Notice of Privacy Practice
Thibodaux Regional Health System
This Notice describes how medical information about you may be used and
disclosed by Thibodaux Regional Health System and how you can get access
to this information. Please review it carefully.
Click here to open a PDF copy of this Notice.
When it comes to your health information, you have certain rights.This
section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
- You can ask to see or get an electronic or paper copy of your medical record
and other health information we have about you. Ask us how to do this.
- We will provide a copy or a summary of your health information, usually
within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
- You can ask us to correct health information about you that you think is
incorrect or incomplete. Ask us how to do this. We may say “no”
to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
- You can ask us to contact you in a specific way (for example, home or office
phone) or to send mail to a different address. We will say “yes”
to all reasonable requests.
Ask us to limit what we use or share
- You can ask us not to use or share certain health information for treatment,
payment, or our operations. We are not required to agree to your request,
and we may say “no” if it would affect your care.
- If you pay for a service or health care item out-of-pocket in full, you
can ask us not to share that information for the purpose of payment or
our operations with your health insurer. We will say “yes”
unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
- You can ask for a list (accounting) of the times we’ve shared your
health information for six years prior to the date you ask, who we shared
it with, and why.
- We will include all the disclosures except for those about treatment, payment,
and health care operations, and certain other disclosures (such as any
you asked us to make). We’ll provide one accounting a year for free
but will charge a reasonable, cost-based fee if you ask for another one
within 12 months.
Get a copy of this privacy notice
- You can ask for a paper copy of this notice at any time, even if you have
agreed to receive the notice electronically. We will provide you with
a paper copy promptly.
Choose someone to act for you
- If you have given someone medical power of attorney or if someone is your
legal guardian, that person can exercise your rights and make choices
about your health information.
- We will make sure the person has this authority and can act for you before
we take any action.
File a complaint if you feel your rights are violated
- You can complain if you feel we have violated your rights by contacting
the Privacy Officer.
You can file a complaint with the U.S. Department of Health and Human Services
Office for Civil Rights by sending a letter to 200 Independence Avenue,
S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting
- We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices about what
we share. If you have a clear preference for how we share your information
in the situations described below, talk to us. Tell us what you want us
to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in your care
- Share information in a disaster relief situation
- Include your information in a hospital directory
If you are not able to tell us your preference, for example if you are
unconscious, we may go ahead and share your information if we believe
it is in your best interest. We may also share your information when needed
to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
In the case of fundraising:
- We may contact you for fundraising efforts, but you can tell us not to
contact you again.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
We can use your health information and share it with other professionals
who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall
Run our organization
We can use and share your health information to run our practice, improve
your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and
Bill for your services
We can use and share your health information to bill and get payment from
health plans or other entities.
Example: We give information about you to your health insurance plan so
it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways –
usually in ways that contribute to the public good, such as public health
and research. We have to meet many conditions in the law before we can
share your information for these purposes. For more information see:
Help with public health and safety issues
We can share health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it,
including with the Department of Health and Human Services if it wants
to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral
director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and
presidential protective services
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative
order, or in response to a subpoena.
- We are required by law to maintain the privacy and security of your protected
- We will let you know promptly if a breach occurs that may have compromised
the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice
and give you a copy of it.
- We will not use or share your information other than as described here
unless you tell us we can in writing. If you tell us we can, you may change
your mind at any time. Let us know in writing if you change your mind.
For more information see:
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all
information we have about you. The new notice will be available upon request,
in our office, and on our web site.
Other Instructions for Notice
This Notice is effective July 25, 2017.
Our Privacy Officer is Dana Rodrigue, RN. She can be reached by phone at
985-493-4760 or by email at
This notice applies to Thibodaux Regional Health System and its affiliate
physician practices noted below:
- Brain and Spine Clinic, 726 N Acadia Road Suite 2100, Thibodaux, LA 70301
- Endocrinology Clinic, 726 N Acadia Road, Suite 3300, Thibodaux, LA 70301
- Family Medicine Clinic - Paincourtville, 114 Hwy 403, Paincourtville, LA 70391
- Family Medicine Clinic - Pierre Part, 3928 Hwy 70 S, Pierre Part, Thibodaux, LA 70339
- Heart & Vascular Surgery Clinic, 604 N Acadia Road Suite 409, Thibodaux, LA 70301
- Internal Medicine Clinic, 506 N Acadia Road, Thibodaux, LA 70301
- Neurology Clinic, 726 N Acadia Road Suite 2300, Thibodaux, LA 70301
- Oncology Clinic, 608 N Acadia Road, Thibodaux, LA 70301
- Orthopaedic Clinic, 602 N Acadia Road, Suite 101, Thibodaux, LA 70301
- Pain Clinic, 726 N Acadia Road Suite 2400, Thibodaux, LA 70301
- Pediatric Cardiology Clinic, 604 N Acadia Road Suite 409, Thibodaux, LA 70301
- Plastic & Reconstructive Surgery Clinic, 604 N Acadia Road, Suite 410,
Thibodaux, LA 70301
- Podiatry Clinic, 726 N Acadia Road, Suite 1700, Thibodaux, La 70301
- Pulmonology & Critical Care Specialty Clinic, 604 N Acadia Road Suite
411, Thibodaux, LA 70301
- Rheumatology Clinic, 726 N Acadia Road Suite 3400, Thibodaux, LA 70301
- Urology Clinic, 504 N Acadia Road, Thibodaux, LA 70301
- Women’s Clinic, 604 N Acadia Road, Suite 500, Thibodaux, LA 70301