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WILLOW CREST HOSPITAL, INC. / MOCCASIN BEND RANCH
NOTICE OF PRIVACY PRACTICES
The following notice
describes how your medical information may be used and disclosed, and how you
may obtain access to this information. Please review the information carefully.
 |
Your confidential healthcare
information may be released to other healthcare professionals within Willow
Crest Hospital/ Moccasin Bend Ranch (W.C.H./ M.B.R.) for the purpose of your
treatment and or healthcare operations. |
| Your confidential healthcare
information may be released for the purpose of Willow Crest Hospital/ Moccasin
Bend Ranch receiving payment for providing you with needed healthcare
services. |
| Your confidential healthcare
information may be released to public or law enforcement officials in the
event of an investigation in which you are a victim of abuse, a crime or
domestic violence. |
| Your confidential healthcare
information may be released to other healthcare providers in the event you
need emergency care. |
| Your confidential healthcare
information may be released to a public health organization or federal
organization in the event of a communicable disease or to report a defective
device or untoward event in a biological product (food or medication.) |
| Your confidential healthcare
information may not be released for any other purpose than that
which is identified in this notice. |
| Your confidential healthcare
information may be released only after receiving written authorization from
you. You may revoke your permission to release confidential healthcare
information at any time. |
| You have the right to
restrict the use of your confidential healthcare information. However, Willow
Crest Hospital/ Moccasin Bend Ranch may choose to refuse your restriction if
it conflicts with providing you with quality healthcare or in the event of an
emergency situation. |
| You have the right to
receive confidential communication about your health status and to choose the
method by which we communicate with you. |
| You have the right to review
and photocopy any/all portions of your healthcare information, subject to
approval by your assigned physician here at Willow Crest Hospital/ Moccasin
Bend Ranch. Your request for coping may incur a per page charge. |
| You have the right to make
changes in your healthcare information. |
| You have the right to know
who has assessed your confidential healthcare information and for what
purpose. |
| You have the right to
possess a copy of this Privacy Notice upon request. This copy can be in the
form of an electronic transmission or on paper. |
| Willow Crest Hospital/
Moccasin Bend Ranch is required by law to protect the privacy of its
patients. It will keep confidential any and all patient healthcare
information and will provide patients with a list of duties or practices that
protect confidential healthcare information. |
| The hospital will abide by
the terms of this notice. The hospital reserves the right to make changes to
this notice and continue to maintain the confidentiality of all healthcare
information. Current patients will receive a mailed copy of any changes to
his notice within 60 days. |
| You have the right to
complain to Willow Crest Hospital/ Moccasin Bend Ranch if you believe your
rights to privacy have been violated. If you feel your privacy rights have
been violated, please mail your complaints to: |
ATTN:
Nelson Sutton, Privacy Officer
Willow Crest Hospital, Inc.
130 “A” St. S.W.
Miami, OK 74354
¨All complaints will be investigated.
You may also send a written complaint to the Secretary of Health and Human
Services. We will take no retaliatory action against you if you file a
complaint about our privacy practices.
| For further information
about this Privacy Notice, please contact: |
Nelson Sutton,
Privacy Officer
Willow Crest
Hospital, Inc.
130 “A” St. S.W.
Miami, OK 74354
| This notice is effective as
of April 14, 2003. |
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