Effective Date: April 14, 2003

Revised Date: May 1, 2004

Revised Date: September 23, 2013

Revised Date: October 7, 2019

Your rights under the Health Insurance Portability & Accountability Act of 1996 (HIPAA)


Who Will Follow This Notice of Privacy Practices (“Notice”): 

This Notice describes Macon Community Hospital’s (the “Facility”) practices and that of:

  • Any health care professional authorized to enter information into your medical record maintained by the Facility
  • All departments and units of the Facility
  • Any member of a volunteer group or student allowed to help you while you are receiving services from the Facility
  • All employees, staff, agents and other Facility personnel
  • All entities, sites and locations within this Facility’s system will follow the terms of this Notice. They also may share health information with each other for treatment, payment, and healthcare operations purposes.

Our Pledge Regarding Health information:

We understand that health information about you and your health is personal and we are committed to protecting your health information. We create a record of care and services you receive at this Facility.  We need this record to provide you with quality care and to comply with certain legal requirements.  This notice applies to all the records of your care generated by the Facility, whether made by hospital personnel or your personal doctor.  Your personal doctor may have different policies or privacy notices regarding the doctor’s use and disclosure of your health information created in the doctor’s office or clinic.

This Notice will tell you about the ways in which the Facility may use and disclose health information about you.  We also describe your rights and certain obligations we have regarding the use and disclosure of health information.

This law requires the Facility to:

  • Make sure that health information that identifies you is kept private;
  • Inform you of our legal duties and privacy practices with respect to health information about you; and
  • Follow the terms of the Notice that is currently in effect.

How the Facility May Use & Disclose Your Health Information

The following categories describe different ways that the law allows us to use and disclose health information.  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 the ways the Facility is permitted to use and disclose information will fall within one of the categories.

For Treatment: Your health information may be used to provide you with medical treatment or services.   We may disclose health information about you to doctors, nurses, technicians, medical students, or other hospital workforce members of the Facility who are involved in taking care of you at the hospital.  We also may disclose health information about you to people outside the hospital who may be involved with your medical care, such as family members, home health nurses, nursing home personnel or others who provide services that are part of your care.

We may release health information about you to your primary care physician to continue care for you when you leave the hospital or for follow-up from an emergency room visit.

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.  In addition, the doctor may need to tell the dietician if you have diabetes so that we can arrange for appropriate meals.  Different departments of the Facility may also share health information about you in order to coordinate the different things you need, such as prescriptions, lab work, and x-rays.

For Payment: Your health information may be used and disclosed so that the treatment and services received at the Facility may be billed and payment may be collected from you, the insurance company, and/or a third party.

For example, the health plan or insurance company may need information about the care you received from the Facility so they can provide payment for the costs of services.  Information may also be given to someone who helps pay for your care.  Your health plan or insurance company may also need information about a treatment you are going to receive to obtain prior approval or to determine whether they will cover the treatment.

There are some services provided in our hospital through contracts with business associates.  For example: radiology services or certain laboratory tests.  We may disclose your health information to our business associates whom we have contracted with to perform specific duties and to assist with billing you or your health plan for services rendered.  To protect your information, we do require the business associate to sign a contract to appropriately safeguard your information.

For Health Care Operations:  Your health information may be used and disclosed for purposes of furthering day-to-day Facility operations.  These uses and disclosures are necessary to run the Facility and to monitor the quality of care our patients receive.

For example, your health information may be:

  • Reviewed to evaluate the treatment and services performed by our staff in caring for you.
  • Combined with that of other Facility patients to decide what additional services the Facility should offer, what services are not needed, and whether certain new treatments are effective.
  • Disclosed to doctors, nurses, technicians, and other agents of the Facility for review and learning purposes.
  • Disclosed to health care students, interns and residents.
  • Combined with information from other facilities to compare how we are doing and see where we can improve the care and services offered. Information that identifies you in this set of health information may be removed so others may use it to study health care and health care delivery without knowing who the specific patients are.
  • Used to assess your satisfaction with our services.
  • Used for population-based activities relating to improving health or reducing health care costs.

