1. You have the right to be given kind and respectful care at Mountain Laurel Medical Center.
2. You have the right to be given an explanation of the issue that you have been diagnosed with and treatment plan in a way that you can understand.
3. You have the right to be given the information that you need to make decisions about your care and to give your informed consent or permission before any diagnostic or therapeutic procedure is performed.
4. You have the right to expect that your personal privacy will be respected by all staff members at Mountain Laurel Medical Center.
5. You have the right to expect that your medical records will be kept private. Your medical records will only be given out with your written consent or permission. This right does not exist in medical emergencies, in response to court orders, or if an individual poses a significant threat of harm to their self or others.
6. You have the right to know the names and positions of people involved in your care by official name tag or personal introduction.
7. You have the right to ask and be given an explanation of any charges billed to you by Mountain Laurel Medical Center, even if they are covered by insurance.
8. You have the right to review any medical records created and maintained by Mountain Laurel Medical Center regarding your care and treatment.
9. You have the right to be given the best possible health care. In certain cases, another facility may have services that Mountain Laurel Medical Center does not have, such as emergency medical services. You will be referred to that facility after you have been given complete information about the referral.
10. You have the right to be given care that places importance on your psychosocial, spiritual, and cultural values.
11. You have the right to file a formal complaint to address complaints or issues.
1. You have the responsibility to give correct and updated information about your health history.
2. You have the responsibility to ask questions if you do not understand the explanation of your diagnosis, treatment, prognosis, or any other instructions.
3. You have the responsibility to give complete information for your patient file including changes to name, address, telephone and insurance.
4. You have the responsibility to pay any charges billed to you.
5. You have the responsibility to follow the rules and regulations posted within the medical center.
6. You have the responsibility to give your practitioner at least a 24-hour notice when you or your family is in need of medications or a prescription refill.
7. You have the responsibility to arrive on time for appointments. We cannot guarantee your appointment if you are 15 minutes or more late.
8. You have the responsibility to call at least 24-hours in advance of your appointment to cancel and/or reschedule.
Notice of Privacy Practices
How We Collect Information About You:
Mountain Laurel Medical Center (MLMC) and its employees collect data through a variety of means including but not necessarily limited to letters, phone calls, emails, voice mails, and from the submission of applications that is either required by law, or necessary to process applications or other requests for assistance through our organization. We are required to maintain the privacy and security of your protected health information. We are obligated to notify you promptly if a breach occurs that may have compromised your information. MLMC may change the terms of this notice, to comply with state and federal privacy and security laws. Changes will be published in writing and on our website.
What We Do Not Do With Your Information:
Information about your financial situation and medical conditions and care that you provide to us in writing, via email, on the phone (including information left on voice mails), contained in or attached to applications, or directly or indirectly given to us, is held in strictest confidence. We do not give out, exchange, sell, or disseminate any information about applicants or patients who apply for or actually receive our services considered confidential, are restricted by law, or have been specifically restricted by a patient in a signed HIPAA consent form for the purposes of marketing or fundraising.
How We Use Your Information:
Information is only used as is reasonably necessary to process your application or to provide you with health or counseling services which may require communication between MLMC and health care providers, organ donation agencies, coroners, medical examiner, funeral director, medical product or service providers, pharmacies, insurance companies, workers compensation, law enforcement, and other providers necessary to: verify your medical information is accurate; determine the type of medical supplies or any health care services you need including, but not limited to; or to obtain or purchase any type of medical supplies, devices, medications, and insurance. If you apply or attempt to apply to receive assistance through us and provide information with the intent or purpose of fraud or that results in either an actual crime of fraud for any reason including willful or un-willful acts of negligence whether intended or not, or in any way demonstrates or indicates attempted fraud, your non-medical information can be given to legal authorities including police, investigators, courts, and/or attorneys or other legal professionals, as well as any other information as permitted by law. You have to right to request a list (accounting) of the dates, times and individuals that viewed your record for 6 months prior to the date of asking. Information may be shared to help with public health and safety issues such as preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect or violence, and preventing serious threat to anyone’s health and safety.
Information We Do Not Collect:
We may use or disclose, as needed, your protected health information in order to support the business activities of this practice. These might include quality care evaluations, utilization review, training of medical students, accreditation, auditing, legal services, or conducting normal business activities, including the following:
1. Calling you to remind you of an appointment
2. Calling you by name in the waiting room when the provider is ready to see you
3. Contacting you by mail regarding appointments and/or billing
4. Providing you with treatment alternatives or health related benefits that may interest you
5. Complying with a subpoena for the records or if we need to disclose the records for the reason of protecting public health, in the event of suspected child abuse, neglect, or domestic violence. Disclosure may occur when requested by law for use by the Dept. of Health and Human Services, in compliance with the federal HIPAA Privacy Rule.
Disclosure of Information and Your Rights:
With your approval, we may from time to time disclose your protected health information to designated family, friends, and others who are involved in your care or in payment of your care in order to facilitate that person’s involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in your best interest, we may share limited protected health information with such individuals without your approval. We may also disclose limited protected health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you. You have the right to request a copy of your protected health information electronically or by paper, cost-based fee. You may request a change to your health record, but your provider maintains the right to refuse the request in writing within 60 days. You have the right to ask that information not be shared with your private insurance if the healthcare service is paid for out of pocket in full. We must follow the duties of this notice You have the right to request a copy of this Notice of Privacy Practices at any time, and to view it electronically online. You can file a complaint if you feel MLMC has violated your rights by contacting the U.S. Dept. of Health and Human Services Office of Civil Rights, 200 Independence Avenue S.W., Washington, DC 20201, or by calling 1-877-696-6775, or visit www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.
Mountain Laurel Medical Center has chosen to participate in the Chesapeake Regional Information System for our Patients, Inc. (CRISP), a regional health information exchange. As permitted by law, your health information will be shared with this exchange in order to provide faster access, better coordination of care and assist providers and public health officials in making more informed decisions. You may “opt-out” and disable all access to your health information available through CRISP by calling 1-877-952-7477 or completing and submitting an Opt-Out form to CRISP by mail, fax or through their website at www.crisphealth.org.
We are required by law to maintain the privacy of your protected health information and provide you with a copy of this notice of our legal duties and privacy practices. If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of Health and Human Services. You may not be retaliated against for filing a complaint.
Sandra Moore · Chief Operating Officer
1027 Memorial Drive · Oakland, MD 21550
Phone: 301-533-3300 · Fax: 301-533-3299
This health center is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).