Privacy Notice

NOTICE OF PRIVACY PRACTICES

This Notice is effective March 26, 2013

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

WE ARE REQUIRED BY LAW TO PROTECT MEDICAL INFORMATION ABOUT YOU

We are required by law to protect the privacy of medical information about you and that identifies you. This medical information may be information

about healthcare we provide to you or payment for healthcare provided to you. It may also be information about your past, present, or future medical

condition.

We are also required by law to provide you with this Notice of Privacy Practices explaining our legal duties and privacy practices with respect to medical

information. We are legally required to follow the terms of this Notice. In other words, we are only allowed to use and disclose medical information in

the manner that we have described in this Notice.

We may change the terms of this Notice in the future. We reserve the right to make changes and to make the new Notice effective forallmedical

information that we maintain. If we make changes to the Notice, we will:

•Post the new Notice in our waiting area.

•Have copies of the new Notice available upon request. Please contact our Privacy Officer at(337) 942-7551to obtain a copy of our current

Notice).

The rest of this Notice will:

•Discuss how we may use and disclose medical information about you.

•Explain your rights with respect to medical information about you.

•Describe how and where you may file a privacy-related complaint.

If, at any time, you have questions about information in this Notice or about our privacy policies, procedures or practices, you can contact our Privacy

Officer at(337) 942-7551.

We use and disclose medical information about patients every day. This section of our Notice explains in some detail how we may use and disclose

medical information about you in order to provide healthcare, obtain payment for that healthcare, and operate our business efficiently. This section then

briefly mentions several other circumstances in which we may use or disclose medical information about you. For more information about any of these

uses or disclosures, or about any of our privacy policies, procedures or practices, contact our Privacy Officer at(337) 942-7551.

1. Treatment

We may use and disclose medical information about you to provide healthcare treatment to you. In other words, we may use and disclose medical

information about you to provide, coordinate or manage your healthcare and related services. This may include communicating with other healthcare

providers regarding your treatment and coordinating and managing your healthcare with others.

Example:Jane is a patient at the health department. The receptionist may use medical information about Jane when setting up an appointment. The

nurse practitioner will likely use medical information about Jane when reviewing Jane’s condition and ordering a blood test. The laboratory technician

will likely use medical information about Jane when processing or reviewing her blood test results. If, after reviewing the results of the blood test, the

nurse practitioner concludes that Jane should be referred to a specialist, the nurse may disclose medical information about Jane to the specialist to

assist the specialist in providing appropriate care to Jane.

2. Payment

We may use and disclose medical information about you to obtain payment for healthcare services that you received. This means that, within the health

department, we mayusemedical information about you to arrange for payment (such as preparing bills and managing accounts). We also maydisclose

medical information about you to others (such as insurers, collection agencies, and consumer reporting agencies). In some instances, we may disclose

medical information about you to an insurance planbeforeyou receive certain healthcare services because, for example, we may need to know whether

the insurance plan will pay for a particular service.

Example:Jane is a patient at the health department and she has private insurance. During an appointment with a nurse practitioner, the nurse

practitioner ordered a blood test. The health department billing clerk willusemedical information about Jane when he prepares a bill for the services

provided at the appointment and the blood test. Medical information about Jane will bedisclosedto her insurance company when the billing clerk sends

in the bill.

WE MAY USE AND DISCLOSE MEDICAL INFORMATION

ABOUT YOU IN SEVERAL CIRCUMSTANCES

Example:The nurse practitioner referred Jane to a specialist. The specialist recommended several complicated and expensive tests. The specialist’s

billing clerk may contact Jane’s insurance company before the specialist runs the tests to determine whether the plan will pay for the test.

3. Healthcare Operations

We may use and disclose medical information about you in performing a variety of business activities that we call "healthcare operations.” These

"healthcare operations” activities allow us to, for example, improve the quality of care we provide and reduce healthcare costs. For example, we may

use or disclose medical information about you in performing the following activities:

•Reviewing and evaluating the skills, qualifications, and performance of healthcare providers taking care of you.

•Providing training programs for students, trainees, healthcare providers or non-healthcare professionals to help them practice or improve

their skills.

