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LSU HEALTH SHREVEPORT NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. LSU Health Shreveprt is cmmitted t prtecting medical, mental health and persnal infrmatin abut yu ("Health Infrmatin"). We are required by law t maintain the privacy f yur Health Infrmatin, prvide yu infrmatin abut ur legal duties and privacy practices, infrm yu f yur rights and the ways in which we may use Health Infrmatin and disclse it t ther entities and persns. HOW YOUR MEDICAL INFORMATION MAY BE USED: In general, we may use yur medical infrmatin in the fllwing ways: Fr Treatment. We may use Health Infrmatin abut yu t prvide yu with medical and mental health treatment r services. We may disclse Health Infrmatin abut yu t dctrs, nurses, technicians, students, r ther health system persnnel wh are invlved in taking care f yu in the health system. Fr example, a dctr treating yu fr a brken leg may need t knw if yu have diabetes because diabetes may slw the healing prcess. A dctr treating yu fr a mental cnditin may need t knw what medicatins yu are currently taking, because the medicatins may affect what ther medicatins may be prescribed t yu. We may als share Health Infrmatin abut yu with ther nn-lsu Health System prviders. The disclsure f yur Health Infrmatin t nn-lsu Health System prviders may be dne electrnically thrugh a health infrmatin exchange that allws prviders invlved in yur care t access sme f yur LSU Health System recrds t crdinate services fr yu. LSU Health Shreveprt participates in shared electrnic health recrds systems and ther patient infrmatin ( Shared Systems ) and may electrnically share yur health infrmatin fr treatment, payment, healthcare peratins, and ther purpses permitted under HIPAA with ther participants in the Shared Systems. The Shared Systems allws yur health care prviders t efficiently access and use yur pertinent medical infrmatin necessary fr treatment and ther lawful purpses. T btain payment. Yur medical infrmatin may als be used by ur business ffice t prepare yur bill and prcess payments frm yu as well as frm any insurance cmpany, gvernment prgram r ther persn wh is respnsible fr payment. Als, we may use yur medical infrmatin t raise funds fr ur rganizatin. Fr ur healthcare peratins. Yur medical infrmatin may be used t review the quality and apprpriateness f the care yu receive. We may als use yur medical infrmatin t put tgether infrmatin t see hw we are ding and t make imprvements in the services and care we give yu. In additin we may have students, trainees, r ther health care persnnel, as well as sme nn-health care persnnel, wh cme t ur facility t learn under ur guidance t practice r imprve their skills. Appintment reminders. We may cntact yu t remind yu that yu have an appintment at LSU Health Shreveprt. Our disclsure f this infrmatin abut yu if yu are hspitalized in a psychiatric hspital will be mre limited. HOW YOUR MEDICAL INFORMATION MAY BE DISCLOSED: In additin t using yur medical infrmatin, we may disclse all r part f it t certain ther peple. This includes giving yur infrmatin t: Yu (the patient). In rder t get yur medical infrmatin, yu will need t fill ut an authrizatin frm. Yu may als have t pay fr the cst f sme r all f the cpies. Peple yu ask us t give it t. If yu tell us that yu want us t give yur medical infrmatin t smene, we will d s. Yu will need t fill ut an authrizatin frm. Yu may stp this authrizatin at any time. We are nt allwed t frce yu t give us permissin t give yur medical infrmatin t anyne. We cannt 1

refuse t treat yu because yu stp this authrizatin. Situatins that will require yur authrizatin include mst uses and disclsures f psychtherapy ntes, prtected health infrmatin (PHI) fr marketing purpses, and disclsures that cnstitute a sale f PHI. Other uses and disclsures nt described in this Ntice and nt required r permitted by law will be made nly with yur authrizatin. Individuals invlved in yur care r payment fr yur care. We may release medical infrmatin t anyne invlved in yur medical care, e.g., a friend, family member, persnal representative, r any individual yu identify. We may als give infrmatin t smene wh helps pay fr yur care. We may als tell yur family r friends abut yur general cnditin and that yu are in the hspital. Disaster relief