The Health Insurance Portability and Accountability Act of 1996 (HIPAA) guarantees certain privacy rights regarding your personal medical/health information. You may learn more about HIPAA by visiting the U.S. Department of Health & Human Services Office for Civil Rights Web site at www.hhs.gov/ocr/hipaa.

THIS NOTICE DESCRIBES HOW MEDICAL/HEALTH INFORMATION ABOUT YOU OR ABOUT THE INDIVIDUAL FOR WHOM YOU ARE AN AUTHORIZED PERSONAL REPRESENTATIVE MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THE INFORMATION. PLEASE REVIEW IT CAREFULLY.

Mississippi State Hospital and the Mississippi Department of Mental Health are dedicated to protecting your medical information.

Mississippi State Hospital is required by law to maintain the privacy of your protected health information and to provide you with this Notice of our legal duties and privacy practices with respect to protected health information. Mississippi State Hospital collects health information from you and stores it in a chart or file and on computer. This is your health record. The health record is the property of Mississippi State Hospital, but the information in the record belongs to you. If you have questions about any part of this Notice or if you want more information about privacy practices at Mississippi State Hospital, please contact:

Mississippi State Hospital
ATTN: HIPAA Coordinator / Bldg. 67
PO Box 157-A
Whitfield, Mississippi 39193
Phone number: 601-351-8261

Effective Date of this Notice: December 1, 2013
Mississippi State Hospital is required to abide by the terms of the Notice currently in effect. This notice is a revision of the Notice of Privacy Practices that was printed on April 14, 2003.

Changes to the Notice: Mississippi State Hospital reserves the right to change the terms of this Notice and to make the new Notice provisions effective for all protected health information that we maintain. If Mississippi State Hospital makes a material change in this Notice, we will post the revised Notice at the hospital and will make a copy of the revised Notice available to you upon request.

Section I: Description of how Mississippi State Hospital may use or disclose your health information and examples of each.
The law permits Mississippi State Hospital to use or disclose your health information without your written consent or authorization for the following purposes:

Treatment:We may use health information, including psychotherapy notes, about you to provide treatment and services. We may disclose your health information to doctors, nurses, technicians, or other staff at Mississippi State Hospital who are involved in taking care of you or when we refer you to another health care provider for treatment or services.

Examples: Your physician may ask a nurse to give you certain medications or information related to your condition or treatment. Another example is that if you had heart problems that required us to consult with heart specialist (cardiologist) outside of the hospital, your doctor at the hospital may refer you to a cardiologist in the community for your care. The hospital would share your information from your health record needed by the staff at the cardiologist's office for your continued care. We may also release your information from your health record needed by the staff at the cardiologist's office for your continued care. We may also release your information to another treatment facility for your continued care after your discharge from this facility.

Payment: We may use and disclose your health information to third party payers, such as insurance companies, Medicaid, or Medicare, when needed to determine your eligibility for benefits, for reimbursement or for other requirements related to payment for treatment or services.

Healthcare Operations: We may use your health information for the purposes of Mississippi State Hospital operations. These use and disclosures are necessary to run or operate the hospital and to make sure that all individuals we serve receive quality care.

Examples: Information on or accompanying a bill to your insurance company or a claim form to the Division of Medicaid may include information, such as your diagnosis, the dates you received the services for which payment is requested or claimed, and the procedures or services you received. Information may be disclosed and used as part of utilization review activities, such as pre certification and preauthorization of services and concurrent and retrospective review of services.

Mississippi State Hospital (MSH) will not use or disclose psychotherapy notes without authorization except to carry out treatment, payment or health care operations as authorized by law. Examples where psychotherapy notes may be used and disclosed without authorization include use by the originator of the notes for treatment, use by oversight agency with respect to the originator of the notes, and use by the hospital for its own training programs in which students, trainees, or practitioners in mental health learn under supervision to practice or improve skills in group, joint, family or individual counseling sessions. The hospital may also use or disclose psychotherapy notes to defend itself in a legal action or proceeding brought by you; with respect to oversight of the originator of the psychotherapy notes; to the coroner or medical examiner as required by law; to prevent or lessen a serious or imminent threat to the health or safety of the person or to the public; to the Secretary of Health and Human Services regarding compliance under HIPAA, and as otherwise required by law.

Psychotherapy notes means notes recorded (in any medium) by the heatlh care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual's medical record. Psychotherapy notes excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical test, any summary of the following items: Diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.

Section II: Other purposes for which we are permitted or required to use or disclose your health information without your consent or authorization:

Examples: Your records may be copied by a secretary to send them to another healthcare provider for your continued treatment. Members of medical/nursing staff and other staff at the hospital may review your health information to assess the care, outcomes, and quality of services you and others at the hospital receive.

