Arkansas Children's Hospital
University of Arkansas for Medical Sciences
ACH Medical Staff
|Joint Notice of Privacy Practices
Effective Date: April 14, 2003
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 Notice is provided on behalf of Arkansas Children’s Hospital
(ACH) and the University of Arkansas Medical Sciences (UAMS) and the members
of the ACH Medical Staff.
We understand that medical information about you and your health is personal,
and we are committed to protecting medical information about you. We create
a record of the care and services you receive at ACH hospital and clinics. We
need this record to provide you with quality care and to comply with certain
legal requirements. This notice will tell you about the ways we may use and
disclose protected health information about you. We also describe your rights
and certain obligations we have regarding the use and disclosure of protected
This Notice of Privacy Practices describes how we may use and disclose your
protected health information to carry out treatment, payment or health care
operations and for other purposes permitted or required by law. “Protected
health information” is information about you or your minor child, including
demographic data such as name, address, phone numbers, etc., that may identify
you and that relates to your past, present or future physical or mental health
and related health care services.
We are required to give you this notice and to maintain the privacy of protected
health information. We must abide by this Notice, but we reserve the right to
change the privacy practices described in it. This Notice may be accessed on
the ACH web page. Revised Notices will be posted in waiting rooms. You may receive
a revised copy by sending a written request to the ACH Privacy Officer, Department
of Regulatory Affairs, Arkansas Children's Hospital, 800 Marshall Street, Little
Rock, AR 72202.
You may complain to us or to the U.S. Secretary of Health and Human Services
if you believe your privacy rights have been violated. To file a complaint with
us, you must send a letter describing the violation to the ACH Privacy Officer.
There will be no retaliation for filing a complaint.
If you have questions or need more information, contact the ACH Privacy Officer
This Notice applies at all ACH clinics, departments and units.
WHO WILL FOLLOW THIS NOTICE? This Notice describes the practices
ACH healthcare professionals authorized to enter information into your records.
ACH employees, ACH medical staff, volunteers and other ACH or clinic personnel.
UAMS doctors, UAMS nurses, and other UAMS employees who work or provide
healthcare services on the ACH campus.
Students-in-training on the ACH campus.
Your Rights. You have the following rights relating to your
protected health information.
- Request a restriction on certain uses and disclosures of your information,
but we are not required to agree to your restrictions. Your restriction request
must be in writing.
- Obtain a paper copy of this Notice.
Inspect and get a copy of records used to make decisions about you. You will
be charged a fee for the cost of copying, mailing or other supplies. In some
situations, we are allowed to deny this request. In some situations you may
ask for a review of this denial by a licensed healthcare professional who was
not involved in the denial decision. We will comply with the outcome of this
Request that we amend your record if you feel the information is incomplete
or incorrect; however, we are allowed to deny this request in certain circumstances.
We may ask you to put these requests for amendments in writing and provide a
reason that supports your request.
Obtain a record of certain disclosures of your protected health information.
Make a reasonable request to receive confidential communications of your protected
health information from us by alternative means or at alternative locations.
Revoke your authorization to use or disclose protected health information except
to the extent that action has already been taken.
To inspect or obtain a copy of your records, send a written request to the
Director of the ACH Medical Records Department. All other requests must be sent
to the ACH Privacy Officer, Department of Regulatory Affairs.
Our Responsibilities. We are required to protect the privacy
of your protected health information, abide by the terms of this Notice, make
this Notice available to you, and notify you if we are unable to agree to a
requested restriction or an alternative means of communicating.
Examples of Uses & Disclosures
We will use your protected health information for treatment.
Information obtained by a nurse, doctor, etc. will be put into the record and
used to plan and manage your treatment. They will record their actions and their
observations so they will know how you are responding to treatment. We may provide
reports or other information to your physician or others who will be involved
in your care when you leave ACH.
We will use your protected health information for payment.
A bill will be sent to you and/or your insurance company with information about
your diagnosis, procedures and supplies used.
We will use your protected health information for regular healthcare
operations. The Medical Staff and other healthcare workers may use
your protected health information to check on the care you received, how you
responded to it, and for other business purposes related to operating the hospital
or clinic. Also, we will share your protected health information as may be necessary
to carry out the routine business functions.
Business Associates. We may share some of your protected health
information with outside people or companies who provide services for us, such
as typing physician reports.
Directory: We will use and disclose your name, location in
the facility, general condition and religious affiliation (shared only with
the clergy) in a directory unless you tell us not to include you. All of this
information, except religious affiliation, will only be given out to people
that ask for the patient by name.
Notification. We may use or disclose protected health information
to notify a family member or other person involved in your care your location
and general condition unless you tell us not to do so.
Communication with family: A doctor, nurse or other healthcare
worker may share protected health information with a family member, a close
personal friend, or a person that you identify, if they are involved in your
care or in payment for your care, unless you tell us not to do so.
Research. Our researchers may use your protected health information
after they receive approval from our special review board whose members review
and approve the research project.
Coroners, Medical Examiners, Funeral Directors. The law allows
us to disclose protected health information to these people so that they may
carry out their duties.
Organ Donor Organizations. If you are an organ donor, we must
share your protected health information with the organ donation agency for the
purpose of tissue or organ donation or as we are required to do so.
Contacts: We may contact you to provide appointment reminders
or to tell you about new treatments or services.
Fundraising: Our Foundation may contact you.
Food and Drug Administration (FDA): We may share your protected
health information with certain government agencies like the FDA so they can
recall drugs or equipment.
Workers Compensation: We may disclose your protected health
information for workers' compensation claims.
Public Health: We may give your protected health information
to public health agencies who are charged with preventing or controlling disease,
injury or disability or as required by law.
Communicable Disease: We may disclose protected health information,
if authorized by law, to a person who may have been exposed to a communicable
disease or may otherwise be at risk of contracting or spreading the disease
Correctional Institution: If you are an inmate of a correctional
institution, we may disclose protected health information needed for your health
or the health and safety of others.
Law Enforcement: We may disclose protected health information
for law enforcement purposes as required by law.
As Required by Law: We must disclose protected health information
about you when required by federal, state or local law.
Health Oversight: We must disclose information to a health
oversight agency for activities authorized by law, for example investigations
and inspections. Oversight agencies are those that oversee the health care system,
government benefit programs, such as Medicaid, and other government regulatory
Abuse or Neglect: We must disclose your protected health information
to a public health authority that is authorized by law to receive reports of
child abuse or neglect.
Legal Proceedings: We may disclose protected health information
in the course of any judicial or administrative proceeding, in response to a
court order, if authorized, and in certain conditions in response to a subpoena,
discovery request or other lawful process.
Required Uses and Disclosures: We must make disclosures when
required by the Secretary of the Department of Health and Human Services to
investigate or determine our compliance with the requirements of the HIPAA Privacy
To Avoid Harm: We may use and disclose information about you
when necessary to prevent a serious threat to your health or safety of the health
or safety of the public or another person.
For Specific Government Functions: In certain situations,
we may disclose protected health information of military personnel and veterans.
We may disclose protected health information for national security activities
required by law.
OTHER USES OF MEDICAL INFORMATION
Use and sharing of medical information not covered by this Notice or the laws
that apply to use will be made only with your written permission. At any time
you may cancel this permission, but you must put this in writing. If you cancel
this permission, we will no longer use or disclose medical information about
you for the reasons covered by your written authorization unless we are required
to do so by law. We are unable to take back any disclosures we have already