A Letter to All Our Patients -

Effective Date: December 1, 2007

Welcome to Kershaw County Medical Center. We appreciate the opportunity to serve you and to provide for your healthcare needs.

We wanted you to know that we are required by federal law to give you the following document. It is called a Notice of Privacy Practices and we are also required to have you sign our hospital acknowledgment form to verify that you have received this document. We realize this documents is long and the next page is an index of what is included in the Notice of Privacy Practices. To hear our Notice of Privacy Practices you may call (803) 713-6645.

This Notice of Privacy Practices describes how the hospital uses and discloses medical information and how you can get access to your medical information. Please read it carefully.

Kershaw County Medical Center reserves the right to change this Notice. We reserve the right to make the revised or changed notice effective for medical 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. The notice will contain on the first page, in the bottom left hand corner the effective date of this Notice.

Each time you register at or are admitted to Kershaw County Medical Center for treatment or health care services as an inpatient or outpatient, you will be given a copy of the current Notice of Privacy Practices in effect.

Kershaw County Medical Center also has a direct telephone number you may call with any questions, concerns or complaints about your medical information or how it was disclosed. This contact number is (800) 826-6762.

Thank you for using Kershaw County Medical Center for your healthcare needs.

INDEX

Who will Follow This Notice

Our Pledge Regarding Medical Information

How We May Use and Disclose Information About You

• For Treatment,
• For Payment,
• For Health Care Operations,
• Appointment Reminders,
• Phone Contacts,
• Treatment Alternatives,
• Health-Related Benefits and Services,
• Fundraising Activities,
• Patient Directory,
• Family and Friends Involved in Your Care or Payment for Your Care,
• Business Associates,
• To Avert a Serious Threat to Health or Safety

Special Situations

• Organ and Tissue Donation,
• Military and Veterans,
• Workers’ Compensation,
• Work-Related Injuries,
• As Required by Law/Public Health Risk,
• Health Oversight Activities,
• Lawsuits and Disputes,
• Law Enforcement,
• Coroners, Medical Examiners, and Funeral Directors,
• National Security and Intelligence Activities,
• Protective Services for the President and Others,
• Inmates

Your Rights Regarding Medical Information About You

• Right to Inspect and Copy,
• Right to Amend,
• Right to an Accounting of Disclosures,
• Right to Request Restrictions,
• Right to Reasonable Accommodations,
• Right to a Paper Copy of This Notice

Changes to This Notice
Complaints
Contact
Other Uses of Medical Information

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.

WHO WILL FOLLOW THIS NOTICE

This notice describes our hospital’s practices and that of:

• Any health care professional authorized to enter information into your hospital chart.
• All departments and units of the hospital.
• Any member of a volunteer group we allow to help you while you are in the hospital.
• All employees, staff and other hospital personnel.
• Kershaw County Medical Center, including all our departments such as Home Health, Hospice, Occupational Health, Healthcare Place at Bethune, Healthcare Place at Elgin, and the Rehabilitation Services, Radiology and Laboratory departments at our West Wateree Medical Complex, will follow this privacy notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or health care operations purposes described in this notice.

OUR PLEDGE REGARDING MEDICAL INFORMATION

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 the hospital. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all your records of your care generated by the hospital, whether made by hospital personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.

This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. We are required by law to:

• make sure that medical information that identifies you is kept private;
• give you this notice of our legal duties and privacy practices with respect to medical information about you; and
• follow the terms of the notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe different ways that we use and disclose medical 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 of the ways we are permitted to use and disclose information will fall within one of the categories.

• For Treatment: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other professionals 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. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of the hospital also may share medical information about you in order to coordinate the different things that you need, such as prescriptions, lab work, and x-rays. We also may disclose medical information about you to people outside the hospital who may be involved in your medical care after you leave the hospital, such as family members, clergy or others we use to provide services that are part of your care. We may also release your personal health information to another health care facility or professional who is not affiliated with our organization but who is or will be providing treatment to you. For instance, if, after you leave the hospital, you are going to receive home health care, we may release your personal health information to that home health care agency so that a plan of care can be prepared for you.

• For Payment: We may use and disclose medical information about you so that the treatment and services you receive 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 insurance company information about surgery you received at the hospital so your health plan will pay for the surgery. We may also tell your health insurance company 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 your information to prepare a bill to send to you or the person responsible for your payments.

• For Health Care Operations: We may use and disclose medical information about you for health care operations. These uses and disclosures are necessary to run our facility and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical 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 disclose information to doctors, nurses, technicians, medical students, and other hospital personnel for review and learning purposes. We may also combine the medical information we have with medical information from other hospitals to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are. We may also use and disclose information for accreditation, licensing, and case management.

• Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the hospital.

