Arkansas Children's Hospital
University of Arkansas for Medical Sciences
ACH Medical Staff
|Joint Notice of Privacy Practices
Effective Date: August 29, 2013
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE READ 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 confidential, and we are committed
to protecting your medical information. We create a record
of the care and services you receive at ACH and our 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 your protected
health information. We also describe your rights and certain
obligations we have regarding the use and disclosure of protected
Most of the patients at ACH are children. When we refer to
“you” or “your” in this Notice, we refer to the patient. When we refer
to types of disclosures of information to “you,” we mean disclosures
to the patient, the patient’s guardian, or the person legally
authorized to receive information about the patient.
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” (PHI)
is information about you or your minor child, including demographic
data such as name, address, phone numbers, and other
identifying information 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
www.archildrens.org and will be posted in prominent areas of our
facility and on CareHub. You may receive a revised copy by sending
a written request to the ACH Privacy Ofcer, Arkansas Children’s
Hospital, #1 Children’s Way Slot 681, 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 fle a complaint with us, you may send a letter describing
the violation to the ACH Privacy Ofcer, Arkansas Children’s Hospital,
#1 Children’s Way Slot 681, Little Rock, AR 72202. There will
be no retaliation for fling a complaint.
If you have questions or need more information, contact the ACH Privacy Officer
This Notice applies at all clinics, departments and units on
the ACH Campus; West Little Rock Clinic; and Centers for Children
(Lowell and Jonesboro).
WHO WILL FOLLOW THIS NOTICE?
This Notice describes the practices
- ACH healthcare professionals authorized to enter information into your records.
- ACH employees, ACH medical staf, volunteers and other ACH or clinic personnel.
- Members of the Organized Health Care Agreement:
UAMS doctors, UAMS medical students, UAMS
nurses, and other UAMS employees who work or
provide health care services on the ACH campus.
- Students-in-training on the ACH campus.
You have the following rights relating to your
protected health information.
- Obtain a paper copy of this Notice.
- Request in writing a restriction on certain uses and disclosures
of your information. We are not required to
agree to the requested restrictions, unless you are requesting
to restrict certain information from your health
plan and you or someone on your behalf has paid for
your ACH services in full. Both the request for the restriction
and the payment in full must be made prior to any
of the services being provided.
Make a reasonable request to receive confdential communications
of your PHI from us by alternative means or
at alternative locations.
Inspect or obtain a copy of records (in paper or electronic form)
used to make decisions about you. You will be
charged a fee for the cost of copying, mailing or other
supplies. We are allowed to deny this request under certain
circumstances. In some situations, you may ask for a
review of this denial by a licensed healthcare professional
identifed by ACH who was not involved in the original
denial decision. We will comply with the outcome of this
review. We can deny access to psychotherapy notes.
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 PHI.
Provide us with written authorization (or permission) for
uses and disclosures of your PHI that are not covered by
the Notice or permitted by law. Except to the extent that
the use or disclosure has already occurred, you may revoke (or cancel)
this authorization. The request to cancel
must be put in writing.
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
We are required to maintain
the privacy of your PHI, abide by the terms of this Notice, make this
Notice available to you, and notify you if a breach of your health information
Examples of Uses & Disclosures
We will use your protected health information for treatment.
Information obtained by a nurse, doctor, or other healthcare
worker will be put into
the medical record and used to plan and manage your treatment.
We may communicate with and provide reports or
other information to your doctor or other authorized persons
who are involved in your care, including healthcare providers
outside of ACH. We may disclose your PHI to other health
care providers, public health reporting entities or health care
plans for treatment, payment or operational purposes using
the State Health Alliance for Records Exchange (SHARE)
unless you have opted out of participation in SHARE. For
more information on SHARE, you may visit the Arkansas Offce
of Health Information Technology website at http://ohit.arkansas.gov/Pages/default.aspx.
PHI may also be shared between ACH and UAMS as necessary to carry out treatment.
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 may also disclose limited information about your bill to
others to obtain payment. PHI may be shared between ACH and
UAMS as necessary to carry out payment.
We will use your protected health information for regular healthcare
operations. ACH may use your PHI 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 may share your
PHI, as necessary, to carry out the routine business functions.
PHI may be shared between ACH and UAMS as necessary to
carry out health care operations.
Business Associates. We may share some of your PHI with
outside people or companies who provide services for us,
such as typing physician reports.
Patient Directory: Unless you tell us not to, we may disclose
your name, location in the facility, and general condition to people who
ask for you by name. If provided by you, your religious afliation may also
be given to members of the clergy.
Notification. We may use or disclose PHI 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 PHI 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. Your PHI may be used for research purposes
in certain circumstances with your permission, or after we
receive approval from a special review board, known as an
Institutional Review Board (IRB), whose members review
and approve the research project. In certain circumstances,
the IRB may determine your authorization is not necessary
and issue a waiver. In all other instances, your authorization
(permission) is required for the disclosure of your PHI for research.
Coroners, Medical Examiners, Funeral Directors. We may
disclose PHI to these people, to the extent allowed by law, so
that they may carry out their duties.
Organ Donor Organizations. If you are an organ donor,
we may share your PHI with the organ donation agency for
the purpose of tissue or organ donation in certain circumstances
or as required by law.
Fundraising: Our Foundation may use information to
notify you about fundraising campaigns or other charitable
events to raise money for ACH. You have the right to opt
out of fundraising communications and may do so by calling
1-800-880-7491 or emailing firstname.lastname@example.org or
Marketing: In certain circumstances, we may contact
you as part of our marketing eforts. We may use your PHI for
marketing purposes without your authorization only when
we discuss such products or services with you face to face or
provide you with a gift of nominal value related to the product
or service. For other types of marketing activities, we will
obtain your written authorization. Providing you information
or refll reminders for a drug you are currently taking is not
Sale of Information: ACH will not sell your information
without your prior written authorization or as otherwise allowed by law.
Food and Drug Administration (FDA): We may share your
PHI 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 PHI 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 your PHI, 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 or condition.
Correctional Institution: If you are an inmate of a
correctional institution, we may disclose your PHI to the institution
or law enforcement as needed for your health or the health
and safety of others.
Law Enforcement: We may disclose your PHI for law
enforcement purposes as required by law.
As Required by Law: We must disclose your PHI when required
by federal, state or local law
Health Oversight: We must disclose your PHI to a health
oversight agency for activities authorized by law, such as investigations
and inspections. Oversight agencies are those
that oversee the health care system, government beneft
programs, such as Medicaid, and other government regulatory programs.
Abuse or Neglect: We must disclose your PHI to government
authorities that are authorized by law to receive reports of
suspected child abuse or neglect involving children or endangered adults.
Legal Proceedings: We may disclose your PHI in the course
of any judicial or administrative proceeding, in response to a
court order, and in certain conditions, in response to a subpoena,
discovery request or other lawful process, as allowed by law.
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 Regulations.
To Avoid Harm: We may use and disclose your information,
when necessary, to prevent a serious threat to your health or safety
or the health and safety of the public or another person.
For Specific Government Functions: In certain situations,
we may disclose PHI of military personnel and veterans. We
may disclose PHI for national security activities required by
OTHER USES OF MEDICAL INFORMATION
Any use or disclosure of medical information not covered
by this Notice or the laws that apply to such use or disclosure
will be made only with your written authorization
(permission.) You may cancel this authorization at any time,
but you must put this in writing. If you cancel this authorization,
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
withdraw any disclosures we have already made.