This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
This Privacy Notice applies to all of Southeast Alabama Medical Center, SAMC Clinics and facilities, and those physicians participating in an organized healthcare arrangement, which includes but is not limited to:
- Southeast Alabama Medical Center Home Health Services I
- Southeast Alabama Medical Center Home Health Services II
- Enterprise Medical Clinic
- Houston Medical Group
- Chipley Medical Group
- Southeast Pain Management Clinic
- NeuroSpine Center
- Advanced Home Medical Equipment
- Contact Information
Exercising your Rights, Restrictions or Requests: To notify any of the above listed facilities in writing regarding your rights, restrictions or requests, please direct your correspondence to the appropriate facility at the following address:
Southeast Alabama Medical Center
ATTN: HIPAA Privacy Officer
P.O. Box 6987
Dothan, AL 36302
Specify the facility or clinic above where your information is on file.
Questions or Complaints
For questions about this Notice, or to file a privacy complaint, please call 334-793-8029.
Understanding your Health Record/Information is extremely important.
Each time you visit a hospital, physician or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment.
Understanding what is in your record and how your health information is used helps you to:
- Ensure it's accuracy
- Better understand who, what, when, where and why others may access your health information
- Make more informed decisions when authorizing disclosures to others
Who Will Follow This Notice? This Notice describes SAMC's practices and that of:
- All healthcare professionals authorized to enter information into your hospital record at SAMC
- All co-workers at SAMC who may have direct or indirect access to your patient information
- Any member of SAMC's volunteer services who helps you while you are under our care
- SAMC Medical Clinic employees and physicians. All clinic sites and locations listed above follow the terms of this Notice. In addition, these listed clinics and the hospital may share medical information with each other for treatment, payment or hospital operation purposes described in this Notice
- Physicians participating in the organized healthcare arrangement. These covered entities will share protected health information with each other, as necessary to carry out treatment, payment or healthcare operations relating to the organized health care arrangement
SAMC is required to:
- Maintain the privacy of your health information
- Provide you a Notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
- Abide by the terms of this Notice
- To 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
Changes to the Notice
We reserve the right to change our practices and to make new provisions effective for all protected health information we maintain. Should our information practices change, we will post the revised copy on this website. Each time you register at any SAMC facility for treatment or healthcare services as an inpatient or outpatient, we will offer you a copy of the current Notice in effect.
We will not disclose your health information without your authorization, except as described in this Notice.
Your authorization can be revoked at any time in WRITING to the facility where your information is located (contact information at the top of this Notice) except to the extent that disclosure made in good faith has already occurred.
Your Rights Regarding Your Protected Health Information (PHI)
You have the following rights with respect to your PHI:
- The Right to See and Receive Copies of your PHI (Inspect and Copy)
In most cases, you have the right to request a review or receive copies of your medical information that we have, such as medical and billing records. We are not able to provide any psychotherapy notes, records that may be needed for civil, criminal or administrative proceedings, any information not allowed by law, or other certain situations. If your request is denied, we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed. We will respond within 30 days from the date of your request (60 days for off-site info) with one 30-day extension, if needed.
Requesting a copy of your Protected Health Information (PHI)
If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. To inspect and copy your medical information, your request can be made in person at the appropriate facility where your information is kept AND/OR in writing to the appropriate facility contact information on the first page of this Notice. The request must include:
- Your name
- Date of birth
- Reason for needing your information
- Social Security Number
- Date of treatment(s) at which SAMC facility
- Specific information needed (i.e. progress notes, history & physical)
- Your signature
We may deny your request to inspect and receive a copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. A licensed healthcare professional chosen by SAMC will review your request and the denial.
The Right to Amend or Update Your PHI
If you feel that medical information we have about you is incorrect or incomplete, you may ask to amend it. Each request will be reviewed and may be approved or denied based on certain criteria.
To request an amendment, your request must be made in person at the facility where the information is kept OR in writing and submitted to the appropriate facility contact information on the first page of this Notice. In addition, you must provide a reason that supports your request. We will respond within 60 days of receiving your request.
If we approve your request, we will include the amendment in your PHI, tell you that it has been included, and tell others that need to know about the amendment in your PHI.
We 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 us, unless the person or entity that created the information is no longer available to make the amendment
- Is not part of the medical information kept by or for the hospital/clinic
- Is not part of the information which you would be permitted to inspect and copy or is accurate and complete
- If your request is denied, a written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial
If you do not file a written statement, you have the right to request that your request and our denial be attached to all future disclosures of your PHI subject to the amendment request.
The Right to Get a List of the Disclosures We Have Made (Accounting of Disclosures)
You have the right to get a list of instances in which we have disclosed your PHI. The list will not include uses or disclosures that you have already consented to, such as those made for treatment, payment or healthcare operations, information given directly to you or to your family or listings made in our facility directory. Also, this list will include information given for national security purposes, and disclosures of limited information that does not directly identify you.
