Privacy Policy

UNDERSTANDING THIS NOTICE
We understand that information about your health, health care and payment for health care is personal and confidential, and we are committed to safeguarding that information. Further, your health information is protected by state and federal laws and regulations. This notice will tell you about the ways in which 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 your protected health information This notice applies to Middle Tennessee Medical Center ("MTMC") its employees and other hospital personnel, volunteers who we allow to help you while you are at MTMC, and health care professionals1 (such as your doctor) with staff privileges at MTMC This notice applies only to your protected health information created while you are a patient at MTMC Health care professionals with staff privileges at MTMC may have different practices or notices regarding your health information created in their offices or clinics.

YOUR HEALTH INFORMATION RIGHTS
Although your health record is the physical property of MTMC, the information belongs to you. You have the right to:

• Request a restriction on certain uses and disclosures of your protected health information for treatment, payment or health care operations. You also have the right to request restrictions on certain disclosures to persons, such as family members involved with your care or the payment for your care. However, we are not required to agree to these requests. We will attempt to notify you if we are unable to grant your request;
• Obtain a copy of this notice of privacy practices upon request. You may request a paper copy of this notice, in person, at MTMC You may also obtain a copy of this notice from MTMC’s website at www.sths.com·
• Inspect and request a copy of your health record as provided by law;
• Request that we amend your health record as provided by law. We will attempt to notify you if we are unable to grant your request;
• Obtain an accounting of certain disclosures of your protected health information as provided by law;
• Request communications of your protected health information by alternative means or at alternative locations. We will accommodate reasonable requests; and
• Revoke your authorization to use or disclose your protected health information except to the extent that action has already been taken in reliance on your authorization. You may exercise your rights set forth in this notice, by providing a written request to MTMC’s Health Information Management Department at 400 N. Highland Ave. Murfreesboro, TN 37130.

OUR RESPONSIBILITIES
In addition to the responsibilities set forth above, we are also required to:

• Maintain the privacy of your health information;
• Provide you with a notice as to our legal duties and privacy practices with respect to protected health information we maintain about you;
• Abide by the terms of MTMC’s Notice of Privacy Practices currently in effect;
• We reserve the right to change our practices and to make changes effective for all protected health information we maintain, including information created or received before the change. Should our privacy practices change, we are not required to notify you, but we may post the revised notice at MTMC, and you may request copies of the revised notice in person at MTMC and on MTMC’s web site at www.sths.com.

HOW WE USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
Generally, we may not use or disclose your protected health information without your written authorization. However, in certain circumstances, we are permitted to use your protected health information without authorization. The following categories describe different ways that we may use and disclose your health information without your written authorization. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information without your written authorization should fall within one of these categories.

WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION FOR TREATMENT.
For example, we may disclose your protected health information to doctors, nurses, technicians, medical students or other personnel who are involved in taking care of you within MTMC We may share medical information about you in order to coordinate different treatments, such as prescriptions, lab work and x-rays. We may also provide your physician or a subsequent healthcare provider with copies of various reports to assist in treating you once you are discharged from care at MTMC.

WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION FOR PAYMENT.
For example, we may send a bill to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures and supplies used.

WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION FOR HEALTH CARE OPERATIONS.
For example, we may use the information in your health record to assess the care and outcome in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and services we provide. We may otherwise use the information about you, as needed, to facilitate the operation of our facility. Further, MTMC and health care professionals with staff privileges may share medical information with each other for treatment, payment or health care operations.

WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION AS OTHERWISE ALLOWED BY LAW.
The following categories describe different ways that we may use and disclose your protected health in formation for other than treatment, payment or health care operations without your written authorizations. Some of the examples listed in these categories may require your permission, though your permission need not be given in writing. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information for other than treatment, payment or health care operations without your written authorization should fall within one of these categories.

Business associates: We provide some services through business associates. Examples include certain laboratory tests and copy services. To protect your information, however, we require business associates to take appropriate measures to safeguard your information.
Directory: Unless you notify us that you object, we will use and disclose your name, location in our facility and general condition for directory purposes while you are a patient at MTMC to people who ask for you by name. If you agree, we may also provide this information and your religious affiliation to clergy, regardless of whether they ask for you by name.
Involvement in Care or Notification: We may use or disclose information to family members or others who you have involved in your care or to notify or assist in notifying a family member, personal representative or another person responsible for your care, of your location, general condition or death.
Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
Funeral directors, coroners and medical examiners: We may disclose information to funeral directors, coroners and medical examiners consistent with applicable law to carry out their duties.
Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs for the purpose of tissue donation and transplant.
Communications for treatment and health care operations: 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.
Marketing: We may communicate with you face-to-face regarding goods and services that may be of interest to you and may provide you with promotional gifts of nominal value
Fund raising: We may contact you as part of a fund-raising effort.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, medications, devices, supplements, product and product defects or post marketing surveillance information to enable product recalls, repairs or replacement.
Health Oversight Activities: We may disclose your health information to a health oversight agency for activities authorized by law These oversight activities might include audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government benefit programs and compliance with civil rights laws.
Worker's compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to worker's compensation or other similar programs established by law.
Public health: Consistent with applicable law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.
Abuse, neglect or domestic violence: Consistent with applicable law, we may disclose health information to a governmental authority authorized by law to receive reports of abuse, neglect or domestic violence.
Judicial, administrative and law enforcement purposes: Consistent with applicable law, we may disclose health information about you for judicial, administrative and law enforcement purposes. This may include, for example, disclosures to avert a serious threat to your health or a third party's health or safety as well as victims of crime or criminal conduct at MTMC.
To avert a serious threat to health or safety: Consistent with applicable law, we may use and disclose your health information when we believe it is 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 or lessen the threat or to law enforcement authorities in particular circumstances. We may release your health information to authorized federal officials for lawful intelligence, counterintelligence and other national security activities authorized by law.
Protective services for the President and others: We may disclose your health in formation to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or for the conduct of special investigations to the extent permitted by law.
Custodial situations: If you are an inmate in a correctional institution and if the correctional institution or law enforcement authority makes certain representations to us, we may disclose your health information to a correctional institution or law enforcement official in certain circumstances.
Required or allowed by law: We may use and disclose your protected health information required to do so by federal, state or local law.

FOR MORE INFORMATION OR TO REPORT
A PROBLEM: If you have questions and would like additional information, you may contact MTMC's Director of Health Information Management at 615-396-4636. If you believe your privacy rights have been violated, you can file a written complaint with the Corporate Privacy Officer at 615-222-6628 (4220 Harding Road, Nashville, TN 37205) or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

1 I understand that the physicians participating in my care at MTMC, including the physicians in the Emergency Department, are not employees or agents of MTMC and are not acting for or on behalf of MTMC. They are either independent physicians who are engaged in the private practice of medicine who have been granted privileges to use this facility for the care of their patients or licensed physicians who are engaged in a post graduate medical education program. I understand that all medical decisions regarding my care and treatment at MTMC are made by such physicians and not by MTMC.