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.
Effective Date: January 2025
This notice describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment, or healthcare operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. Protected health information is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health condition and related healthcare services.
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at Citizens Medical Center. We need this record to provide you with quality care and to comply with certain legal requirements.
This notice applies to all of the records of your care generated by Citizens Medical Center, whether made by hospital personnel or your personal doctor. We are required by law to maintain the privacy of your protected health information, provide you with this notice of our legal duties and privacy practices, and follow the terms of this notice currently in effect.
The following categories describe different ways that we use and disclose protected health information:
We may use your health information to provide you with medical treatment or services. We may disclose health information about you to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. Different departments of our hospital also may share health information about you in order to coordinate your care, such as prescriptions, lab work, and X-rays.
We may use and disclose health information about you so that the treatment and services you receive at the hospital may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about surgery you received at the hospital so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
We may use and disclose health information about you for hospital operations. These uses and disclosures are necessary to run the hospital and make sure that all of our patients receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many hospital patients to decide what additional services the hospital should offer, what services are not needed, and whether certain new treatments are effective.
We may also use or disclose your protected health information in the following situations without your authorization or providing you the opportunity to agree or object:
Other uses and disclosures of your health information not covered by this notice or the laws that apply to us will be made only with your written authorization. These include:
If you provide us authorization to use or disclose health information about you, you may revoke that authorization, in writing, at any time. However, the revocation will not apply to information that has already been released in response to an authorization.
You have the following rights regarding health information we maintain about you:
You have the right to inspect and copy health information that may be used to make decisions about your care. This includes medical and billing records, but does not include psychotherapy notes. You must submit your request in writing to the Medical Records Department. We may charge a fee for the costs of copying, mailing, or other supplies associated with your request.
If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the hospital. Your request must be submitted in writing and provide a reason that supports the request. We may deny your request under certain circumstances and will provide you with a written explanation.
You have the right to request an accounting of disclosures, which is a list of the disclosures we made of health information about you for purposes other than treatment, payment, healthcare operations, and certain other activities. Your request must be submitted in writing and state a time period (no longer than six years). The first accounting within a 12-month period is free; additional requests may be charged a fee.
You have the right to request a restriction on the health information we use or disclose about you for treatment, payment, or healthcare operations. You may also request a limit on the health information we disclose about you to someone involved in your care or payment. We are not required to agree to your request except when you pay for services out-of-pocket in full and request we not disclose to your health plan.
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. Your request must be in writing and must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy.
You have the right to be notified in the event of a breach of your unsecured protected health information. We will notify you of any such breach as required by law.
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the hospital and on our website. The notice will contain the effective date on the first page.
If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with the hospital, contact our Privacy Officer at the address below.
You will not be penalized or retaliated against for filing a complaint.
To file a complaint with the federal government:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775 | www.hhs.gov/ocr
For more information about this notice or to exercise any of your rights, please contact:
Citizens Medical Center
Privacy Officer / Health Information Management
2701 Hospital Drive
Victoria, TX 77901
Phone: (361) 573-9181