Franklin County Memorial Hospital is dedicated to protecting your medical information. We are required by law to maintain the privacy of protected health information and to provide you with this NOTICE of our legal duties and privacy practices with respect to protected health information. Franklin County Memorial Hospital is required by law to abide by the terms of this NOTICE, making any revision applicable to all the protected health information we maintain. If we revise the terms of this NOTICE, we will post a revised notice at the Hospital and its facilities and will make paper copies of this NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION available upon request.

We will use your medical information as part of providing patient care. For example, your medical information may be used by the health care professional treating you, by the business/insurance office to process your payment for the services provided and by administrative personnel reviewing the quality and appropriateness of the care you receive.

We may also use and/or disclose your information in accordance with Federal and State laws for the following purposes:

• We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

• We may contact you to raise funds for the hospital.

• We may disclose medical information when required by the United States Department of Health and Human Services as part of an investigation or determination or the Hospital’s compliance with relevant laws.

• Unless you object, we will include general information, including your name, location in the hospital, your condition described in general terms (Reference-Policy and Procedure for Release of Information) and your religious affiliation in a directory of individuals located in the Hospital. The directory information, except for your religious affiliation, will be released to people who ask for you by name. Your religious affiliation may be given to members of the clergy, even if they do not ask for you by name.

• Unless you object, we may disclose to family members, other relatives or close personal friends the medical information directly relevant to such person’s involvement with your care.

• Unless you object, we may use or disclose your medical information to notify a family member, a personal representative or another person responsible for your care of your location, general condition or death.

• We may disclose your medical information to a public or private entity for the purpose of coordinating with that entity to assist in disaster relief efforts.

• We may use or disclose your medical information for public health activities, including the reporting of disease, injury, vital events and the conduct of public health surveillance, investigation and/or intervention. We may disclose your medical information to health oversight agency for oversight activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions, administrative and/or legal proceedings. We may disclose your medical information concerning abuse, neglect or violence in accordance with federal and state law.

• We may disclose your medical information in the course of certain judicial or administrative proceedings.

• We may disclose your medical information for law enforcement purposes or other specialized governmental functions.

• We may disclose your medical information to a coroner, medical examiner or a funeral director.

• If you are an organ donor, we may disclose your medical information to an organ donation and procurement organization.

• We may disclose your medical information for certain research purposes.

• We may use or disclose your medical information to prevent or lessen a serious threat to the health or safety of another person or the public.

• We may disclose your information as authorized by `laws relating to workers’ compensation or similar programs.

We will not use or disclose your medical information for any other purpose without your written authorization. Once given, you may revoke your authorization in writing at any time.

You have the following rights with respect to your medical information:

• The right to request restrictions on certain uses and disclosures of your medical information. We are not required to agree to your requested restriction, but if we do, we will honor it.

• The right to receive communications from us in a confidential manner.

• The right to inspect and copy your medical information. This right is subject to certain specific exceptions, and you may be charged a reasonable fee for any copies of your record.

• The right to request an amendment of your medical information. We may deny your request for certain specific reasons, and, if denied, we will provide you with a written explanation for the denial and information regarding further rights you would have at that point.

• The right to receive an accounting of the disclosures of your medical information made by the Hospital in the six years prior to your request (following April 14, 2003), except for disclosures for treatment, payment or Hospital operational purposes and for certain other specific disclosure types.

• The right to request a paper copy of this Notice of Privacy Practices for Protected Health Information.

• The right to complain to the Hospital and/or to the United States Department of Health and Human Services if you believe that the Hospital has violated your privacy right. To complain to the Hospital, please contact:

If you choose to file a complaint, you will not be retaliated against in any way.

If you would like further information regarding your rights or regarding the uses and disclosures of your medical information, you may contact:

                                        Lance Moak, Administrator

                                        Franklin County Memorial Hospital

                                        Meadville, Mississippi 39653

                                        (601) 384-5801

Copyright© 2002-2008, Franklin County Memorial Hospital
Franklin County Memorial Hospital ● P.O. Box 636 ● Meadville, MS 39653 ● (601) 384-5801