Facility Directory: We may include certain limited information about you in the Facility Directory while you are a patient at the Facility.  The information may include your name, location in the facility, your general condition (e.g., good, fair) and your religious affiliation.  This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.  You will be given an opportunity to decline or “opt out:” being listed in the directory at the time of your admission to the hospital and you may request to have your name taken out of the directory at any time during your stay.

Appointment Reminders and Follow-up calls: Your health information may be used to contact you to remind you of an appointment you have at the Facility or for follow-up calls. Unless you have requested, we communicate with you in a different way, we may leave a message on you answering machine/voice mail or with a family member or other person who answers the phone if you are not home.  We will, however, make every effort to limit the information disclosed in these ways.

Treatment Alternatives: Your health information may be used to tell you about or recommend possible treatment options or alternative that may be of interest to you.

Health-Related Benefits and Services:  Your health information may be used to tell you about health-related benefits or services that may be of interest to you.

Individuals Involved in Your Care or Payment of Your Care:  With your permission, your health information may be released to a family member, guardian, or other individuals involved in your care.  They may also be told about your condition unless you have requested additional restrictions.    In addition, your health information may be disclosed to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

Fundraising and Marketing: We will not use your health information for fundraising or marketing activities without your prior consent. We may post cards and comments received on public display or in advertisements.  We will not use your health information for marketing communications without your written authorization

Research:  Under certain circumstances, your health information may be used and disclosed for research purposes.

For Example, A research project may involve comparing the health and recovery of patients who received one medication to those who received another, for the same condition.  All research projects, however, are subject to a special approval process.  The process evaluates a proposed research project and its use of health information, balancing the research needs with the patient’s need for privacy of their health information.  Your health information may be disclosed to people preparing to conduct a research project.

As Required by Law: Your health information will be disclosed when required to do so by federal, state, or local authorities, laws, rules and/or regulations.

♦  Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, your health information will be disclosed in response to a court or administrative order, subpoena, discovery request, or other lawful process by someone else involved in the dispute when we are legally required to respond.

♦ Law Enforcement:  Your health information will be released if requested by a law enforcement official:

  • In response to a court order, subpoena, warrant, summons or similar process;
  • To identify or locate a suspect, fugitive, material witness, or missing person;
  • About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
  • About a death we believe may be the result of criminal conduct; and
  • In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

♦ National Security and Intelligence Activities:  Your health information will be released to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

♦ Protective Services for the President of the United States and Other:  Your health information may be disclosed to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

♦ To Alert a Serious Threat to Health or Safety:  Your health information may be used and disclosed when necessary to prevent a serious threat to your health and safety and that of the public or another person.  Any disclosure, however, would only be to someone able to help prevent the threat.

♦ Health Oversight Activities:  Your health information may be disclosed to a health oversight facility for activities authorized by law.  These oversight activities include, for example, audits, investigations, inspections, and licensure.  These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.

Private Accreditation Organizations:   Your health information may be used to fulfill this Facility’s requirements to meet the guidelines of private facility accreditation organizations such as DNV, Joint Commission, National Committee for Quality Assurance, etc.

Business Associates:  There are some services provided in this Facility through contracts with business associates.  Examples include information technology support services or a contracted radiology service.  When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered.  To protect your health information, however, business associates, and subcontractors of business associates, are required by federal law to appropriately safeguard your information.

Future Communications:  We may communicate to you via mail outs, newsletters, or other means regarding health-related information, disease-management programs, wellness programs, or other community-based initiatives or activities our Facility is participating in.

Special Situations

Organ and Tissue Donation: If you are an organ or tissue donor, we may release your health information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Medical Devices:  Your social security number and other required information will be released in accordance with federal laws and regulations to the manufacturer of any medical device(s) you have implanted or explanted during a hospitalization and to the Food and Drug Administration, if applicable.  This information may be used to locate you should there be a need with regard to such medical devices(s).

