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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For more Information or to Report a Problem - If you have questions and would like additional
information, or if you believe your privacy rights have been violated, you may contact the
local privacy officer.

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

or the Office for Civil Rights, U.S. Department of Health and Human Services.

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue S.W.
Room 509F, HHH Building
Washington, D.C. 20201

There will be no retaliation for filing a complaint with either the Privacy Officer or the Office
for Civil Rights.

Examples of Disclosures for Treatment, Payment and Health Operations
We will use your health information for treatment. For example: Information obtained by
a nurse, physician, or other member of your health care team will be recorded in your record
and used to determine the course of treatment that should work best for you. Your physician
will document in your record his or her expectations of the members of your health care team.
Members of your health care team will then record the actions they took and their observations.
In that way, the physician will know how you are responding to treatment. When appropriate,
we will also provide your physician or a subsequent health care provider with copies of
various reports that should assist him or her in treating you once you are discharged from
this hospital or clinic.

We will use your health information for payment. - For example: A bill may be sent to you or a
third-party payer. The information on or accompanying the bill may include information that
identifies you, as well as your diagnosis, procedures, and supplies used.

We will use your health information for regular health operations. For example: Members of the
medical staff, the risk or quality improvement manager, or members of a quality improvement
team may use information in your health record to assess the care and outcomes in your case
and others like it. This information will then be used in an effort to continually improve the
quality and effectiveness of the healthcare and service we provide.

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