PRIVACY NOTICE

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAINTAINED BY THE MCDOWELL HOSPITAL, MARION, NORTH CAROLINA MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.

HOW THE MCDOWELL HOSPITAL MAY USE OR DISCLOSE YOUR HEALTH INFORMATION

FEDERAL LAW REQUIRES THE MCDOWELL HOSPITAL TO MAINTAIN THE PRIVACY OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION AND TO PROVIDE YOU WITH NOTICE OF ITS LEGAL DUTIES AND PRIVACY PRACTICES WITH RESPECT TO SUCH INFORMATION. THE MCDOWELL HOSPITAL MUST ABIDE BY THE TERMS AND CONDITIONS OF THIS PRIVACY NOTICE, AS THE MCDOWELL HOSPITAL MAY REVISE THIS PRIVACY NOTICE FROM TIME TO TIME.

USES OR DISCLOSURES OF HEALTH INFORMATION FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS

When you sign a written consent, you agree that The McDowell Hospital may use your individually identifiable health information for treatment, payment and health care operations. Examples of treatment, payment and health care operations include:

• “Treatment” could include consulting with or referring your case to another health care provider. The type of health information that could be used or disclosed includes such health conditions as HIV status, a diagnosis or AIDS or other communicable diseases that are subject to public health reporting requirements.

• “Payment” could include The McDowell Hospital’s efforts to obtain reimbursement from you or a responsible third party for services that The McDowell Hospital has provided to you.

• “Health care operations” could include activities such as quality assessment and improvement activities and audits of the process of billing you or a third party for health care services The McDowell Hospital provides to you. As part of The McDowell Hospital’s treatment of you and operation of a health care organization, The McDowell Hospital may contact you, by phone or mail, to provide appointment reminders or to provide information about treatment alternatives or other health-related services that may be of interest to you.

USES OR DISCLOSURES THE MCDOWELL HOSPITAL MAY MAKE WITHOUT YOUR CONSENT OR AUTHORIZATION

In addition to treatment, payment and health care operations, and unless this Privacy Notice recites a more stringent restriction in Section C, the law permits or requires The McDowell Hospital to use or disclose individually identifiable health information without your consent or authorization to: (i) comply with public health reporting and notification requirements, including reports of adverse product events to the Food and Drug Administration, (ii) report suspected abuse, neglect or domestic violence, as required by law, (iii) submit information to health oversight agencies for oversight activities, such as audits, authorized by law, (iv) respond to a final order or subpoena of a court or administrative tribunal, (v) assist law enforcement personnel, as required by law, or to fulfill a law enforcement request for certain limited information for the purpose of identifying or locating a suspect, witness, or victim in an investigation, or to report a potential crime, (vi) assist a medical examiner or funeral director, (vii) assist an organ procurement organization or organ bank in facilitating organ or tissue donation and transplantation, (viii) further research, provided that The McDowell Hospital complies with federal requirements, (ix) avert a serious and imminent threat to public health safety, (x) assist with government activities related to the military, veterans or national security, (xi) comply with workers’ compensation or similar laws, (xii) allow individuals responsible for your care to assist you in the event of your incapacity or an emergency, (xiii) business associates and, (xiv) with your agreement, may also disclose certain information for purposes of its:

Please initial one or both of the following:

_____ Patient directory or census

_____ To inform relatives or other individuals directly involved in your care or payment for your care regarding your condition.

MORE STRINGENT PROTECTION FOR YOUR HEALTH INFORMATION

In certain cases, North Carolina law provides more stringent privacy protections of your health information than this Privacy Notice recites above. Specifically, the following:

• If you are a patient with AIDS or HIV infection or a communicable disease or condition subject to public health reporting requirements, The McDowell Hospital will only disclose information regarding your AIDS, HIV or communicable disease status with your written permission except

(i) if you cannot be identified from the information, (ii) as disclosure is required or permitted under communicable disease law or laws specifically authorizing or requiring disclosure of AIDS, HIV or communicable disease information or records, (iii) if a subpoena or court order requires disclosure, or (iv) if release is necessary to protect public health. When you sign a written consent, you are agreeing that The McDowell Hospital may disclose or use this information for treatment, payment and health care operations purposes. If The McDowell Hospital reveals your information for any purpose other than treatment, payment or health care operations purposes, then you must sign a different permission form.

