Food and Drug Administration (FDA): We may disclose to

the FDA, or an entity subject to FDA jurisdiction, your health

information for public health purposes related to the quality, safety
or effectiveness of an FDA-regulated product or activity for which
that person has responsibility. For example, your information may
be disclosed in connection with the reporting of an adverse event,
product defect, product tracking or to provide post marketing
surveillance information.

Organized Health Care Arrangement

Nebraska Health Information Initiative (NeHII)

Two of the MHS affiliates Nebraska Methodist Hospital (including

the Methodist Womens Hospital) and Jennie Edmundson Hospital
are clinically integrated care settings in which patients receive care
from both hospital staff and independent providers who belong to the
Medical Staff. These Hospitals and their Medical Staff must be able to
share protected health information freely for treatment, payment and
health care operations.

Workers Compensation: We may disclose your health information

to the extent authorized by and to the extent necessary to comply
with laws relating to workers compensation or other similar
programs established by law.

Therefore, each Hospital and all eligible providers on the Hospitals

Medical Staff have entered into an organized health care arrangement
or OHCA. Under the OHCA, each Hospital and the eligible
providers will:

NeHII is a state-wide, internet-based, health information exchange.

NeHII is sponsored by Nebraska health care providers and health
insurers who share and use your information for treatment, payment
or health care operations purposes. Using NEHII, participating
providers and health insurers can see certain health, demographic and
payment information (your health information) in each others records.
They can use this information for treatment, payment or health care
operations purposes.

Public Health: When required or permitted by law, we may disclose

your health information to public health or legal authorities
responsible for preventing or controlling disease, injury or disability
or performing other public health functions. In addition, we may
disclose your health information in order to avert a serious threat to
health or safety.
Specialized Governmental Functions: We may disclose your
health information for military and veterans activities, national
security and intelligence activities and similar special governmental
functions as required or permitted by law.
Correctional Institution: If you are an inmate of a correctional
institution, we may disclose to the institution or agents thereof
health information necessary for your health and the health and
safety of other individuals.
Law Enforcement: We may disclose your health information
for law enforcement purposes as required or permitted by
law or in response to a valid subpoena, court order or other
binding authority.
Disclosures Required by Law: We may use or disclose your health
information as required by law provided such use or disclosure
complies with and is limited to the relevant requirements of
such law.
Health Oversight Agencies: We may disclose your health
information to an appropriate health oversight agency, public
health authority or attorney involved in health oversight activities.

Use a joint notice of privacy practices (this Notice) for all inpatient
and outpatient visits;
Obtain a single signed acknowledgment of receipt;
Share protected health information from inpatient and outpatient
hospital visits with eligible providers so that they can help the
Hospital with its health care operations; and
Follow the privacy and information practices described in this
Notice. Each OHCA participant is individually responsible to
follow the practices in this Notice.

MHS is a participant in this initiative. Because of this, all MHS

patients are included in the NeHII information exchange unless
they specifically request to opt-out of NeHII.

For More Information or to Report a Problem

METHODIST HEALTH SYSTEM

PRIVACY NOTICE

If you have questions or would like additional information, you

may contact the Privacy Officer or Director of Health Information
Management at this MHS affiliate. If you believe your privacy rights
have been violated, you can file a complaint with the Director of
Health Information Management, at the phone number listed at the
beginning of this Notice, or with the Office of Civil Rights. We will
not retaliate against you for filing a complaint.

THIS NOTICE SERVES AS THE JOINT NOTICE OF PRIVACY

PRACTICES OF THE ORGANIZED HEALTH CARE
ARRANGEMENT FOR EACH OF THE MHS HOSPITALS
LISTED ABOVE.
Who is included? The participants in each OHCA include the MHS
affiliate Hospital and all eligible providers on its Medical Staff. Eligible
providers are providers who are themselves covered health care providers
under HIPAA.
What sites are included? Each OHCA covers only the MHS
affiliate Hospital and its outpatient surgical, rehabilitation and
other ancillary service sites. The OHCA does not cover the private
offices of the providers or their information practices there or
at other practice locations.

Judicial and Administrative Proceedings: We may disclose your

health information for judicial or administrative proceedings as
required or permitted by law or in response to a valid subpoena,
court order or other binding authority.

bestcare.org

Effective Date: February 1, 2012

2012 Methodist Health System

10677 MHS Privacy Notice 2012_2.indd 1

2/13/12 2:38 PM

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.
This Notice applies to the following organizations that are
affiliated as part of the Methodist Health System (MHS) and
share similar information practices:
Methodist Health System (402) 354-2174
Nebraska Methodist Hospital and
Methodist Womens Hospital (402) 354-4667
Jennie Edmundson Hospital (712) 396-6084
Physicians Clinic, Inc. (402) 354-5616
Heart Consultants, P.C. (402) 354-4667
Methodist Endoscopy Center, LLC (402) 354-4667
The organizations listed above will share your health information
with each other, as necessary, to carry out treatment, payment and
health care operations.

Understanding Your Health Record/Information

Every time you visit a hospital, physician or other health care
provider, a record of your visit is made. This record may include
your symptoms, examination and test results, diagnosis, treatment
and plans for future care or treatment. Your medical provider
uses this information your health record to plan your care
and treatment. The many health care professionals who assist in
your care communicate through your health record. Your health
information is also used by insurance companies to verify that
services for which we billed were actually provided.

