For Health Care Operations: We will use and disclose your health information for regular hospital operations. These uses and disclosures are necessary to run the hospital and make sure that all our patients receive quality care. For example, Thibodaux Regional Medical Center 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 new treatments are effective. We may disclose information to doctors, nurses, technicians, and other hospital personnel for review and learning purposes. We may disclose your health information to another health care provider for its health care operations if that other provider has or had a relationship with you and is required by law to maintain the privacy of your health information. Furthermore, we only will disclose your health information to another health care provider for the certain specific activities of that provider, such as quality assessment and improvement, licensing and credentialing.
Business Associates: There are some services provided in our hospital through contracts with business associates. An example is a copy service used when making copies of your medical record. Thibodaux Regional Medical Center may disclose your health information to these business associates so that they can perform the services we have asked them to do. To protect your health information, however, we require the business associates to appropriately safeguard your information.
Fundraising Activities: Thibodaux Regional Medical Center may contact you as part of a fund-raising effort. If you do not want the hospital to contact you for fundraising efforts, you must notify the Marketing Director in writing. The address of the Marketing Director is: 602 North Acadia Road, Thibodaux, LA 70301.
Hospital Directory: Thibodaux Regional Medical Center may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition (e.g. fair, stable, etc.) and your religious affiliation. Unless you notify us that you object, the directory information, except your religious affiliation, may be released to people who ask for you by name. Unless you notify us that you object, your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don’t ask for you by name. This is so your family, friends, and clergy can visit you in the hospital and generally know how you are doing.
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 about you relevant to that person’s involvement in your care or payment related to your care.
Disaster Relief: We may disclose health information to a public or private entity to assist that entity in its disaster relief efforts.
Research: Thibodaux Regional Medical Center may disclose information for research purposes when the hospital’s Institutional Review Board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved the research. 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.
As Required by Law: Thibodaux Regional Medical Center will disclose health information about you when required to do so by law.
To Avert a Serious Threat to Health or Safety: We may use and disclose health 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.
Organ and Tissue Donation: Consistent with applicable state law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, eyes or tissue.
Military and Veterans: If you are a member of the armed forces, we may release medical information about you as required by military command authorities. Thibodaux Regional Medical Center may also release medical information about foreign military personnel to the appropriate foreign military authority.
Workers’ Compensation: Thibodaux Regional Medical Center 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.
Food and Drug Administration (FDA): We may disclose to the FDA health information for the purpose of reporting adverse events with respect to food, supplements, product and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement. Such disclosure may be made to a person or entity that is subject to FDA jurisdiction and is responsible for the FDA-regulated product or activity at issue.
Public Health Risks: Thibodaux Regional Medical Center may disclose health information about you for public health activities. These activities generally include the following:
- To prevent or control disease, injury, or disability
- To report births and deaths
- To report child abuse or neglect
- To report reactions to medications or problems with medical products
- To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease
- To notify the appropriate government authority if we reasonably believe a patient has been the victim of abuse, neglect, or domestic violence
- To notify the appropriate governmental authority regarding contraction or spreading of a communicable disease.
Health Oversight Activities: Thibodaux Regional Medical Center 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 laws.
Lawsuits and Disputes: If you are involved in a lawsuit or a legal dispute, we may disclose health information about you in response to a court or administrative order. Thibodaux Regional Medical Center may also release health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to notify you about the request or to obtain an order protecting the information requested.
Marketing, Treatment Alternatives, Health-Related Benefits and Services: Thibodaux Regional Medical Center may contact you to provide appointment reminders, provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Law Enforcement: Thibodaux Regional Medical Center may release health information to law enforcement official:
- As required by law
- 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 or a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement
- About a death we suspect may be the result of criminal conduct
- About criminal conduct at the hospital and
- 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.
Coroners, Medical Examiners and Funeral Directors: Thibodaux Regional Medical Center may release health information to a coroner or medical examiner, as permitted by law. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information to funeral directors consistent with applicable law.
National Security and Intelligence Activities: Thibodaux Regional Medical Center may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. We may also disclose health information to authorized federal officials for the provision of protective services to the U.S. President or other persons designated by law.
Correctional Institution: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release to the correctional institution or law enforcement official health information necessary for the provision of health care to you, the health and safety of the officers and employees of the correctional institution, the health and safety of individuals responsible for the transport of inmates, law enforcement on the premises of the correctional institution, the administration of the safety and security of the correctional institution, your health and the health and safety of other individuals.
Uses Requiring Written Authorization: The following uses and disclosures may be made only with written authorization from you.
- Most uses and disclosures of psychotherapy notes
- Uses and disclosures for marketing purposes, including those for which Thibodaux Regional receives compensation
- Uses and disclosures that are a sale of PHI by Thibodaux Regional
- Other uses and disclosures not covered above
For More Information or to Report a Problem
If you have questions about this Notice and Thibodaux Regional Medical Center’s obligations, or would like additional information, you may contact Thibodaux Regional Medical Center’s Privacy Officer, Dana Rodrigue, R.N., at 985-493-4761.
If you believe that your privacy rights have been violated, you may file a complaint with the hospital and/or with the Secretary of the Department of Health and Human Services in Washington D.C. To file a complaint with the hospital, contact:
Dana Rodrigue, RN
Chief Quality Resource Officer/Privacy Officer
All complaints must be submitted in writing. There will be no retaliation for filing a complaint.
This hospital and some of the physicians who practice at this hospital are independent contractors and do not hereby assume any liability for the services or conduct of each other.
EFFECTIVE DATE: April 14, 2003
REVISED: September 20, 2013