HIV, Substance Abuse, Mental Health and Genetic Information:

Special privacy protections apply to HIV-related information, alcohol and substance abuse, mental health, and genetic information.  Some parts of the Notice may not apply to these kinds of protected health information.  Please check with our Facility Privacy Officer for information about the special protections that do apply.  For example, if we give you a test to determine if you have been exposed to HIV, we will not disclose the fact that you have taken the test to anyone without your written consent unless otherwise required by law.

Military and Veteran: If you are a member of the Armed Forces, we may release health information about you as required by military command authorities. If you are a member of the foreign military personnel, your health information may be release to the appropriate foreign military authority.

Emergency/Disaster Situations:  In the case of a disaster (such as mass casualties), we may disclose health information about you to an entity assisting in disaster relief effort so that your family can be notified about your condition, status and location.

Workers Compensation: If you seek treatment for a work-related illness or injury, we must provide full information in accordant with state-specific laws regarding workers’ compensation claims.  Once state-specific requirements are met and appropriate written request is received, only the records pertaining to the work-related illness or injury may be disclosed.

Public Health Risk: Your health information may be used and disclosed for public health activities.  These activities generally include the following:

  • To prevent or control disease, injury, or disability;
  • To report births and deaths;
  • To report child abuse or neglect;
  • To report reactions to medications or problems with products;
  • To notify people of recalls of products they may be using;
  • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
  • To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Coroners, Medical Examiners, and Funeral Directors:  We may release health information to a coroner or medial examiner.  This may be necessary, for example, to identify a deceased person or determine the cause of death.  We may also release health information about patients of the hospital to funeral directors as necessary to carry out their duties.

Inmate: If you are an inmate of a correctional institution or in the custody of a law enforcement official, we may release health information about you to the correctional institution, the institution’s medical practitioner, or law enforcement official.  This release would be necessary for the following reasons:

  • For the institution to provide you with health care;
  • To protect the health and safety of you and others; and
  • For the safety and security of the correctional institution.


Other Uses of Health information:  Other uses and disclosures of health information not covered by the Notice of the laws that apply to this Facility will be made only with your written authorization.  You understand that we are unable to take back any disclosures already made with your permission, and that we are required to retain our records of the care that the Facility provided to you, therefore disclosures that we made in reliance on your authorization before you revoke it will not be affected by the revocation

Patient Portal:  If you chose to participate in the Patient Portal it is your responsibility to protect the user ID and password that you chose. Please take caution with whom you share your password as this will allow access to your health information through the portal. MCH does not have access to your password.

Your Rights Regarding Your Health information

You have the following rights regarding health information the Facility maintains about you:

NOTE:  All requests to Access and Obtain a Copy your Protected Health information or to Receive and Electronic Copy of the Health information that May be Used to Make Decisions About Your Must Be Submitted in Writing to the Facility Medical Records Department.

Right to Access and Obtain a Copy: You have the right to access your Protected Health Information that may be used to make decisions about your medical care, unless otherwise limited by law,  in a form or format that is readily able to be produced in paper or electronic copy. Usually, this includes medical and billing records, but does not include psychotherapy records. The MCH Medical Record Staff will make all efforts to generate this information to you in the format you request, usually within 30 days. You also have the right to request an explanation or summary of your health information.

To inspect and obtain a copy of your health information, you must submit your request in writing to the Privacy Officer.  HIPAA compliant forms are available at our Facility.

If you request a paper copy of the information, we may charge a fee for the cost of copying, mailing or other supplies associated with your request.

If the Facility uses or maintains an electronic health record in one or more designated record sets with respect to your health information, we must provide you with access to the electronic information in electronic format and the format requested, if it is readily producible, or, if not, in a readable form and format mutually agreed upon.  You may direct the Facility to transmit the copy to another entity or person that you designate provided the choice is clear, conspicuous, and specific.  Your request must be submitted to the Facility Medical Records Department in writing; it must be signed by you; and it must clearly identify the designated person or persons and where to send the copy.

We may deny your request to inspect and copy in certain very limited circumstances, as permitted by law (see below). You will be notified of a denial telling you why in writing within 60 days. If you are denied access to health information, you may request that the denial be reviewed. Another licensed health care professional, other than the person who denied your request, will be chosen by the Facility to review your request and the denial. We will comply with the outcome of the review.

