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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- Business associates: There are some services provided in our organization through contracts
with business associates. Examples include physician services in the emergency
department, radiology and certain laboratory tests. When these services are contracted, we
may disclose your health information to our business associate so that they can perform
the job we’ve asked them to do and bill you or your third-party payer for services rendered.
To protect your health information, however, we require by contract that the business associate
appropriately safeguard your information.

- Hospital Directory: If you are a patient of the Hospital, unless you notify us that you object,
we will use your name, location in the facility, general condition, and religious affiliation for
directory purposes. This information may be provided to members of the clergy and except for
religious affiliation, to other people who ask for you by name.

- Notification: We may use or disclose information to notify a family member, personal
representative, or person responsible for your care of your location and general condition.

- Communication with family: Health professionals, using their best judgment, may disclose
to a family member, other relative, close personal friend or any other person you identify,
health information relevant to that person’s involvement in your care or payment related to
your care.

- Research: We may disclose information to researchers when their research has been
approved by an institutional review board and protocols have been established to ensure
the privacy of your health information.

- Funeral directors: We may disclose health information to funeral directors consistent with
applicable law.

- Organ procurement organizations: Consistent with applicable law, we may disclose health
information to organ procurement organizations or other entities engaged in the procurement,
banking, or transplantation of organs for the purpose of tissue donation and transplant.

- Marketing: We may contact you to provide appointment reminders or information about
treatment alternatives or other health-related benefits and services that may be of interest to
you.

- Fund-raising: We may contact you as part of our fund-raising effort.

- Food and Drug Administration (FDA): We may disclose to the FDA health information relative to
adverse events with respect to food, supplements, product and product defects, or post
marketing surveillance information to enable product recalls, repairs, or replacement.

- Workers compensation: We may disclose health information to the extent authorized by and to
the extent necessary to comply with laws relating to workers compensation or other similar
programs established by law.

- Public health: As required by law, we may disclose your health information to public health or
legal authorities charged with preventing or controlling disease, injury, or disability.

- Law-enforcement: We may disclose health information for law enforcement purposes as
required by law or in response to a valid subpoena. Federal law makes provision for your
health information to be released to an appropriate health oversight agency, public health
authority or attorney, provided that a work force member or business associate believes in
good faith that we have engaged in unlawful conduct or have otherwise violated professional
or clinical standards and are potentially endangering one or more patients, workers or
the public.

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