Memorial Physician Practices Notice of Privacy Summary

This notice describes how your medical information may be used and disclosed and how you can obtain access to your information. Please review the summary carefully. If you need additional detailed information on your right to privacy or would like to speak with someone regarding this notice, please call the hospital at 575-522-8641 and ask to speak with the Privacy Officer.

I. When Medical Information Can Be Used Without Your Authorization

Treatment: The doctors, nurses, technicians and other Team Members of Memorial Medical Center (MMC) and companies that act on behalf of the hospital can use medical information so you can get treatment and care. For example, we can tell the doctor that might be treating you for a broken leg about your diabetes because that medical information is important for healing.

Payment: We can use and share medical information about you to the company or person who is paying your medical bills. For example, we can share medical information on your surgery to get your broken leg fixed so they will pay us or pay you back if you paid for the surgery.

Health Care Operations: We can use or share medical information about you as part of our health care operations. For example, we may use your medical information to review our treatment and services and to see how well the doctors, nurses and other medical staff cared for you while you were in the hospital.

Other Permitted Purposes: We may also share medical information about you if we are required to do so by state or federal law. We may also use or release medical information about you if a court, police or other law enforcement personnel, the public health office, or other government agencies, requires it. For example, we may be required to give the court medical information about the treatment you received in the emergency department if that information is necessary for the court. We may be required to report to the New Mexico Department of Health that you have a communicable disease, like tuberculosis. We may be required to call the police and provide specific information about violent crimes.

II. When Medical Information Cannot be Used Without Your Authorization

We cannot use or share medical information about you in other situations. Specifically, we cannot share medical information about you with people who are doing marketing, fund-raising, or research studies without your permission. We will not release the notes made by a psychotherapist about you, without your permission, except under specific circumstances.

III. Your Rights to Your Medical Information

You have a right to request that we restrict access to your medical information for only treatment, payment, or health care operations. We may not be able to agree with your request but will do our best to restrict access. For example, you may not want us to tell the Department of Health that you have tuberculosis but we are required by state law to report this disease and will not be able to honor your request. You also have a right to request that we provide medical information to you by an alternative means or at an alternative location. For example, if you request that we send appointment reminders to your work address rather than to your home address, we will try to honor that request.

You also have a right to inspect your medical information and request a copy of it. You have a right to request that your medical information be amended. You also have a right to request a list of people or companies we provided your medical information to for a six-year period (beginning on April 14, 2003) which is not related to treatment, payment, health care operations, or other permitted purposes.

IV. Our Responsibilities

We pledge to keep medical information about you private and not use that information or share that information in a manner that invades your privacy. We are required to provide you with this notice so that you will understand your rights and our responsibility with respect to your medical information. We will abide by the terms of the Notice of Privacy that is currently in effect. We reserve the right to change the Notice and use the terms of that Notice to protect new medical information about you. However, we will make a revised Notice available to you if you contact us at the number listed at the top of this Notice or when you come to our facilities again.

If you believe that we have violated your right to keep your medical information private, please call the MMC Privacy Officer. You also have a right to file a complaint with the Secretary of Health and Human Services. We will not punish you for filing a complaint.

Effective Date: April 14, 2003

If you would like to receive this information in Spanish, please call the Privacy Officer at 575-522-8641.