effrts. We may disclse Health Infrmatin abut yu t an entity assisting in a disaster relief effrt s that thers can be ntified abut yur cnditin, status and lcatin. Payers. We have the right t give yur medical infrmatin t insurance cmpanies, gvernment prgrams (such as Medicare and Medicaid) and the peple wh prcess their claims as well as t thers wh are respnsible fr paying fr all r part f the cst f treatment prvided t yu. Fr example, we may tell yur health insurance cmpany what is wrng with yu and what treatment is recmmended r has been given. Als, if yur treatment is r may be cvered by wrker s cmpensatin, we may give medical infrmatin t the peple wh handle yur wrker s cmpensatin, the Luisiana Office f Wrker s Cmpensatin Administratin and t yur emplyer. Our business assciates. Business assciates are cmpanies r peple that we cntract with t d certain wrk fr us. Examples include infrmatin t auditrs, attrneys and specialized peple prviding management, analysis, utilizatin review r ther similar services t us. Anther example is the giving f health infrmatin t a business assciate s that the business assciate can create a de-identified data base. Business assciates are required t agree t take reasnable steps t prtect the privacy f yur medical infrmatin. Limited data set recipients. If we use yur infrmatin t make a limited data set, we may give the limited data set that includes yur infrmatin t thers fr the purpses f research, public health actin r health care peratins. The persns wh receive limited data sets are required t agree t take reasnable steps t prtect the privacy f yur medical infrmatin. The Secretary f the U. S. Department f Health and Human Services. The Secretary r designee has the right t see yur recrds in rder t make sure we fllw the law. Public health authrities. We may disclse yur medical infrmatin t a public health authrity respnsible fr preventing r cntrlling disease, maintaining vital statistics r ther public health functins. We may als give yur medical infrmatin t the Fd and Drug Administratin in cnnectin with FDA-regulated prducts. Law enfrcement fficers. We may reveal yur medical infrmatin t the plice. We may als give yur medical infrmatin t persns whse jb is t receive reprts f abuse, neglect r dmestic vilence. If we believe that releasing this infrmatin is needed t prevent a serius threat t the health r safety f a persn r the public, we are allwed t reveal yur medical infrmatin. Health versight agencies. We may give yur medical infrmatin t agencies respnsible fr health versight activities, such as investigatins and audits, f the health care system r benefit prgrams, as allwed by law. Curts and administrative agencies. We may reveal yur medical infrmatin as required by a judge fr a legal issue. Crners and funeral directrs. We may reveal medical infrmatin abut persns wh have died t crners, medical examiners and funeral directrs, as allwed by law. Organ transplant services. We may reveal yur medical infrmatin t agencies that are respnsible fr getting and transplanting rgans. 2

Wrkers' cmpensatin. We may use r disclse Health Infrmatin abut yu fr Wrkers' Cmpensatin r similar prgrams as authrized r required by law. These prgrams prvide benefits fr wrk-related injuries r illness. Research. We may use and disclse yur health infrmatin t researchers either when yu authrize the use and disclsure f yur health infrmatin, r an apprved Institutinal Review Bard apprves an authrizatin waiver fr the use and disclsure f yur health infrmatin fr a research study. In additin t disclsing Health Infrmatin fr research, researchers may cntact patients regarding their interest in participating in certain research studies. Researchers may nly cntact yu if they have been given apprval t d s by the special review prcess. Yu will nly becme a part f ne f these research prjects if yu agree t d s and sign a specific permissin frm called an Authrizatin. When apprved thrugh a special review prcess, ther studies may be perfrmed using yur Health Infrmatin withut requiring yur authrizatin. These studies will nt affect yur treatment r welfare, and yur Health Infrmatin will cntinue t be prtected. T create de-identified databases. We may use yur medical infrmatin fr the purpse f remving infrmatin that tells anyne wh yu are, and putting it in a cmputer prgram. Yur