PUTNAM GENERAL HOSPITAL
Notice Of Privacy PracticesPUTNAM GENERAL HOSPITAL
NOTICE OF PRIVACY PRACTICES
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
Effective Date: September 23, 2013
If you have any questions about this notice, please contact the Putnam General Hospital Privacy Officer at (706)923-2010.
WHO WILL FOLLOW THIS NOTICE
This notice describes the practices of:
• Putnam General Hospital
• Any health care professional authorized to enter information into your medical record maintained by
Putnam General Hospital, including members of Putnam General Hospital's medical staff and allied
health staff.
• All departments and units of Putnam General Hospital that have access to your medical record.
• All these persons, entities, sites, and locations follow the terms of this notice. In addition, these persons,
entities, sites, and locations may share medical information with each other for treatment, payment, or
health care operations purposes and other 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 from Putnam General
Hospital. We need this record to provide you with quality care and to comply with certain legal requirements. This
notice applies to all of the records of your care and billing for that care that are generated or maintained by Putnam
General Hospital whether made by Putnam General Hospital personnel or other health care providers. Other health
care providers may have different policies or notices about confidentiality and disclosure that apply to your medical
information that is created in their offices or at locations other than Putnam General Hospital.
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 your 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 at Putnam General Hospital and your legal
rights, with respect to medical information about you; and
• Follow the terms of the notice that is currently in effect.
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HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
If you do not give your consent for Putnam General Hospital to use and disclose your medical information as
outlined in this Notice, we will only use and disclose your medical information in the following circumstances:
• To providers who are personally involved in providing care pursuant to your consent to treatment (whether
such consent is express, implied by law, or through substituted consent as authorized by law), but only
during the period of time they are providing care to you;
• To bill you for the charges you incurred while you were a patient of Putnam General Hospital;
• To third parties when required by law or by appropriate legal process issued by a court or governmental
agency with jurisdiction;
• If you are a Medicare, Medicaid, CHAMPUS/TriCare, or other federal or state program beneficiary or
enrollee, for treatment and payment purposes as outlined in this Notice;
• In the case of an emergency, when we are transferring you to a receiving facility for care; and
• In the case of an emergency, in order to provide you with care that is required by federal and state law.
Should you give your consent, we will use and disclose your medical information as outlined in this Notice. 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,
volunteers, or other personnel who are involved in taking care of you at Putnam General Hospital For example,
a doctor treating you for a broken hip may need to know if you have diabetes because diabetes may slow the
healing process. We also may disclose medical information about you to people outside Putnam General
Hospital who are involved in your medical care after you have been treated by Putnam General Hospital, such
as family members or employees or medical staff members of any hospital or skilled nursing facility to which
you are transferred or subsequently admitted.
�� For Payment. We may use and disclose medical information about you so that the treatment and services you
receive from Putnam General Hospital 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 plan information about treatment you
received from Putnam General Hospital so your health plan will pay us or reimburse you for the treatment. We
also may disclose information about you to another health care provider, such as a receiving facility, for their
payment activities concerning you.
�� 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 Putnam General 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 Putnam General Hospital should offer, and
what services are not needed. We may also disclose information to doctors, nurses, technicians, medical
students, and other personnel for review and learning purposes. We may also combine the medical information
we have with medical information from other health care 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
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ATLANTA 1404231.1
learning the identities of specific patients. We also may disclose information about you for another health care
provider's health care operations if you also have received care from that provider, and we also may disclose
information about you for the health care operations of other providers for use in their health care operations.
�� Treatment Alternatives. We may use and disclose medical information to tell you about or recommend
different ways to treat you.
�� Fundraising Activities. We may use medical information about you to contact you in an effort to raise money
for Putnam General Hospital and its operations. Specifically, we may use information about you, such as the
unit or department from which you received services, to target our fundraising efforts. For example, if we are
raising money for women's health services, we may focus our fundraising efforts on individuals who have
received women's health care services from us in the past. We may also disclose medical information to a
business partner or a foundation related to Putnam General Hospital so that the business partner or the
foundation may contact you in raising money for Putnam General Hospital. We would release limited
information about you, such as your name, address and phone number, age and date of birth, gender, your
physician, the part of the facility where you received your care, and the dates you received treatment or services
at Putnam General Hospital.
