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Willingway Hospital Patient Notice of Confidentiality Laws

GENERAL INFORMATION
Information regarding your health care, including payment for health care, is protected by two federal laws: the Health Insurance Portability and Accountability Act of 1996 (“HIPPAA), 42 U.S.C., 132d et seq., 45 C.F.R. Parts 160 & 164, and the Confidentiality Law, 42 U.S.C., 290dd-2, 42 C.F.R. Part 2. Your health care information is also protected by state laws. Under theses laws, Willingway may not say to a person outside Willingway that you are or have been a patient or that you have had an evaluation, nor may Willingway disclose any information identifying you as an alcohol or drug abuser or disclose any other protected information except as permitted by federal and state laws. Willingway must obtain your written consent before we disclose information about you for payment purposes. For example, we must obtain your written consent before we can disclose information to your health insurer in order to be paid for services. Generally, you must also sign a written consent before Willingway can share information for treatment purposes or for health care operations. However, federal and state laws permit Willingway to disclose information without your written permission:

1. Pursuant to an agreement with a qualified service organization/business associate;
   
2. For research, audit or evaluations;
   
3. To report a crime committed on Willingway premises or against Willingway personnel;
   
4. To medical personnel in a medical emergency;
   
5. To appropriate authorities to report suspected child abuse or neglect;
   
6. As allowed by a court order.
   

For example, Willingway can disclose information without your consent to obtain legal or financial services or can disclose information to another medical facility to provide health care to you, as long as there is a qualified service organization/business associate agreement in place. Before Willingway can use or disclose any information about your health in a manner which is not described above, we must first obtain your specific written consent allowing the disclosure. Any such written consent may be revoked by you except when action has been taken in reliance on it. Your revocation must be in writing.

YOUR RIGHTS
Under HIPAA, you have the right to receive a paper copy of this notice. You have the right to request restrictions on certain uses and disclosures of your health information. Willingway is not required to agree to any restrictions you request, but if we do agree then we are bound by that agreement and may not use or disclose any information which you have restricted except as necessary in a medical emergency. You have the right to request that we communicate with you by alternative means or at an alternative location. Willingway will accommodate such requests that are reasonable and will not request an explanation from you. Under HIPAA, you also have the right to inspect and copy your own health information maintained by Willingway, except to the extent that the information contains information compiled in reasonable anticipation of, or for use in a civil, criminal or administrative action or proceeding and except in other limited circumstances. Under HIPAA you also have the right, with some exceptions, to amend or correct health care information maintained in Willingway’s records. Your request to amend or correct your protected health information must be made in writing and must state the reason for the requested amendment/correction. You have the right to request and receive an accounting of disclosures of your health related information made by Willinway during the six years prior to your request. Your request must be made in writing. The accounting of disclosures will only include disclosures made after the effective date of the HIPAA law, which is April 14, 2003.

WILLINGWAY’S DUTIES
Willinway is required by law to maintain the privacy of your health information and to provide you with notice of our legal duties and privacy practices with respect to your health information. Willingway is required by law to abide by the terms of this notice. Willinway reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information we maintain. The method for notification of changes to the terms of this notice will be to post it on Willingway’s web site and to post it in visible locations throughout the facility. You have the right to receive a paper copy of a revised notice upon request.

COMPLAINTS AND REPORTING VIOLATIONS
You may complain to Willingway and the Secretary of the United States Department of Health and Human Services if you believe that your privacy rights have been violated under HIPAA. Contact Willingway’s Privacy Officer or Chief Executive Officer at 311 Jones Mill Road, Statesboro, Georgia 30458, (912) 764-6236 to file a complaint with Willingway. You will not be retaliated against for filing such a complaint. Violation of the Confidentiality Law 42 C.F.R. Part 2 by a program is a crime. Suspected violations of the Confidentiality Law may be reported to the United States Attorney in the district where the violation occurs.

CONTACT
For further information, contact Willingway's Privacy Officer or Chief Executive Officer at 311 Jones Mill Road, Statesboro, Georgia, (912) 764-6236

EFFECITIVE DATE
The effective date of this notice is April 14, 2003.