This notice describes how information about you may be used and disclosed and how you can gain access to this information. Please read it carefully.

Understanding Your Health Record/Information

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. This information, often referred to as your health or medical record, serves as:
• Basis for planning your care and treatment
• Means of communication among the many health professionals who contribute to your care
• Legal document describing the care you received
• Means by which you or a third-party payer can verify that services billed were actually provided
• A tool in educating health professionals
• A source of data for medical research
• A source of information for public health officials charged with improving the health of the nation
• A source of data for facility planning and marketing
• A tool OMC can use to assess and continually work to improve rendered care and achieved outcomes

Understanding what is in your record and how your health information is used helps you to:
• Ensure its accuracy
• Better understand who, what, when, where, and why others may access your health information
• Make more informed decisions when authorizing disclosure to others

Your Health Information Rights

Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to:
• Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522
• Obtain a paper copy of the notice of privacy practices upon request
• Inspect and copy your health record as provided for in 45 CFR 164.524
• Amend your health record as provided in 45 CFR 164.528
• Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528
• Request communications of your health information by alternative means or at alternative locations
• Revoke your authorization to use or disclose health information except to the extent that action has already been taken

OMC’s Responsibilities

OMC is 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 information we collect and maintain about you
• Abide by the terms of this notice
• 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.
• OMC reserves the right to change its practices and make the new provisions effective for all protected health information it maintains. The most recent copy of OMC’s Notice of Privacy Practices is available at the main campus, clinics and on the website, located at www.ozarksmedicalcenter.com.

OMC will not use or disclose your health information without your authorization, except as described in this notice.

For More Information
or to Report a Problem

If you have questions and would like additional information, you may contact Ozarks Medical Center's Privacy Officer at (417) 257-6774.

If you believe your privacy rights have been violated, you may file a complaint with OMC’s Privacy Officer or with the secretary of Health and Human Services. There will be no retaliation for filing a complaint.

Examples of Disclosures for Treatment, Payment and Health Operations
• OMC will use your health information for treatment.
• For example: Information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record and used to determine the best course of treatment. Your physician will document in your record his or her expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. As a result, the physician will know how you are responding to treatment.

• OMC will also provide your physician or sub-sequent healthcare provider with copies of various reports that should assist him or her in treating you once you are discharged from this hospital.

OMC will use your health
information for payment.

For example: A bill may be sent 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.

OMC will use your health information for regular health operations.

For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.

Business associates: There are some services provided in the OMC organization through contacts with business associates. Examples include physician services in the emergency department and radiology, certain laboratory tests, and independent auditing firms. When these services are contracted, OMC may disclose your health information to its business associate so that they can perform the job the healthcare organization has asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Uses or Disclosures for Which You May Object

Directory: Unless you notify Ozarks Medical Center that you object, OMC will use your name, location in the facility, general condition and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.

Notification: Unless you notify OMC that you object, it may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location and general condition. Your directory information may be given to Public Relations, to members of the clergy or released to the media.

Communication with family: Unless you notify OMC that you object, health professionals, using their best judgment, may disclose 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.

Uses and Disclosures OMC is Permitted to Make without your Authorization

Research: OMC 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: OMC may disclose health information to funeral directors and coroners consistent with applicable law to carry out their duty.

Organ procurement organizations: Consistent with applicable law, OMC 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.

Marketing: OMC may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Appointment Reminders: OMC may contact you to provide appointment reminders.

Fund raising: OMC may contact you as part of a fund-raising effort.

Food and Drug Administration (FDA): OMC may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects or post marketing surveillance information to enable product recalls, repairs or replacement.

Workers compensation: OMC may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Abuse, neglect and domestic violence: OMC may use or disclose protected health information to provide information about suspected abuse, neglect and domestic violence as required by law.

Judicial and administrative proceedings: OMC may use or disclose protected health information as necessary to comply with a court order or with a HIPAA compliant subpoena as consistent with a judicial or administrative proceeding.

Threat to health or safety: OMC is permitted to use or disclose protected health information about you if healthcare officials believe that it is necessary to avert a serious threat to the health and safety of yourself or others.

Specialized Governmental Functions: OMC may use or disclose protected health information as necessary for specialized governmental functions, such as national security and intelligence activities.

Public health: As required by law, OMC may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Correctional institution: Should you be an inmate of a correctional institution, OMC may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.

Law enforcement: OMC may disclose limited health information for law enforcement purposes.

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 OMC has engaged in unlawful conduct or has otherwise violated professional standards and are potentially endangering one or more patients, workers or the public.

Effective Date: April 14, 2003

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