If you do not want Putnam General Hospital to contact you for fundraising efforts, you must notify Putnam
General Hospital's Privacy Officer, either in writing, by a telephone call, or by filling out a form during your
treatment. If you have not already done so, we must ask you each time we contact you for fundraising efforts if
you wish to opt out of all future fundraising communications. If you do opt out of future fundraising
communications, we will no longer disclose your information for fundraising purposes. However, in the future
you may let us know that you would like to receive these fundraising communications. Your decision whether
or not to receive targeted fundraising materials from us will have no impact on your access to health care
services or the treatment we provide to you.
Even if you have opted-out, we may send you non-targeted fundraising materials that are sent out to the general
community and are not based on information from your treatment or stay.
�� Hospital Directory and Release to the Media. Unless you tell us otherwise, we may include certain limited
information about you in a hospital directory while you are a patient at Putnam General 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. Your religious affiliation may be given to a member of the clergy, such as
a priest or rabbi, even if they don't ask for you by name. This is so your family, friends, and clergy can visit
you in Putnam General Hospital and generally know how you are doing. This same limited information about
you may be made available in press releases to the media. If you do not want anyone to know this information
about you, if you want to limit the amount of information that is disclosed, or if you want to limit who gets this
information, you must notify Putnam General Hospital's Privacy Officer in writing.
�� 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 one medication to those who received another for the same condition. Medical information about you
that has had identifying information removed may be used for research without your consent. We also may
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 Putnam General Hospital. If the researcher will have information about your mental health treatment that
reveals who you are, we will seek your consent before disclosing that information to the researcher. Unless we
notify you in advance and you give us written permission, we will not receive any money or other thing of value
in connection for using or disclosing your medical information for research purposes except for money to cover
the costs of preparing and sending the medical information to the researcher.
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�� 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. This would include persons named in
any durable health care power of attorney or similar document provided to us. We may also give information to
someone who helps pay for some or all of your care. In addition, we may disclose medical information about
you to an entity assisting in a disaster relief effort so that your family can be notified about your condition,
status, and location. You can object to these releases by telling us that you do not wish any or all individuals
involved in your care to receive this information. If you are not present or cannot agree or object, we will use
our professional judgment to decide whether it is in your best interest to release relevant information to
someone who is involved in your care or to an entity assisting in a disaster relief effort.
�� As Required or Permitted By Law. We may disclose medical information about you when required or
permitted to do so by federal, state, or local law.
�� To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you
when it appears necessary to prevent a serious threat to your health and safety or the health and safety of the
public or another person. Any disclosure would be to someone who appears able to help prevent the threat and
will be limited to the information needed.
SPECIAL SITUATIONS
�� Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations
that handle organ procurement or organ, eye, or tissue transplantation, or to an organ donation bank as
necessary to facilitate organ or tissue donation and transplantation.
�� Active Duty Military Personnel and Veterans. If you are an active duty member of the armed forces or Coast
Guard (including National Guardsmen who are in "Title 10" status), we must give certain information about
you to your commanding officer or other command authority as required by DOD Directive 6025.18-R. We
may also release medical information about foreign military personnel to the appropriate foreign military
authority. We may use and disclose to components of the Department of Veterans Affairs medical information
about you to determine whether you are eligible for certain benefits.
�� Workers' Compensation. In accordance with state law, we may release without your consent medical
information about your treatment for a work-related injury or illness or for which you claim workers'
compensation to your employer, insurer, or care manager paying for that treatment under a workers'
compensation program that provides benefits for work-related injuries or illness.
�� Public Health Risks. We may disclose without your consent medical information about you for public health
activities. These activities generally include but are not limited to the following:
• To report, prevent or control disease, injury, or disability;
• To report births, deaths, and certain injuries or illnesses;
• To report reactions to medications or problems with products;
• To notify people of recalls of products they may be using;
• 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; and
• To report suspected abuse or neglect as required by law.
