JOHNSON MEMORIAL HOSPITAL

1125 W. Jefferson Street, Franklin, IN 46131

NOTICE OF PRIVACY PRACTICES
Effective Date: April 14, 2003

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

This notice describes our hospital's practices and that of :

1. Todd-Aikens Health Center, 1125 W. Jefferson Street, Franklin, IN 46131.

2. Johnson Memorial Home Care Services, 1101 W. Jefferson Street - Suite R, Franklin, IN 46131.

3. Johnson Memorial Hospital Immediate Care and Occupational Medicine Center, 2085 Acorn Drive, Franklin, IN 46131.

4. All other departments and units of the hospital.

5. Members of the hospital's medical staff and any other health care professional authorized to enter information into your hospital chart.

6. Any member of a volunteer group we allow to help you while you are in the hospital.

7. All employees, staff and other hospital personnel.

OUR DUTIES REGARDING MEDICAL INFORMATION.
We understand that protected health information ("medical information") about you is personal. We are committed to protecting medical information about you. This notice applies to all of the records of your care generated by the hospital, whether made by hospital personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your medical information created in the doctor's office or clinic. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of your medical information.

We are required by law to:

1. Maintain the privacy of your medical information.

2. Give you this notice of our legal duties and privacy practices regarding your medical information.

3. Follow the terms of this notice that is currently in effect.

WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU TO CARRY OUT TREATMENT, PAYMENT OR HEALTH CARE OPERATIONS.
The following categories describe different ways that we may use and disclose medical information about you to carry out treatment, payment or health care operations.

Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students or other hospital personnel who are involved in taking care of you at the hospital. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of the hospital also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose medical information about you to another health care provider so that the other provider can treat you. For example, we may disclose medical information about you to your doctor so that he can provide medical care to you.

Payment. We may use and disclose medical information about you so that the treatment and services you receive at the hospital may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan or insurance company information about surgery you received at the hospital so your health plan or insurance company will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. We also may disclose medical information about you to another health care provider, health plan or health care clearinghouse for the payment activities of that other provider or entity. For example, we may disclose medical information about you to your doctor so that he may obtain reimbursement for the services which he has provided to you.

Health Care Operations. We may use and disclose medical information about you for hospital operations. These uses and disclosures are necessary to run the hospital and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many hospital patients to decide what additional services the hospital should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students and other hospital personnel for review and learning purposes. We may also combine the medical information we have with medical information from other hospitals to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are. We also may disclose medical information about you to another health care provider, health plan or health care clearinghouse for the health care operations of that other provider or entity, if that other provider or entity either has or had a relationship with you. For example, we may disclose medical information about you to another hospital where you were treated for the quality assessment and improvement activities of the other hospital.

Organized Health Care Arrangement. An organized health care arrangement includes a clinically integrated care setting in which patients receive health care from more than one health care provider. A hospital is perhaps the most common example of a clinically integrated care setting, when a hospital and physicians with medical staff privileges at the hospital together provide treatment to patients. We may disclose medical information about you to another entity that participates with the hospital in providing for your care. For example, we may disclose medical test results about you to your doctor so that he is able to treat you.

Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the hospital.
Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

Fundraising Activities. We may use medical information about you to contact you in an effort to raise money for the hospital. If you do not want the hospital to contact you for fundraising efforts, you must notify the Johnson County Health Foundation at 1125 W. Jefferson Street, Franklin, IN 46131 in writing.

WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU FOR A HOSPITAL DIRECTORY AND TO GIVE INFORMATION TO INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE.
The following categories describe different ways that we may use and disclose medical information about you for a hospital directory and to give information to individuals involved in your care or payment for your care. However, generally speaking, we must orally inform you of this and give you the opportunity to orally agree to or prohibit or restrict use and disclosure of medical information about you for these purposes. In certain situations, such as emergencies, your incapacity or disaster relief purposes, we do not have to inform you or give you an opportunity to agree or object to our use and disclosure of medical information about you for these purposes.
Hospital Directory. We may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don't ask for you by name. This is so your family, friends and clergy can visit you in the hospital and generally know how you are doing.

Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to a person who has been determined to be involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in the hospital. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU WITHOUT YOUR WRITTEN AUTHORIZATION OR THE OPPORTUNITY FOR YOU TO ORALLY AGREE OR OBJECT IN CERTAIN SITUATIONS.
The following categories describe different ways that we may use and disclose medical information about you in certain situations without your written authorization or the opportunity for you to orally agree or object to the use and disclosure.

As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law.

Public Health Activities. We may disclose medical information about you for public health activities. These activities include but are not limited to the following: reports to public health authorities for the purpose of preventing or controlling disease, injury or disability, including reporting such items and reporting births and deaths, and reports to the Food and Drug Administration.

Victims of Abuse, Neglect or Domestic Violence. We may disclose to a government authority medical information about a person whom we believe to be a victim of abuse, neglect or domestic violence.

Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Judicial and Administrative Proceedings. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made by the person seeking the information to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement Purposes. We may release medical information about you to a law enforcement official under certain circumstances. These include, but are not limited to: a response to a court order, subpoena, warrant, summons or similar process; to identify or locate a suspect, fugitive, material witness, or missing person; to give information about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement; about a death we believe may be the result of criminal conduct; about criminal conduct at the hospital; and in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.

Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients' need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but we may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave the hospital. We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the hospital.

To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

Specialized Government Functions. Military and veterans activities: If you are or have been a member of the armed forces, we may release medical information about you as required by military command authorities or for veterans purposes. We may also release medical information about foreign military personnel to the appropriate foreign military authority. National security and intelligence activities: We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. Protective services for the President and others: We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations. Law enforcement custodial situations: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official.

Workers' Compensation. We may release medical information about you for workers' compensation or similar programs that provide benefits for work-related injuries or illness.

YOU HAVE RIGHTS REGARDING YOUR MEDICAL INFORMATION.
You have the following rights regarding your medical information:

Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions regarding your medical information from the hospital or the Immediate Care and Occupational Medicine Center, you must make your request in writing to the Medical Information Department of Johnson Memorial Hospital. To request restrictions regarding your medical information from Todd-Aikens Health Center, you must make your request in writing to Todd-Aikens Health Center. To request restrictions regarding your medical information from Johnson Memorial Home Care Services, you must make your request in writing to Johnson Memorial Home Care Services. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse. We have the right to terminate restrictions that we have agreed to.

Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications from the hospital or from the Immediate Care and Occupational Medicine Center, you must make your request in writing to the Medical Information Department of Johnson Memorial Hospital. To request confidential communications from the hospital or from the Immediate Care and Occupational Medicine Center, you must make your request in writing to the Medical Information Department of Johnson Memorial Hospital. To request confidential communications from Todd-Aikens Health Center, you must make your request in writing to Todd-Aikens Health Center. To request confidential communications from Johnson Memorial Home Care Services, you must make your request in writing to Johnson Memorial Home Care Services. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to Inspect and Copy. You have the right to inspect and copy your medical information. Usually, this includes medical and billing records, but it does not include psychotherapy notes.
To inspect and copy medical information from the hospital or the Immediate Care and Occupational Medicine Center that may be used to make decisions about you, you must submit your request in writing to the Medical Information Department of Johnson Memorial Hospital. To inspect and copy medical information from Todd-Aikens Health Center that may be used to make decisions about you, you must submit your request in writing to Todd-Aikens Health Center. To inspect and copy medical information from Johnson Memorial Home Care Services that may be used to make decisions about you, you must submit your request in writing to Johnson Memorial Home Care Services. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain circumstances. If you are denied access to medical information, in most situations you may request that the denial be reviewed. If we deny your request and if you have the right of review, another licensed health care professional chosen by the hospital or other entity which denied your request will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the hospital or other entity.
To request an amendment from the hospital or the Immediate Care and Occupational Health Center, your request must be made in writing and submitted to the Medical Information Department of Johnson Memorial Hospital. To request an amendment from Todd-Aikens Health Center, your request must be made in writing and submitted to Todd-Aikens Health Center. To request an amendment from Johnson Memorial Home Care Services, your request must be made in writing and submitted to Johnson Memorial Home Care Services. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: 1. Was not created by us, unless the person or entity that created the information is no longer available to make the amendment. 2. Is not part of the medical information kept by or for us. 3. Is not part of the information which you would be permitted to inspect and copy. 4. Or, is accurate and complete.

Right to an Accounting of Disclosures. Under some circumstances, you have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you. However, this is no right to an accounting for certain types of disclosures, for example, disclosures to carry out treatment, payment and health care operations.
To request this list or accounting of disclosures from the hospital or from the Immediate Care and Occupational Medicine Center, you must submit your request in writing to the Medical Information Department of Johnson Memorial Hospital. To request this list or accounting of disclosures from Todd-Aikens Health Center, you must submit your request in writing to Todd-Aikens Health Center. To request this list or accounting of disclosures from Johnson Memorial Home Care Services, you must submit your request in writing to Johnson Memorial Home Care Services. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. Generally speaking, we are allowed 60 days to provide you with this information.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. You may contact: Patient Registration or the Medical Information Department for the hospital or the Immediate Care and Occupational Health Center, Patient Registration for Todd-Aikens Health Center, and Patient Registration for Johnson Memorial Home Care Services. If you are currently an inpatient at the hospital, you make ask your nurse to assist you in obtaining this copy. You may obtain a copy of this notice at our website, www.johnsonmemorial.org.

CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the hospital, the Immediate Health and Occupational Care Center, Todd-Aikens Health Center, and Johnson Memorial Home Care Services. The notice will contain the effective date on the first page. In addition, each time you register at or are admitted to any of those locations as an inpatient or outpatient, we will offer you a copy of the current notice in effect.

COMPLAINTS; CONTACT INFORMATION
If you have a complaint, you may file it with the hospital if it is applicable to the hospital, the Immediate Care and Occupational Medicine Center, Todd-Aikens Health Center or Johnson Memorial Home Care Services or with the Secretary of the Department of Health and Human Services. If you want to file a complaint with us or need further information from us about the matters covered by this notice, you may contact the Patient Advocate for Johnson Memorial Hospital, the Immediate Care and Occupational Health Center, Todd-Aikens Health Center or Johnson Memorial Home Care Services by calling (317) 346-3929 or by mail (at the address for the applicable entity shown above). All complaints must be submitted in writing. You will not be retaliated against for filing a complaint.