•Cooperating with outside organizations that evaluate, certify or license healthcare providers, staff or facilities in a particular field or

specialty.

•Reviewing and improving the quality, efficiency and cost of care that we provide to you and our other patients.

•Improving healthcare and lowering costs for groups of people who have similar health problems and helping manage and coordinate the

care for these groups of people.

•Cooperating with outside organizations that assess the quality of the care others and we provide, including government agencies and

private organizations.

•Planning for our organization’s future operations.

•Resolving grievances within our organization.

•Reviewing our activities and using or disclosing medical information in the event that control of our organization significantly changes.

•Working with others (such as lawyers, accountants and other providers) who assist us to comply with this Notice and other applicable laws.

Example:Jane was diagnosed with diabetes. The health department used Jane’s medical information – as well as medical information from all of the

other health department patients diagnosed with diabetes – to develop an educational program to help patients recognize the early symptoms of

diabetes. (Note: The educational program would not identify any specific patients without their permission).

Example:Jane complained that she did not receive appropriate healthcare. The health department reviewed Jane’s record to evaluate the quality of

the care provided to Jane. The health department also discussed Jane’s care with an attorney.

4. Persons Involved in Your Care

We may disclose medical information about you to a relative, close personal friend or any other person you identify if that person is involved in your care

and the information is relevant to your care. If the patient is a minor, we may disclose medical information about the minor to a parent, guardian or other

person responsible for the minor except in limited circumstances. For more information on the privacy of minors’ information, contact our Privacy Officer

at(337) 942-7551.

We may also use or disclose medical information about you to a relative, another person involved in your care or possibly a disaster relief organization

(such as the Red Cross) if we need to notify someone about your location or condition.

You may ask us at any time not to disclose medical information about you to persons involved in your care. We will agree to your request and not

disclose the information except in certain limited circumstances (such as emergencies) or if the patient is a minor. If the patient is a minor, we may or

may not be able to agree to your request.

Example: Jane’s husband regularly comes to the health department with Jane for her appointments and he helps her with her medication. When the

nurse practitioner is discussing a new medication with Jane, Jane invites her husband to come into the private room. The nurse practitioner discusses

the new medication with Jane and Jane’s husband.

5. Required by Law

We will use and disclose medical information about you whenever we are required by law to do so. There are many state and federal laws that require

us to use and disclose medical information. For example, state law requires us to report gunshot wounds and other injuries to the police and to report

known or suspected child abuse or neglect to the Department of Social Services. We will comply with those state laws and with all other applicable

laws.

6. National Priority Uses and Disclosures

When permitted by law, we may use or disclose medical information about you without your permission for various activities that are recognized as

"national priorities.” In other words, the government has determined that under certain circumstances (described below), it is so important to disclose

medical information that it is acceptable to disclose medical information without the individual’s permission. We will only disclose medical information

about you in the following circumstances when we are permitted to do so by law. Below are brief descriptions of the "national priority” activities

recognized by law. For more information on these types of disclosures, contact our Privacy Officer at(337) 942-7551.

Threat to health or safety:We may use or disclose medical information about you if we believe it is necessary to prevent or lessen a

serious threat to health or safety.

Public health activities:We may use or disclose medical information about you for public health activities. Public health activities require

the use of medical information for various activities, including, but not limited to, activities related to investigating diseases, reporting child

abuse and neglect, monitoring drugs or devices regulated by the Food and Drug Administration, and monitoring work-related illnesses or

injuries. For example, if you have been exposed to a communicable disease (such as a sexually transmitted disease), we may report it to

the State and take other actions to prevent the spread of the disease.

Abuse, neglect or domestic violence:We may disclose medical information about you to a government authority (such as the

Department of Social Services) if you are an adult and we reasonably believe that you may be a victim of abuse, neglect or domestic

violence.

Health oversight activities:We may disclose medical information about you to a health oversight agency – which is basically an agency

responsible for overseeing the healthcare system or certain government programs. For example, a government agency may request

information from us while they are investigating possible insurance fraud.

Court proceedings:We may disclose medical information about you to a court or an officer of the court (such as an attorney). For

example, we would disclose medical information about you to a court if a judge orders us to do so.