�� Health Oversight Activities. We may disclose without your consent medical information to a health oversight
agency for activities authorized by law. These oversight activities include, for example, audits, investigations,
inspections, and licensure. The government uses these activities to monitor the health care system, government
programs, and compliance with civil rights laws.
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�� Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we must disclose medical information
about you in response to a court or administrative order. We also may disclose medical information about you
in response to a subpoena or other lawful process from someone involved in a civil dispute.
�� Law Enforcement. We may release without your consent medical information to a law enforcement official:
• In response to a court order, warrant, summons, grand jury demand, or similar process;
• To comply with mandatory reporting requirements for violent injuries, such as gunshot wounds, stab
wounds, and poisonings;
• In response to a request from law enforcement for certain information to help locate a fugitive, material
witness, suspect, or missing person;
• To report a death or injury we believe may be the result of criminal conduct;
• To report suspected criminal conduct committed at Putnam General Hospital facilities; or
• To report suspected criminal conduct witnessed by Putnam General Hospital staff members away from the
Putnam General Hospital campus.
�� Coroners and Medical Examiners. We may release without your consent medical information to a coroner or
medical examiner. This may be done, for example, to identify a deceased person or determine the cause of
death. We also may release medical information about deceased patients of Putnam General Hospital to funeral
directors to carry out their duties.
�� National Security and Intelligence Activities. We may release without your consent medical information
about you as required by applicable law to authorized federal or state officials for intelligence,
counterintelligence, or other governmental activities prescribed by law to protect our national security.
�� 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 to conduct special investigations.
�� Psychotherapy Notes. Regardless of the other parts of this Notice, psychotherapy notes will not be disclosed
outside the Putnam General Hospital except as authorized by you in writing or pursuant to a court order, or as
required by law. Psychotherapy notes about you will not be disclosed to personnel working within Putnam
General Hospital, except for training purposes or to defend a legal action brought against Putnam General
Hospital, unless you have properly authorized such disclosure in writing.
�� Marketing of Health-Related Products and Services. "Marketing" means a communication for which we
receive any sort of payment from a third party that encourages you to use a service or buy a product. Before we
may use or disclose your medical information to market a health-related product or service to you, we must
obtain your written authorization to do so. The authorization form will let you know that we have been paid to
make the communication to you. Marketing does not include: prescription refill reminders or other information
that describes a drug you currently are being prescribed, so long as any payment we receive for that
communication is to cover the cost of making the communication; face-to-face communications; or gifts of
nominal value, such as pens or key chains stamped with our name or the name of a health care product
manufacturer. Communications made about your treatment, such as when your physician refers you to another
health care provider, generally are not marketing.
�� Sale of Medical Information. We cannot sell your medical information without first receiving your
authorization in writing. Any authorization form you sign agreeing to the sale of your medical information
must state that we will receive payment of some kind for disclosing your information. However, because a
"sale" has a specific definition under the law it does not include all situations in which payment of some kind is
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received for the disclosure. For example, a disclosure for which we charge a fee to cover the cost to prepare
and transmit the information does not qualify as a "sale" of your information.
�� Inmates. If you are an inmate of a correctional institution or in the custody of law enforcement, we may release
medical information about you to the correctional institution or law enforcement official who has custody of
you, if the correctional institution or law enforcement official represents to Putnam General Hospital that such
medical information is necessary: (1) to provide you with health care; (2) to protect your health and safety or
the health and safety of others; (3) to protect the safety and security of officers, employees, or others at the
correctional institution or involved in transporting you; (4) for law enforcement to maintain safety and good
order at the correctional institution; or (5) to obtain payment for services provided to you. If you are in the
custody of the Georgia Department of Corrections ("DOC") and the DOC requests your medical records, we are
required to provide the DOC with access to your records.
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 receive a copy of your medical record unless
your attending physician determines that information in that record, if disclosed to you, would be harmful to
your mental or physical health. If we deny your request to inspect and receive a copy of your medical
information on this basis, you may request that the denial be reviewed. Another licensed health care
professional chosen by Putnam General Hospital will review your request and the denial. The person
conducting the review will not be the person who denied your request. We will do what this reviewer decides.
If we have all or any portion of your medical information in an electronic format, you may request an electronic
copy of those records or request that we send an electronic copy to any person or entity you designate in
writing.