We will respond within 60 days from the date of your request, with an allowable 30-day extension if needed.
To request this list or accounting of disclosures, your request must be made in person at the facility where the information is kept OR in writing and submitted to the appropriate facility. Contact information is on the first page of this Notice.
Time Period Limitations
Your request must state a time period that may not be longer that six years and may not include dates before April 14, 2003. Your Accounting of Disclosures will be sent to you in paper form.
The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
The Right to Request Limits on Uses and Disclosures of Your PHI (Restrictions)
You have the right to ask that we limit how we use and disclose your information. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not legally required to agree to your request. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make. To request restrictions, your request must be made in person at the facility where the information is kept OR in writing and submitted to the appropriate facility contact information on the first page of this Notice.
In your request, you must tell us:
- What information you want to limit;
- Whether you want to limit our use, disclosure or both
- To whom you want the limits to apply, for example, disclosures to your spouse.
The Right to Choose How We Send PHI to You (Confidential Communications)
You have the right to ask that we send information to you at an alternate address (for example, you may choose to have your information sent to work rather than at home). We must agree to your request so long as we can easily provide it in the format you requested.
To request confidential communications, your request must be made in person at the facility where the information is kept OR in writing and submitted to the appropriate facility contact information on the first page of this Notice.
We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this Notice. We will provide or otherwise make available a copy at your first registration, and you may also ask us to give you a copy of this Notice at any time. You may obtain a copy of this Notice at this website, www.samc.org. To obtain a paper copy of this Notice, please call 334-793-8029.
Use and Disclosures for Treatment, Payment, and Health Operations
Upon admission or registration we may use and disclose your PHI for:
We may disclose your PHI to physicians, nurses and other healthcare personnel who are involved in your care. We will also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you once you are discharged from this hospital.
- Emergency Treatment
We may disclose your PHI to others without your consent in certain situations. For example, your consent is not required if you need emergency treatment, as long as we try to get your consent after treatment or we try to get your consent but you are unable to communicate with us (for example, if you are unconscious or in severe pain).
We may use and disclose your PHI in order to bill and collect payment for the treatment and services provided to you. For example, we may provide portions of your PHI to our billing department and your health plan to get paid for the healthcare services we provided to you. We may also provide your PHI to our business associates, such as billing companies, claims processing companies and others who process our healthcare claims.
We may disclose your PHI in order to operate this facility. For example, we may use your PHI in order to evaluate the quality of healthcare services that you received or to evaluate the performance of the healthcare professionals who provided healthcare services to you. We may also provide your PHI to our accountants, attorneys, consultants and others in order to make sure we are complying with the laws that affect us.
Disclosures that do not Require your Authorization
We may use and disclose your PHI without your authorization for the following reasons:
- Workers compensation
We may disclose health information to the authorized institutions and/or those agencies required by law relating to workers compensation or other similar programs established by law. These programs provide benefits for work-related injuries or illness.
- Food and Drug Administration (FDA)
We may disclose to the FDA any health information related to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs or displacement.
- 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. We may also release medical information about foreign military personnel to the appropriate military authority.
- Public health as required by federal and Alabama state law
We may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.
- Law enforcement
We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena, court order or search warrant.
- Correctional institution
Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health safety of other individuals.
- As required by law
We will disclose medical information about you when required to do so by federal, state or local law.
- To avert a serious threat to safety or health
We may use and disclose medical 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.
Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
Two Additional Disclosures that You May Request to Restrict
- Patient directories
We will include your name and room location at SAMC (inpatient or outpatient) in our patient directory and it will be available to visitors who ask for you by name, unless you object. General condition may also be available as well. Religious affiliation will be available for use by clergy, unless you object. The opportunity to consent may be obtained retroactively in emergency situations.
- Disclosures to family, friends or others
We may provide your PHI to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
All Other Uses and Disclosures Require Your Prior Written Authorization
In any other situation not described in the sections above, we will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke that authorization in writing to stop any future uses and disclosures (to the extent that we have not taken any action relying on the authorization).
For More Information or to Report a Problem
If you have more questions and would like additional information, you may call the contact information on the first page of this Notice. If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the Privacy Officer listed on the first page of this Notice. You also may send a written complaint to the U.S. Secretary of the Department of Health and Human Services. All must be submitted in writing to: Region IV, Office for Civil Rights, U.S. Department of Health and Human Services, Atlanta Federal Center, Suite 3B70, 61 Forsyth Street, SW., Atlanta, GA 30303-8909. Voice Phone 404-562-7886. FAX 404-562-7881.
You will not be penalized in any way by SAMC for filing a complaint.