• If you are an Outreach home care patient of The McDowell Hospital, your personal and medical records may not be disclosed by the Outreach program without your written release unless disclosure is required by law. The written release must specify to whom the disclosure may be made except if disclosure is: (a) for the purposes of payment, treatment or health care operations and is a party contracted with the Outreach home care program (and the contract requires disclosure), (b) to the treating physician, or (c) to agencies/institutions/individuals providing emergency medical services. You may object in writing to a treating physician’s access to your medical records and the Outreach Home Care Program may not refuse to abide by such objection.

• If you provide confidential information to a substance abuse professional affiliated with The McDowell Hospital, then the substance abuse professional will not reveal that information to anyone, unless you give permission in writing. When you sign a written consent, you are agreeing that a substance abuse professional may share information you have provided to the substance abuse professional when the substance abuse professional discloses this information for treatment, payment and health care operations purposes. If the substance abuse professional reveals your information for any purpose other than treatment, payment or health care operations purposes, then you must sign a different permission form. However, please note that the substance abuse professional may reveal the information without your written permission if there is a clear and imminent danger to you or to others; in a medial emergency, but then only to an appropriate professional or to public authorities; or, when the law requires the substance abuse professional to disclose the information.

• For patients of The McDowell Hospital’s cardiac rehabilitation program, you have the right to object in writing to The McDowell Hospital’s cardiac rehabilitation program disclosing your individually identifiable health information to the North Carolina Department of Health and Human Services during an inspection.

• If you are an unemancipated minor under North Carolina law, The McDowell Hospital physicians will not disclose, without your consent, information related to your health status regarding treatment for venereal disease, pregnancy, abortion, abuse of drugs or alcohol or emotional disturbance to a parent, legal guardian, person standing in loco parentis or a legal custodian who has legal authority to provide permission for your medical or psychiatric care.

NO OTHER USES OR DISCLOSURES WITHOUT YOUR WRITTEN AUTHORIZATION

The McDowell Hospital will not make any other uses and disclosures of your individually identifiable health information without your written authorization. Your authorization may be revoked at any time if you provide written notice to The McDowell Hospital.

YOUR RIGHTS

Federal and state law protects your rights to keep your individually identifiable health information private. You may request restrictions on certain uses and disclosures of protected health information for purposes of treatment, payment and health care operations; however, the law does not require The McDowell Hospital to agree to the requested restrictions. You may also request that you receive communications from The McDowell Hospital regarding individually identifiable health information by alternative means or at alternative locations. You must make your request for confidential communications in writing and must submit this request to the office listed below. The McDowell Hospital reserves the right to condition your request on the receipt of information regarding how you desire The McDowell Hospital handle payment and/or on the availability of an alternative address or method of contact that you may request.

You have the right to inspect and obtain a copy of any individually identifiable health information in your medical record unless your attending physician has determined that there is a sound medical reason to deny you access or unless the law restricts The McDowell Hospital from disseminating the information. You also have the right to amend the health information which you inspect, unless The McDowell Hospital did not create such information or unless The McDowell Hospital determines that your medical record is accurate and complete in its existing form.

You have the right to request and receive an accounting of disclosures of your individually identifiable health information that The McDowell Hospital has made in the six (6) years prior to the request date, or during the period between the request date and the date that federal law required The McDowell Hospital to comply with federal privacy regulations (April 14, 2003), whichever is more recent. Such an accounting will not include disclosures made to carry out treatment, payment or health care operations, to create an accurate patient directory or notify persons involved in your care, to ensure national security, to comply with the authorized requests of law enforcement or to inform you of the content of your medical records. If you would like more information on how to exercise these right, please contact The McDowell Hospital’s Chief Privacy Officer at (828) 659-5100.

GRIEVANCES OR FURTHER INQUIRES

If you believe that The McDowell Hospital has violated your privacy rights with respect to individually identifiable health information, you may file a complaint with The McDowell Hospital and the Department of Health and Human Services. To file a complaint with The McDowell Hospital, please contact the Chief Privacy Officer at (828) 659-5100. The McDowell Hospital will not retaliate against you for filing a complaint. You may also contact the Chief Privacy Officer for a copy of this Privacy Notice or for further information regarding its contents.

AMENDMENTS

The McDowell Hospital reserves the right to amend the terms of this Privacy Notice at any time and to apply the revised Privacy Notice to all individually identifiable health information that it maintains. If The McDowell Hospital amends this Privacy Notice, you will be provided with a revised copy at your next visit to The McDowell Hospital, or upon request. The revised Privacy Notice will also be available on The McDowell Hospital’s web site, www.mcdhospital.org. This Privacy Notice is effective on April 14, 2003.