Your medical information is contained in records that are the property of Putnam General Hospital. To inspect
or receive a copy of medical information that may be used to make decisions about you, you must submit your
request in writing to Putnam General Hospital's Privacy Officer. If you request a copy of the information, we
may charge a fee for the costs of copying, mailing, or other supplies associated with your request, and we may
collect the fee before providing the copy to you. If you agree, we may provide you with a summary of the
information instead of providing you with access to it, or with an explanation of the information instead of a
copy. Before providing you with such a summary or explanation, we first will obtain your agreement to pay
and will collect the fees, if any, for preparing the summary or explanation.
�� Right to Amend. If you feel that medical information we have about you in your record 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 or for Putnam General Hospital.
To request an amendment, make your request in writing to Putnam General Hospital's Privacy Officer. 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 Putnam General Hospital;
• Is not part of the information that you would be permitted to inspect and copy; or
• Has been determined to be accurate and complete.
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If we deny your request for an amendment, you may submit a written statement of disagreement and ask that it
be included in your medical record.
�� Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we have
made of medical information about you during the past six years.
To request this list or accounting of disclosures, submit your request in writing to Putnam General Hospital's
Privacy Officer and state whether you want the list on paper or electronically. Your request must state a time
period that may not be longer than six years. 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.
We may collect the fee before providing the list to you.
�� Right to Request Restrictions. Except where we are required to disclose the information by law, you have the
right to request a restriction or limitation on the medical information we use or disclose about you. For
example, you could revoke any and all authorizations you previously gave us relating to disclosure of your
medical information.
We are not required to agree to your request, with the exception of restrictions on disclosures to your health
plan, as described below. If we do agree, we will comply with your request unless the information is needed to
provide you with emergency treatment.
To request restrictions, make your request in writing to Putnam General Hospital's Privacy Officer. In your
request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use,
disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
You may request that we not disclose your medical information to your health insurance plan for some or all of
the services you receive during a visit to any Putnam General Hospital location. If you pay the charges for those
services you do not want disclosed in full at the time of such service, we are required to agree to your request.
"In full" means the amount we charge for the service, not your copay, coinsurance, or deductible responsibility
when your insurer pays for your care. Please note that once information about a service has been submitted to
your health plan, we cannot agree to your request. If you think you may wish to restrict the disclosure of your
medical information for a certain service, please let us know as early in your visit as possible.
�� Right to Request Confidential Communications. 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, or at another mailing address other than your home address. We will
accommodate all reasonable requests. We will not ask you the reason for your request. To request confidential
communications, make your request in writing to the Privacy Officer and 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 or any revised 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, request a copy from Putnam General Hospital's Privacy Officer in
writing.
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 at Putnam General Hospital's office. The notice will contain the effective date on the first
page, in the top right-hand corner. If the notice changes, a copy will be available to you upon request.
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INVESTIGATIONS OF BREACHES OF PRIVACY
We will investigate any discovered unauthorized use or disclosure of your medical information to determine if it
constitutes a breach of the federal privacy or security regulations addressing such information. If we determine that
such a breach has occurred, we will provide you with notice of the breach and advise you what we intend to do to
mitigate the damage (if any) caused by the breach, and about the steps you should take to protect yourself from
potential harm resulting from the breach.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with Putnam General Hospital or
with the Secretary of the United States Department of Health and Human Services. To file a complaint with Putnam
General Hospital, contact Putnam General Hospital's Privacy Officer by mail at 101 Lake Oconee Parkway,
Eatonton, Georgia 31024. 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 may be made only with your written
authorization or as required by law. If you authorize us to use or disclose medical information about you, you may
revoke that authorization, in writing, at any time. Your revocation will be effective as of the end of the day on
which you provide it in writing to Putnam General Hospital's Privacy Officer. If you revoke your permission, we
will no longer use or disclose medical information about you for the purposes that you previously had authorized in
writing. 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.
IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
Vickie Lynn Holder, RHIT, Privacy Officer
Putnam General Hospital
101 Lake Oconee Parkway
Eatonton, Georgia 31024
Office # (706) 923-2010
Fax # (706) 923-2139