infrmatin may be cmpletely de-identified r partially de-identified. This infrmatin is ften used fr research purpses. If yur infrmatin is partially de-identified, it is called a limited data set. Specialized gvernmental functins. We may disclse yur medical infrmatin fr certain specialized gvernmental functins, as allwed by law. Such functins include: Military and veterans activities Natinal security and intelligence activities Prtective services t the President and thers Medical suitability determinatins Inmates. If yu are an inmate f a crrectinal institutin r in the custdy f a law enfrcement fficial, we may release yur health infrmatin t the institutin r law enfrcement fficial. This release wuld be necessary fr the institutin t prvide yu with health care, t prtect yur health and safety r the health and safety f thers, r fr the safety and security f the crrectinal institutin. Required by Law. We may als reveal yur medical infrmatin in any ther circumstance where the law requires us t d s. Prtective services fr the president and thers. As required by law, we may disclse Health Infrmatin abut yu t authrized federal fficials s they may cnduct special investigatins r prvide prtectin t the President, ther authrized persns r freign heads f state. Luisiana health infrmatin exchange. LSU Health Shreveprt facilities participate in the Luisiana Health Infrmatin Exchange, a statewide internet-based health infrmatin exchange. As permitted by law, yur health infrmatin will be shared with this exchange in rder t prvide faster access, better crdinatin f care and assist prviders and public health fficials in making mre infrmed decisins. Future cmmunicatins. We may prvide cmmunicatins t yu with newsletters r ther means regarding treatment ptins, health related infrmatin, disease management prgrams, wellness prgrams, r ther cmmunity based initiatives r activities in which ur facility is participating. Marketing. LSU Health Shreveprt may ask yu t authrize us t use and disclse yur health infrmatin fr marketing purpses. Marketing is a cmmunicatin abut a prduct r service that yu may be interested in purchasing. If LSU Health Shreveprt receives payment f any kind frm a third party in rder fr LSU Health Shreveprt t prmte the prduct r service t yu, then LSU Health Shreveprt is required t btain yur written authrizatin befre we can use r disclse yur health infrmatin. LSU Health Shreveprt is nt required t btain yur authrizatin t discuss with yu abut LSU Health Shreveprt s health-related prducts r services that are available fr yur health care treatment, case management r care crdinatin, r t direct r recmmend alternative treatments, therapies, prviders, r settings f care, prviding face t face discussins and ffering samples r prmtinal gifts f nminal value. Yu have the right t revke yur marketing authrizatin and LSU Health Shreveprt will hnr the revcatin. T pt ut f these 3

cmmunicatins, yu may cntact the LSU Health Shreveprt Cmpliance Office at 318.675.5067 r send a written request t: LSU Health Shreveprt, Cmpliance Office, 1501 Kings Highway, Shreveprt, LA 71103. OBJECTIONS TO USES AND DISCLOSURES: In certain situatins, yu have the right t bject befre yur medical infrmatin can be used r revealed. This des nt apply if yu are being treated fr certain mental r behaviral prblems. If yu d nt bject after yu are given the chance t d s, yur medical infrmatin may be used: Patient directry. In mst cases, this means yur name, rm number and general infrmatin abut yur cnditin may be given t peple wh ask fr yu by name. Als, infrmatin abut yur religin may be given t members f the clergy, even if they d nt ask fr yu by name. Yu have the pprtunity t limit the release f directry infrmatin by telling LSU Health Shreveprt at the time f yur hspitalizatin. Our disclsure f this infrmatin abut yu if yu are hspitalized in a psychiatric hspital will be mre limited. Family and friends. We may disclse t yur family members, ther relatives and clse persnal friends, any medical infrmatin that they need t knw if they are invlved in caring fr yu. Fr example, we can tell smene wh is assisting with yur care that yu need t take yur medicatin r get a prescriptin refilled r give them infrmatin abut hw t care fr yu. We can als use yur medical infrmatin t find a family member, a persnal representative