Your Rights
Although your health record belongs to the health care provider or
facility that compiled it, you do have certain rights with regard to
your health information.
You have a right to expect that your health information will
be kept secure and used only for legitimate purposes.
You have a right to understand how your health information
may be used and disclosed by MHS affiliates.
You have a right to receive this privacy notice that tells you
how your health information may be used or disclosed.

10677 MHS Privacy Notice 2012_2.indd 2

You have a right to ask questions about any health privacy issue
and have those questions clearly and promptly answered.

Disclosures for Treatment, Payment and

Health Care Operations

You have a right to know who has received your health

information, and for what purpose. If you make additional
requests for such an accounting during any 12-month period, we
may charge you a reasonable, cost-based fee.

When state law requires us to obtain your written permission to use

or disclose your health information for treatment, payment or health
care operations, we will do so. However, there are also situations where
we may use or disclose your information for treatment, payment, and
health care operations without your permission.

You have a right to view, and to keep a copy, of all of your health
records (except psychotherapy notes). Your request for a copy of
your record must be in writing. If we provide an electronic copy
of your record, we may charge a reasonable, cost-based, copying or
labor fee.
You have a right to ask for correction of anything in your records
that you feel is in error. You also have the right to request that
a statement of disagreement be included in your record. Your
request must be in writing and include supporting documentation.
You have a right to authorize or refuse additional uses of your
health information, such as for fundraising, marketing or research.
You have a right to request extra protections for health
information you consider especially sensitive, and to request that
we communicate with you by alternative means.

Our Responsibilities
We also have certain responsibilities. These include:
Maintaining the privacy of your health record;
Providing you with a copy of this Notice;
Abiding by the terms of this Notice;
Notifying you if we are unable to agree to a requested amendment
or restriction; and
Accommodating reasonable requests you may have to
communicate health information by alternative means or at
alternative locations.
We may revise this Notice as our information practices change. Any
revision will be effective for all information in the record, regardless of
whether it was gathered before or after the change took effect. However,
before we change our practices, a copy of our new notice will be posted
at all Methodist Health System affiliates and on our Web site. The
effective date of our Notice will always appear at the end of the Notice.
We will not use or disclose your health information without your
authorization, except as described in this Notice.

We may use or disclose your health information for treatment.

For example: Information obtained by members of your health care
team will be documented in your record and used to determine
the course of your treatment. Health care team members may
communicate with each other personally and through your health
record to coordinate your care. We may provide your physician or other
health care provider with copies of reports that may help determine
your future treatment.
We may also disclose your information to another health care provider
for its payment purposes or its health care operations. These exchanges
may be done through electronic health information exchange networks.
We may use or disclose your health information for payment.
For example: We may send your bill to you or your insurance company.
Your bill may contain information that identifies you, as well as your
diagnosis, procedures and supplies used. Alternatively, you may pay
for a service yourself and instruct that we not provide information to
others for payment.
We may use or disclose your health information for health care
operations and internal business practices.
For example: Members of the medical staff, members of the quality
improvement team, or the risk or quality improvement manager may
use information in your health record to assess your care and outcomes.
This information is used in our ongoing efforts to improve the quality
and effectiveness of the health care and services we provide.

Other Disclosures That May be Made Without

Your Authorization
Unless we are otherwise restricted from doing so, we may also use
or disclose your information for the following purposes without
your authorization:
Notification: We may use or disclose information to notify or assist in
notifying a family member, personal representative, or another person
responsible for your care about your location and general condition.

Hospital Directory: Unless state or federal law otherwise

restricts us, or unless you instruct us not to, we may release your
location within the hospital to people who ask for you by name.
In addition, unless you instruct us not to, we may release your
name, location, and religious affiliation to members of the clergy.
Business Associates: Some services of our organization are
provided through contractual arrangements with business
associates. These include radiology, certain laboratory services,
supplemental staffing, transcription, and data management.
When services are provided by business associates, we may
disclose your health information to our business associates so
that they can perform the job we have asked them to do and bill
you or your insurance company for those services. In addition,
we may disclose your health information to accrediting agencies
and certain outside consultants. Our business associates must use
appropriate safeguards to protect your health information.
Funeral Directors/Medical Examiners: We may disclose your
health information to funeral directors, medical examiners and/or
coroners consistent with applicable law so that they can carry out
their duties.
Organ Procurement Organizations: Consistent with applicable
law, we may disclose your health information to organ
procurement organizations or other entities engaged in the
procurement, banking, or transplantation of organs for the
purpose of tissue donation and transplant.
Research: We may disclose information to researchers when
their research has been approved by an institutional review
board that has reviewed the research proposal and established
protocols to ensure the privacy of your health information.
In addition, we may disclose information to researchers in
preparation for research.
Marketing: We may use your information to provide you
with information regarding a health-related product or service
provided by MHS or an MHS affiliate or information regarding
your treatment or care, such as appointment reminders or
information about treatment alternatives. In addition, your health
information may be used in face-to face encounters or to provide
you with gifts of nominal value.
Fundraising: We may use your name and limited demographic
information to contact you as part of an MHS fundraising effort.

Communication with Family: We may disclose to a family member,

other relative, close personal friend or any other person you identify,
health information relevant to that persons involvement in your care or
payment related to your care.

2/13/12 2:38 PM