  • A licensed health care professional has determined, in the exercise of professional judgement, that the access requested is reasonably likely to endanger the life or physical safety of the individual or another person.
  • The protected health information makes reference to another person (unless such other person is a health care provider) and a licensed health care professional has determined, in the exercise of professional judgment, that the access requested is reasonably likely to cause substantial harm to such other person.
  • The request for access is made by the individual’s personal representative, a licensed health care professional has determined, in the exercise of professional judgement, that the provision of access to such personal representative is reasonably likely to cause substantial harm to the individual or another person.
  • The information requested is not maintained by our Facility. In such situation, if we know the location of the information requested, we must provide that information to you.

Right to Amend: 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.

To request an amendment, your request must be made in writing and submitted to the Privacy Officer.  In addition, you must provide a reason that supports your request.

We may deny your request if:

  • Your request is not in writing or does not include a reason to support the request;
  • The health information was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  • The health information is not part of the health information kept by or for the facility;
  • The health information is not part of the information you would be permitted to inspect and copy; or
  • The health information is accurate and complete.

Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures”.  This is a list of disclosures we made of health information for purposes other than treatment, payment and health care operations.

To request this list of accounting of disclosures:

  1. You must submit your request in writing to the Privacy Officer.
  2. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003.
  3. Your request should indicate in what form you want the list (for example, on paper, electronically).

The first list you request within a 12-month period will be free.  For additional lists, we may charge you for the costs of providing the list.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. We are not required to agree with your request, and we may deny the request if it would affect your care. We try to honor all reasonable requests.

You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had. You may restrict disclosure to your insurance company if you pay for your health service in full and out of pocket under HITECH § 13405(a).

To request restrictions, you must make your request in writing to the Facility Privacy Officer.  In your request, you must tell us:

  1. What information you want to limit;
  2. Whether you want to limit our use, disclosure or both;
  3. To whom you want the limits to apply (for example, disclosure to your spouse).

If we agree to your request, we must follow your restrictions (unless the information is necessary for emergency treatment).  You may cancel the restrictions at any time.  In addition, we may cancel a restriction at any time, unless it relates to a health care item or service that is paid out of pocket and in full, as long as we notify you of the cancellation and continue to apply the restriction to information collected before the cancellation.

Right to Confidential Communication: 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; or if you wish not to have appointment reminders left on your answering machine.

To request confidential communications, you must make your request in writing to the Facility Privacy Officer.  We will not ask you the reason for your request.  Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests for alternative requests for confidential communications. We reserve the right to contact you at any known location or in any way legally permitted if payment is overdue, and you do not respond to initial notification.

Right to a Paper Copy of This Notice: 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 of this Notice. You may obtain a paper copy of this notice upon request from the Admitting/ER Registration Office or any Outpatient Registration Office.

Right to Receive Notice of a Breach:  We are required to notify you by first class mail or by email (if you have indicated a preference to receive information by email), of any breach of your unsecured protected health information.

Personal Representative: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.  We will make sure the person has this authority and can act for you before we take any action.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here unless you give us authorization in writing. If you give us authorization, you may change your mind at any time and revoke the authorization, in writing.  Understand that we are unable to take back any disclosures we have already made prior to you revoking your permission.


Changes to This Notice:  We reserve the right to change this Notice and 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 current copy of the Notice, with the effective date, within our Facility and on our website.  If we make a substantial change to this notice, a revised notice will be available to you at the next time you register. In addition, each time you present for treatment or healthcare services, as an inpatient or outpatient, we will offer you a copy of the current Notice in effect and the Notice is always available upon your request.

Complaints:  If you believe your privacy rights have been violated, you may file a complaint with the MCH Privacy Officer using the contact information at the bottom of this document. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.  The address and phone number of the Privacy Officer is listed on the last page of this document.  You will not be penalized for filing a complaint.

Contact Information for the Privacy Officer:

Privacy Officer
Macon Community Hospital
P.O. Box 378
Lafayette, TN 37083

Phone: 615-688-7910