r anther persn respnsible fr yur care and t ntify them where yu are, abut yur cnditin r f yur death. If it is an emergency r yu are nt able t cmmunicate, we may still give certain infrmatin t persns wh can help with yur care. Disaster relief. We may reveal yur medical infrmatin t a public r private disaster relief rganizatin assisting with an emergency. OTHER RIGHTS REGARDING YOUR MEDICAL INFORMATION: Yu als have the fllwing rights regarding yur medical infrmatin: Right t request a restrictin. Yu have the right t ask us t treat yur medical infrmatin in a special way, different frm what we nrmally d. Unless yu have the right t bject t the use f the infrmatin, we d nt have t agree with yu. If we d agree t yur wishes, we have t fllw yur wishes until we tell yu that we will n lnger d s. If yu pay ut f pcket fr a service yu have the right t restrict the disclsure f the infrmatin cncerning the service(s) yu paid fr t yur health plan. Right t cnfidential cmmunicatins. Yu have the right t tell us hw yu wuld like us t send yur infrmatin t yu. Fr example, yu might want us t call yu nly at wrk r nly at hme. Or yu may nt want us t call yu at all. If yur request is reasnable, we will fllw yur request. Right t inspect and cpy. Yu have the right t lk at yur medical infrmatin and, if yu want, t get a cpy f it. We can charge yu fr a cpy, but nly a reasnable amunt. Yur right t lk at and cpy yur medical recrds is based upn certain rules. Fr example, we can ask yu t make yur request in writing r, if yu cme in persn, that yu d s at certain times f the day. Right t request an amendment r addendum. Yu have the right t ask us t change yur medical infrmatin. Fr example, if yu think we made a mistake in writing dwn what yu said abut when yu began t feel bad, yu can tell us. If we d nt agree t change yur recrd, we will tell yu why, in writing, and give yu infrmatin abut yur rights. We may deny yur request fr an amendment if it is nt in writing, we cannt determine frm the request the infrmatin yu are asking t be changed r crrected r yur request des nt include a reasn t supprt the change r additin. In additin, we may deny yur request if yu ask us t amend infrmatin that: Was nt created by LSU Health Shreveprt; 4

Is nt part f the Health Infrmatin kept by r fr LSU Health Shreveprt; Is nt part f the infrmatin which yu wuld be permitted t inspect and cpy; r LSU Health Shreveprt believes t be accurate and cmplete. Right t an accunting f disclsures. Yu have the right t be tld t whm we have given yur medical infrmatin in the six years befre yu ask. This des nt apply t all disclsures. Fr example, if we gave smene yur medical infrmatin s that they culd treat yu r pay fr yur care, we d nt have t keep a recrd f that. Right t request restrictins. Yu have a right t restrict disclsures f yur medical infrmatin t yur payr if yu wish t pay ut f pcket in full fr items r services prvided t yu. Right t pt ut. Yu have the right t pt ut f receiving cmmunicatins regarding fundraising. Right t receive a paper cpy. Yu have the right t receive a paper cpy f this ntice at n charge. Right t be ntified f a breach. Yu have the right t be ntified if we r ne f ur Business Assciates discvers a breach f unsecured Health Infrmatin abut yu. Right t cmplain. Yu have the right t cmplain t us r t the United States Department f Health and Human Services if yu believe that we have vilated yur privacy rights. If yu chse t file a cmplaint, yu will nt be penalized in any way. CHANGES TO OUR PRIVACY PRACTICES AND THIS NOTICE We reserve the right t change ur privacy practices and this Ntice. We reserve the right t make the revised r changed Ntice effective fr Health Infrmatin we already have abut yu as well as any infrmatin we receive in the future. We will pst a cpy f the current Ntice at key lcatins thrughut LSU Health Shreveprt. In additin, at any time yu may request a cpy f the current Ntice in effect. If yu wuld like further infrmatin abut yur rights r abut the uses and disclsures f yur medical infrmatin, yu may cntact the Cmpliance/Privacy Office at 1.800.447.8477 r by writing t the Cmpliance/Privacy Office, 1501 Kings Highway, Shreveprt, LA 71103. This ntice is effective as f September 20, 2013. Revisin Dates: June 17, 2014, September 10, 2015 5

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