Law enforcement:We may disclose medical information about you to a law enforcement official for specific law enforcement purposes.

For example, we may disclose limited medical information about you to a police officer if the officer needs the information to help find or

identify a missing person.

Coroners and others:We may disclose medical information about you to a coroner, medical examiner, or funeral director or to

organizations that help with organ, eye and tissue transplants.

Workers’ compensation:We may disclose medical information about you in order to comply with workers’ compensation laws.

Research organizations:We may use or disclose medical information about you to research organizations if the organization has

satisfied certain conditions about protecting the privacy of medical information.

Certain government functions:We may use or disclose medical information about you for certain government functions, including but

not limited to military and veterans’ activities and national security and intelligence activities. We may also use or disclose medical

information about you to a correctional institution in some circumstances.

7. Authorizations

Other than the uses and disclosures described above (#1-6), we will not use or disclose medical information about you without the "authorization” – or

signed permission – of you or your personal representative. In some instances, we may wish to use or disclose medical information about you and we

may contact you to ask you to sign an authorization form. In other instances, you may contact us to ask us to disclose medical information and we will

ask you to sign an authorization form.

If you sign a written authorization allowing us to disclose medical information about you, you may later revoke (or cancel) your authorization in writing

(except in very limited circumstances related to obtaining insurance coverage). If you would like to revoke your authorization, you may write us a letter

revoking your authorization or fill out an Authorization Revocation Form. Authorization Revocation Forms are available from our Privacy Officer. If you

revoke your authorization, we will follow your instructions except to the extent that we have already relied upon your authorization and taken some

action.

The following uses and disclosures of medical information about you will only be made with your authorization (signed permission):

Uses and disclosures for marketing purposes.

Uses and disclosures that constitute the sales of medical information about you.

Most uses and disclosures of psychotherapy notes, if we maintain psychotherapy notes.

Any other uses and disclosures not described in this Notice.

You have several rights with respect to medical information about you. This section of the Notice will briefly mention each of these rights. If you would

like to know more about your rights, please contact our Privacy Officer at(337) 942-7551.

1. Right to a Copy of This Notice

You have a right to have a paper copy of our Notice of Privacy Practices at any time. In addition, a copy of this Notice will always be posted in our

waiting area. If you would like to have a copy of our Notice, ask the receptionist for a copy or contact our Privacy Officer at(337) 942-7551.

2. Right of Access to Inspect and Copy

You have the right to inspect (which means see or review) and receive a copy of medical information about you that we maintain in certain groups of

records. If we maintain your medical records in an Electronic Health Record (EHR) system, you may obtain an electronic copy of your medical records.

You may also instruct us in writing to send an electronic copy of your medical records to a third party. If you would like to inspect or receive a copy of

medical information about you, you must provide us with a request in writing. You may write us a letter requesting access or fill out anAccess Request

Form. Access Request Forms are available from our Privacy Officer.

We may deny your request in certain circumstances. If we deny your request, we will explain our reason for doing so in writing. We will also inform you

in writing if you have the right to have our decision reviewed by another person.

If you would like a copy of the medical information about you, we will charge you a fee to cover the costs of the copy. Our fees for electronic copies of

your medical records will be limited to the direct labor costs associated with fulfilling your request.

$25.00 Research Fee;

$1.00 per page up to 25 pages; 50˘/page 26-50 pages; 25˘/page 51 pages & over

We may be able to provide you with a summary or explanation of the information. Contact our Privacy Officer for more information on these services

and any possible additional fees.

3. Right to Have Medical Information Amended

You have the right to have us amend (which means correct or supplement) medical information about you that we maintain in certain groups of records.

If you believe that we have information that is either inaccurate or incomplete, we may amend the information to indicate the problem and notify others

who have copies of the inaccurate or incomplete information. If you would like us to amend information, you must provide us with a request in writing

and explain why you would like us to amend the information. You may either write us a letter requesting an amendment or fill out anAmendment

Request Form. Amendment Request Forms are available from our Privacy Officer.