• Phone Contacts: We may also contact you by phone to provide you with test results, return your call, answer questions, obtain additional information on billing, or other related issues. If you are not in, we will only leave our name, the name of our hospital, and our phone number, for confidentiality reasons.

• Treatment Alternatives: We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

• Health-Related Benefits and Services: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

• Patient Directory: We may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name.

• Family and Friends Involved in Your Care or Payment for Your Care: We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in the hospital. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so your family can be notified about your condition, status and location.

• Business Associates: Certain hospital services are performed through contracts with outside persons or organizations, such as auditing, accreditation, legal services, etc. At times it may be necessary for us to provide certain health information to one or more of these outside persons or organizations who assist us with our health care operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information. Business Associates are also required by law to protect your confidentiality and privacy and they sign a contract to this effect.

• To Avert a Serious Threat to Health or Safety: We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

SPECIAL SITUATIONS

• Organ and Tissue Donation: We are required by federal law and the Joint Commission on Accreditation of Healthcare Organizations standards to notify organizations that handle organ procurement, organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation, whenever there is a death in our facility. This is to facilitate a patient or family’s request to be an organ or tissue donor.

• Military and Veterans: If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.

• Workers’ Compensation: We may release medical information about you for workers’ compensation or similar programs, if necessary, for your benefit determination for work-related injuries or illness.

• As Required by Law/Public Health Risk: We will disclose medical information about you when required to do so by federal, state or local law. We may disclose medical information about you for public health activities. These activities generally include the following but are not limited to:
  • to prevent or control disease, injury or disability,
  • to report births and deaths; stillborns, injury, cancer surveillance, trauma to the trauma registry data bank, birth defects, heart attacks to the national registry of myocardial infarctions and for required public health investigations,
  • to report child abuse or neglect, elder abuse or neglect, domestic violence if serious physical injury is present,
  • to report reactions to medications or problems with products,
  • to the Governor’s Office of Victims of Crime Assistance, to help you get financial assistance if you have been the victim of a crime or sexual assault.
  • to notify people of recalls of products they may be using; and to the Food and Drug Administration to report adverse events or product defects,
  • 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 report gunshot wounds, knife stabbing, suspicious injury and burns, as required by law,
  • to release information to your employer when we have provided health care to you at the request of your employer.

• Health Oversight Activities: We may disclose medical information to a Health Oversight Agency 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.

• Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

• Law Enforcement: We may release medical information if asked to do so 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;
  • about criminal conduct at an organization; 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.

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

• National Security and Intelligence Activities: We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

• Protective Services for the President and Others: We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

• Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding medical information we maintain about you:

• Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. This usually includes medical billing and records, but does not include psychotherapy notes.

  To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the

  Kershaw County Medical Center Health Information Management Department at Post Office Box 7003 Camden, South Carolina 29021. If you request a copy of the information.

• We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. A physician or nurse chosen by the hospital will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

• Right to Amend: If you feel that medical 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 our facility.

  To request an amendment, your request must be made in writing and submitted to the Kershaw County Medical Center Health Information Management Department at Post Office Box 7003 Camden, South Carolina 29021 on our designated forms which can be obtained by contacting our Health Information Management Department at (803) 432-4311. In addition, you must provide a reason that supports your request.

  We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

  • was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  • is not part of the medical information kept by or for the hospital;
  • is not part of the information which you would be permitted to inspect and copy; or
  • 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 the disclosures we made of medical information about you.

  To request this list or accounting of disclosures, you must submit your request in writing to the Kershaw County Medical Center Health Information Management Department at Post Office Box 7003 Camden, South Carolina 29021. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. 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 medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.

  We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

  To request restrictions, you must make your request in writing to the Kershaw County Medical Center Health Information Management Department at Post Office Box 7003 Camden, South Carolina 29021 on our designated forms which can be obtained by contacting our Health Information Department at (803) 432-4311. In your request, you must tell us: (1) what information you want to limit; (2) whether you want to limit use, disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

• Rights to Reasonable Accommodations: 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.

  To request confidential communications, you must make your request in writing to the Kershaw County Medical Center Health Information Management Department at Post Office Box 7003 Camden, South Carolina 29021. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

• 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 copy of this notice at our website: www.kcmc.org.

To obtain a paper copy of this notice, call our HIPAA Response Line at (803) 713-6236.

CONTACT

Contact the Kershaw County Medical Center Reporting Line at (800) 826-6762 or the Kershaw County Medical Center Privacy Officer at (803) 713-6236 if you have any questions about the notice or for further information.

COMPLAINTS

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 Kershaw County Medical Center Reporting Line at (800) 826-6762 or the Kershaw County Medical Center Privacy Officer at (803) 713-6236. All complaints must be submitted in writing to our Kershaw County Medical Center Privacy Officer at Post Office Box 7003 Camden, South Carolina 29021.

You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

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