1. We may contact you to provide or remind you of an appointment,
information about treatment alternatives, or other health related
benefits and services that may be of interest to you. Examples of how we may contact you include:

Telephone calls (Messages to call the center/hospital may be left on
the answering machine.)
Written correspondence
Facsimile (fax)
Electronic mail
Written correspondence or telephone calls asking you to help identify
what services might be beneficial to you, to ask about your
satisfaction with our services, or to ask about your ongoing treatment after discharge.

2. We may disclose your health information to you or your authorized
personal representative, except as restricted under applicable laws
and regulations.

3. Information may be released about you for public health activities,
such as:

- To prevent or control diseases.
- To report death.
- To report abuse or neglect.

To track products as regulated by the federal Food and Drug Administration (FDA) and to report problems or reactions to medication or products.
To provide notification and communication about product recalls, replacements and look-backs.

4. Information may be released to health oversight agencies for activities authorized by law. These activities may include investigations, inspections and licensure, and other lawful activities. These activities may also include providing access to your health information on a need-to-know basis by members of the Human Rights Advocacy Committee for approved activities. All specific information gained by the Human Rights Committee shall remain confidential.

5. Information may be disclosed in the course of any administrative or judicial proceeding:
- In response to a court order.
- Under certain restricted circumstances, in response to a subpoena or a similar process.

6. Information may be disclosed for law enforcement purposes under certain circumstances, such as reporting of certain types of physical injuries, locating persons and reporting and investigating of crimes.

7. Information may be disclosed to a coroner, medical examiner, or funeral directors, consistent with applicable law.

8. If you are a organ, eye or tissue donor, your health information may be disclosed to organizations involved in procurement, banking or transplantation to facilitate organ, eye or tissue donation or transplantation.

9. Information may be disclosed for public safety reasons to appropriate persons in order to prevent or lessen a serious and/or imminent threat to the health or safety of a particular person or the general public.

10. Information may be disclosed as necessary to comply with Workers Compensation laws.

11. Information may be disclosed for research purposes, only as approved by the facility's research committee that serves as an Institutional Review Board and/or privacy board.

12. We may disclose your health information for other purposes as required or permitted by law.

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Section III: When Mississippi State Hospital may not use or disclose your health information. Description of uses and disclosures that require your authorization. MSH will not use or disclose your protected health information for marketing purposes or make any disclosures that constitute a sale without your authorization. If you do authorize the hospital to use or disclose your information for purposes other than as provided in this Notice, you may revoke your authorization at any time in writing.

Other uses and disclosures not described in the Notice of Privacy Practices will be made only with authorization from individual.

Please Note: Release of information and/or other health information rights relating to substance abuse treatment/services and to nursing home services are also subject to rights and/or restrictions set out in other federal law and regulations.

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Section IV: Your Health Information Rights
You have the following rights with respect to your Protected Health Information (PHI)

1. The right to request restrictions on certain uses and disclosures of protected health information. Mississippi State Hospital is not required to agree to your requested restriction unless it is to restrict information to a health plan for a health care item or service which you or a person other than the health plan have paid in full . If the hospital does agree to your requested restriction, we will comply with your request, unless the information is needed to provide you with emergency treatment.

2. The right to receive confidential communications of protected health information. You have the right to request in writing to the Privacy Officer that the hospital only communicate to you in a certain format (for example, in writing) and/or location (for example, only at your work address). We will accommodate all reasonable requests.

3. The right to inspect and copy protected health information, subject to certain restrictions as provided for by law. You may be charged a fee for copying and/or postage.

4. The right to amend protected health information. You have a right to request that Mississippi State Hospital amend or change your health information. Mississippi State Hospital is not required to change your health information under certain conditions. You must make requests for amendments in writing and include the reason(s) for your request.

5. The right to receive an accounting of disclosures of protected health information. You have a right to receive an accounting of disclosures of your health information made by the hospital, except for disclosures such as treatment, payment, healthcare operations, and certain other disclosures as provided for by law.

6. The right to receive a paper copy of this Notice of Privacy Practices. If you agreed to receive this Notice electronically, you also have the right request a paper copy.

7. The right to be notified of a breach. You have a right to be notified following a breach of unsecured Protected Health Information if it is reasonably believed your information has been accessed, acquired or disclosed as a result.

Section V: How you can exercise your health information rights
You may exercise one or more of the right described in the Notice or receive additional information by contacting:

HIPAA Coordinator
Mississippi State Hospital
Whitfield, Mississippi 39193
Phone number: 601-351-8261

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Section VI: Complaints
If you believe your health information privacy rights have been violated, you may contact:

Mississippi State Hospital
ATTN: Patient Advocate/ Bldg 67
PO Box 157-A
Whitfield, Mississippi 39193
Phone Number: 601-351-8500

Or, you may contact:

OCR Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
Sam Nunn Atlanta Federal Center
Suite 16T70
61 Forsyth Street, S.W.
Atlanta, GA 30303-8909

Or

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

You will not be retaliated against for filing a complaint.

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