Seymour Hospital Notice of Privacy Practices

Effective Date April 1, 2003
Revised September 18, 2013

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.

If you have any questions about this notice, please contact Brenda Elliott

Who Will Follow Seymour Hospital Notice of Privacy Practices?

This notice describes Seymour Hospital’s practices and that of:

  • Any health care professional authorized to enter information into your chart
  • All departments and units of Seymour Hospital
  • Any member of a volunteer group we allow to help you while you are in the care of Seymour Hospital
  • All employees, staff and other Seymour Hospital personnel
  • Seymour Hospital (and all Departments associated with), Seymour Hospital Rural Health Clinic, Seymour Hospital Home Health, Seymour Hospital EMS and all other off campus sites associated with Seymour Hospital. All these entities, sites and locations follow the terms of this notice. In addition these entities, sites and locations may share medical information with each other for treatment payment of Seymour Hospital operations purposes described in this notice.

Our Responsibilities

  • Seymour Hospital is required by federal and state law to make sure that medical information that identifies you is kept private.
  • Provide you with a copy of this notice of our legal duties and privacy practices with respect to medical information about you.
  • We are required to abide by the terms of this notice currently in effect, and while we reserve the right to make changes to the notice, any changes to the notice will be effective for all protected health information we maintain.
  • Seymour Hospital will provide our Notice of Privacy Practices on our web site at and post it in a clear and prominent location at all registration points in our health system.

Understanding Your Health Record

Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made to manage the care you receive. This notice applies to all of the records of your care generated by Seymour Hospital, whether made by Seymour Hospital personnel, agents of Seymour Hospital, or your personal doctor. Seymour Hospital understands that the medical information that is recorded about you and your health is personal, and we care about keeping it protected.

Although your health record itself is the physical property of Seymour Hospital, the personal health information in the record belongs to you.

Your Rights Regarding Your Medical Information

You have the following rights regarding your medical information, provided that you make a written request to invoke the right on the form provided by us.

  • Inspect and Request a Copy: You have the right to inspect and obtain a copy of the health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. We may be allowed to charge you for the cost of making the copy. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. Another licensed health care professional chosen by the hospital will review you 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.
  • Obtain a Copy of your Electronic Health Record: At your request, Seymour Hospital is required to fulfill the request of a patient’s electronic health record no later than the 15th business day after the date we receive a written request from you for those records. Seymour Hospital shall provide the requested record to you in electronic form if the current electronic system is capable, or unless you agree to accept the record in another form. Seymour Hospital is not required to provide access to your protected health information that is excluded from access, or to which access may be denied.
  • Amendment to your Medical Record: If you feel that medical information we have about you is incorrect or incomplete, you may ask to amend the information. You have the right to request an amendment for as long as the information is kept by and for the hospital. The request must be made in writhing, using the Seymour Hospital form. We may deny your request for an amendment, and if this occurs, you will be notified of the reason for the denial.
  • An Accounting of Disclosures: You have the right to know who has received your PHI. Any uses or disclosures of protected health information other those permitted by the Privacy Rule will be made only with written authorization of the individual, and you have the right to revoke an authorization.
  • Notice of Electronic Disclosure:  Seymour Hospital may create, receive and maintain your protected health information in electronic form. If Seymour Hospital intends to disclose your protected health information for reasons other than described in this notice, we will ask you to authorize that specific disclosure.
  • 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. However, agreement with your request is not required by law, with one exception. An individual has the right to restrict certain disclosures of personal health information to a health plan where the individual has paid out of pocket in full for the health care item or service.
  • Request for Alternative Communication Methods: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. We will attempt to accommodate all reasonable requests, but in certain circumstances we may not be able to do so.
  • Breach notification:  Seymour Hospital takes the protection of your confidential information seriously, and we will make every reasonable effort to keep it protected, however, in the event of a breach, meaning your protected health information is disclosed to an unintended recipient, we will notify you.

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 these 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 hospital personnel who are involved in taking care of your service. 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 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.
  • For Payment:  We may use and disclose medical information about you so that the treatment and services you receive at Seymour Hospital may be billed and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health care information about treatment you received at Seymour Hospital so your health plan will pay us or reimburse you for the care. We may also tell your health plan about a treatment or service you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
  • For Health Care Operations: We may use and disclose medical information about you for Seymour Hospital operations. These uses and disclosures are necessary to run Seymour Hospital 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 patients to decide what additional services the Seymour 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 Seymour Hospital personnel for review and learning purposes. We may also combine the medical information we have with medical information from other health providers 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 health information:
    1. To business associates we have contracted with to perform a service and to enable them to bill for that service
    2. To remind you that you have an appointment for medical care
    3. To assess your satisfaction with our services
    4. To tell you about health-related benefits or services
    5. To inform funeral directors, consistent with applicable law
    6. For population based activities relating to improving health or reducing healthcare costs
    7. For conducting training programs or reviewing competence of healthcare professionals

    Additionally, when disclosing information, primarily appointment reminders and billing/collections efforts; we may leave messages on your answering machine/voicemail.

  • Fundraising Activities: We may use medical information about you to contact you in an effort to raise money for Seymour Hospital and its operations. We may disclose medical information to a foundation related to the Seymour Hospital so that the foundation may contact you in raising money for Seymour Hospital. We would only release contact information, such as, your name, address and phone number and the dates you received treatment or services at Seymour Hospital. Any fundraising materials you receive will give you the opportunity to opt out of any future communications
  • 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.
  • Marketing and Sale of PHI: All uses and disclosures of personal health information for marketing purposes and disclosures that constitute a sale of personal health information, require patient authorization. Other uses and disclosures not described in the Notice of Privacy Practices will be made only with patient authorization.
  • Business Associates: There are some services provided in our organization through contracts with business associates. Examples include: physician services in the emergency department and radiology, certain laboratory tests; personal health record vendors; and subcontractors that create, maintain, receive, or transmit personal health information on behalf of Seymour Hospital. When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we’ve asked them to do or bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your personal health information.
  • As Required by Law: we may also use and disclose health information for the following types of entities, when required to do so by federal , state or local law, including but not limited to:
    1. Food and Drug Administration
    2. Public Health or Legal Authorities charged with preventing or controlling disease, injury, or disability
    3. Correctional Institutions
    4. Workers Compensation Agents
    5. Organ and Tissue Donation Organizations
    6. Military Command Authorities
    7. Health Oversight Agencies
    8. Funeral Directors, Coroners, and Medical Directors
    9. National Security and Intelligence Agencies
    10. Protective Services for the President and Others

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. Usually, this includes medical and billing records, but does not include psychotherapy notes.
      • Individuals 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. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that you family can be notified about your condition, status and location.
      • Research:  Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received on medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients’ need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but we may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave the Seymour Hospital. We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care with Seymour Hospital.

To request confidential communications, you must make your request in writing to Brenda Elliott. 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.

To obtain a paper copy of this notice, please call 940-889-5572 or write us at:

Seymour Hospital
200 Stadium Drive
Seymour, Texas 76380

Changes to This Notice: We reserve 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 waiting room. The notice will contain on the first page, in the top right hand corner, the effective date. In addition, each time you register at the front desk for treatment or health care services as an inpatient or an outpatient, we will offer you a copy of the current notice in effect.

Complaints: If you believe your privacy rights have been violated, you may file a complaint with the Seymour Hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with the Seymour Hospital, contact Brenda Elliott, Privacy Officer, at 940-889-5572. All complaints must be submitted in writing.

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.

The final HIPAA privacy rules prohibit the notice and consent from being combined into a single document

If you have questions or need additional information please CONTACT US


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