NOTICE of PRIVACY PRACTICES
Grady Memorial Hospital - Five Oaks Medical Group - Rush Springs Family Medical Clinic

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

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Introduction - At Grady Memorial Hospital and Clinics, we are committed to treating and using
protected health information about you responsibly. This Notice of Health Information Practices
describes the personal information we collect, and how and when we use or disclose that
information. It also describes your rights as they relate to your protected health information.
This Notice is effective April 2, 2003 and applies to all protected health information as
defined by federal regulations.

Understanding Your Health Record/Information - Each time you visit Grady Memorial Hospital or
one of the Clinics, a record of your visit is made. Typically, this record contains your symptoms,
examination and test results, diagnoses, treatment, and a plan for future care or treatment.
This information, often referred to as your health or medical record, serves as a:

- Basis for planning your care and treatment,
- Means of communication among the many health professionals who contribute to your care,
- Legal document describing the care you received,
- Means by which you or a third-party payer can verify that services billed were actually provided,
- A tool in educating health professionals,
- A source of data for medical research,
- A source of information for public health officials charged with improving the health of this
state and the nation, - A source of data for our planning and marketing,
- A tool with which we can assess and continually work to improve the care we render and
the outcomes we achieve.

Understanding what is in your record and how your health information is used helps you to:
ensure its accuracy, better understand who, what, when, where, and why others may access
your health information, and make more informed decisions when authorizing disclosure to
others.

Your Health Information Rights - Although your health record is the physical property of Grady
Memorial, the information belongs to you. You have the right to:

- Inspect and copy your health record as provided for in (Federal Law) 45 CFR 164.524,
- Amend your health record as provided in (Federal Law) 45 CFR 164.526,
- Obtain an accounting of disclosures of your health information as provided in (Federal Law)
45 CFR 164.528,
- Request communications of your health information by alternative means or at alternative
locations,
- Request a restriction on certain uses and disclosures of your information as provided by
(Federal Law) 45 CFR 164.522, and
- Revoke your authorization to use or disclose health information except to the extent that
action has already been taken.

Our Responsibilities - Grady Memorial Hospital and the Clinics are required to:

- Maintain the privacy of your health information,
- Provide you with this notice as to our legal duties and privacy practices with respect to
information we collect and maintain about you,
- Abide by the terms of this notice,
- Notify you if we are unable to agree to a requested restriction, and
- Accommodate reasonable requests you may have to communicate health information by
alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for
all protected health information we maintain. Revisions will be posted and available upon
request. Except as described in this notice and in Hospital Policies related to Privacy
Practices we will not use or disclose your health information without your authorization.

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Grady Memorial Hospital / 2220 Iowa Ave. / Chickasha, OK 73018 / (405) 224 - 2300
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