YOU HAVE RIGHTS WITH RESPECT

TO MEDICAL INFORMATION ABOUT YOU

We may deny your request in certain circumstances. If we deny your request, we will explain our reason for doing so in writing. You will have the

opportunity to send us a statement explaining why you disagree with our decision to deny your amendment request and we will share your statement

whenever we disclose the information in the future.

4. Right to an Accounting of Disclosures We Have Made

You have the right to receive an accounting (which means a detailed listing) of disclosures that we have made for the previous six (6) years. If you

would like to receive an accounting, you may send us a letter requesting an accounting, fill out anAccounting Request Form, or contact our Privacy

Officer. Accounting Request Forms are available from our Privacy Officer.

The accounting will not include several types of disclosures, including disclosures for treatment, payment or healthcare operations. If we maintain your

medical records in an Electronic Health Record (EHR) system, you may request that include disclosures for treatment, payment or healthcare

operations. The accounting will also not include disclosures made prior to April 14, 2003.

If you request an accounting more than once every twelve (12) months, we may charge you a fee to cover the costs of preparing the accounting.

$25.00 per hour of Research

5. Right to Request Restrictions on Uses and Disclosures

You have the right to request that we limit the use and disclosure of medical information about you for treatment, payment and healthcare operations.

Under federal law, we must agree to your request and comply with your requested restriction(s) if:

1.Except as otherwise required by law, the disclosure is to a health plan for purpose of carrying out payment of healthcare operations (and

is not for purposes of carrying out treatment); and,

2.The medical information pertains solely to a healthcare item or service for which the healthcare provided involved has been paid out-ofpocket

in full.

Once we agree to your request, we must follow your restrictions (except if the information is necessary for emergency treatment). You may cancel the

restrictions at any time. In addition, we may cancel a restriction at any time as long as we notify you of the cancellation and continue to apply the

restriction to information collected before the cancellation.

You also have the right to request that we restrict disclosures of your medical information and healthcare treatment(s) to a health plan (health insurer) or

other party, when that information relates solely to a healthcare item or service for which you, or another person on your behalf (other than a health

plan), has paid us for in full. Once you have requested such restriction(s), and your payment in full has been received, we must follow your restriction(s).

6. Right to Request an Alternative Method of Contact

You have the right to request to be contacted at a different location or by a different method. For example, you may prefer to have all written information

mailed to your work address rather than to your home address.

We will agree to any reasonable request for alternative methods of contact. If you would like to request an alternative method of contact, you must

provide us with a request in writing. You may write us a letter or fill out anAlternative Contact Request Form. Alternative Contact Request Forms are

available from our Privacy Officer.

7. Right to Notification if a Breach of Your Medical Information Occurs

You also have the right to be notified in the event of a breach of medical information about you. If a breach of your medical information occurs, and if that

information is unsecured (not encrypted), we will notify you promptly with the following information:

A brief description of what happened;

A description of the health information that was involved;

Recommended steps you can take to protect yourself from harm;

What steps we are taking in response to the breach; and,

Contact procedures so you can obtain further information.

8. Right to Opt-Out of Fundraising Communications

If we conduct fundraising and we use communications like the U.S. Postal Service or electronic email for fundraising, you have the right to opt-out of

receiving such communications from us. Please contact our Privacy Officer to opt-out of fundraising communications if you chose to do so.

YOU MAY FILE A COMPLAINT

ABOUT OUR PRIVACY PRACTICES

If you believe that your privacy rights have been violated or if you are dissatisfied with our privacy policies or procedures, you may file a written complaint

either with us or with the federal government.

We will not take any action against you or change our treatment of you in any way if you file a complaint.

To file a written complaint with us, you may bring your complaint directly to our Privacy Officer, or you may mail it to the following address:

Tammy Robert

7591 I 49 Service Road South

Opelousas LA 70570

To file a written complaint with the federal government, please use the following contact information:

Office for Civil Rights

U.S. Department of Health and Human Services

200 Independence Avenue, S.W.

Room 509F, HHH Building

Washington, D.C. 20201

Toll-Free Phone: 1-(877) 696-6775 Website:http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.htmlEmail:OCRComplaint@hhs.gov


 

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