William R. Sharpe, Jr. Hospital

Your Rights

  1.  Authorization.  We may use or disclose your health information for any purpose that is listed in this notice.  When your written authorization or consent is required to disclose such information, it is specifically stated above.  We will not use or disclose your health information for any other reason without your authorization.  If you authorize us to use or disclose your health information, you have the right to revoke the authorization at any time.  For information about how to authorize us to use or disclose your health information, or about how to revoke an authorization, contact the person listed under “Whom to Contact” at the end of this notice.  You may not revoke an authorization for us to use and disclose your information to the extent that we have taken action in reliance on the authorization.  If the authorization is to permit disclosure of your information to an insurance company, as a condition of obtaining coverage, other law may allow the insurer to continue to use your information to contest claims or your coverage, even after you have revoked the authorization.

2.  Request Restrictions.  You have the right to ask us to restrict  how we use or disclose your health information.  We will consider your request.  However, we are not required to agree.  If we do agree, we will comply with your request unless the information is needed to provide you with emergency  treatment.  We cannot agree to restrict disclosures that are required by law .

3.  Confidential Communication.  You have the right to ask us to communicate with you at a special address  or by a special means.  For example, you may ask us to send mail to a different address rather than to your home.  Or you may ask us to speak to you personally on the telephone rather than sending your health information by mail.  We will not ask you to explain why you are making the request.  We will agree to any reasonable request. 

4.  Inspect And Receive a Copy of Health Information.  You have a right to inspect the health information about you that we have in our records, and to receive a copy  of it.  This right is limited to information about you that is kept in records that are used to make decisions about you.  For instance, this includes medical and billing records.  If you want to review  or receive a copy of these records, you must make the request in writing.  We may charge a fee for the cost of copying  and mailing the records.  To ask to inspect your records, or to receive a copy, contact the person listed under “Whom to Contact” at the end of this notice .  We will respond to your request within 30 days.  We may deny you access to certain information.  If we do, we will give you the reason, in writing.  We will also explain how you may appeal  the decision. 

5.  Amend Health Information.  You have the right to ask us to amend  health information about you which you believe is not correct, or not complete.  You must make this request in writing, and give us the reason you believe the information is not correct or complete.  We will respond to your request in writing within 30 days.  We may deny your request if we did not create the information, if it is not part of the records we use to make decisions about you, if the information is something you would not be permitted to inspect or copy , or if our existing information is complete and accurate.

6.  Accounting of Disclosures.  You have a right to receive an accounting  of certain disclosures of your information to others.  This accounting will list the times we have given your health information to others.  The list will include dates of the disclosures, the names of the people or organizations to whom the information was disclosed, a description of the information, and the reason.  We will provide the first list of disclosures you request at no charge.  We may charge you for any additional lists you request during the following 12 months.  You must tell us the time period you want the list to cover.  You may not request a time period longer than six years.  We cannot include disclosures made before April 14, 2003.  Disclosures for the following reasons will not be included on the list:  disclosures for treatment, payment, or health care operations; disclosures of information in a facility directory ; disclosures for national security purposes ; disclosures to correctional or law enforcement personnel; disclosures that you have authorized; and disclosures made directly to you. 

7.  Paper Copy of this Privacy Notice.  You have a right to receive a paper copy of this notice .  If you have received this notice electronically, you may receive a paper copy  by contacting the person listed under “Whom to Contact” at the end of this notice.

8.  Complaints.  You have a right to complain about our privacy practices, if you think your privacy has been violated.  You may file your complaint with the person listed under “Whom to Contact” at the end of this notice .  You may also file a complaint directly with the Secretary of the U. S. Department of Health and Human Services, at the Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington, D.C. 20201.  All complaints  must be in writing.  We will not retaliate against you if you file a complaint.

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