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.


Each time you visit a medical center, physician, or other health care provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care of treatment and billing-related information. This notice applies to all of the records of your care generated by the medical center whether made by medical center personnel, agents of the medical center, or your personal physician. Your personal physician may have different policies or notices regarding the physician’s use and disclosure of our medical information created in the physician’s office or clinic.


This notice describes the practices of Maury Regional Medical Center and all of its affiliates. We refer to these entities collectively as “MRMC.” This notice applies to MRMC, its employees and other personnel, volunteers, students or trainees who we allow to help you while you are at the medical center and health care professionals (such as your physician) with staff privileges at MRMC. This notice applies only to your protected health information while you are a patient at MRMC. Health care professionals with staff privileges at MRMC may have different practices or notices regarding your health information created in their offices or clinics. All entities, sites, and locations follow the terms of this notice.


The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we explain what we mean and give some examples. Not every use or disclosure in a category is listed. However, the ways we are permitted to use and disclose information fall within one of the categories.

Treatment. We may use information about you to provide you with medical treatment or services. We may disclose information about you to physicians, nurses, technicians, medical students, or other medical center personnel who are involved in taking care of you at the medical center. For example, a physician treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, a physician may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of the medical center 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 information about you to people outside the medical center who may be involved in your medical care after you leave the medical center, such as primary care physicians, family members, clergy or others we use to provide services that are a part of your care.

Payment. We may use and disclose medical information about you so that the treatment and services that you receive at the medical center 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 insurance company information about your surgery so your health plan 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 covers the treatment.

Health Care Operations. We may use and disclose medical information about you for medical center operations. These uses and disclosures are necessary to run the medical center 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 medical center patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to physicians, nurses, technicians, medical students and other medical center personnel for review and learning purposes. We may also combine the medical information with medical information from other facilities 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.

The following uses and disclosures will be made only with your authorization:

  • Uses and disclosures for marketing purposes;
  • Uses and disclosures that constitute the sale of protected health information;
  • Most uses and disclosures of psychotherapy notes; and
  • Other uses and disclosures not described in this notice.


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 one of our facilities.

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.

Organized Health Care Arrangement. This medical center and its medical staff members have organized and are presenting you this document as a joint notice. Information will be shared as necessary to carry out treatment, payment and health care operations. Physicians and caregivers may have access to your protected health information in their offices to assist in reviewing past treatment as it may affect treatment at the time. Your information may be shared by and among members of the Maury Regional Medical Center Organized Health Care Arrangement. Your information may also be shared with the Vanderbilt Health Affiliated Network Organized Health Care Arrangement unless you object.

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 certain information (name, address, telephone number or e-mail information, age, date of birth, gender, health insurance status, dates of service, department of service information, treating physician information or outcome information) to contact you for the purpose of raising money for MRMC and you will have the right to opt out of receiving such communications with each solicitation. For the same purpose, we may provide your name to our institutionally related foundation. The money raised will be used to expand and improve the services and programs we provide to the community. You are free to opt out of fundraising solicitation, and your decision will have no impact on your treatment or payment for services at any of our facilities.

Medical Center Directory. We may include certain limited information about you in the medical center directory while you are a patient at the medical center. The information may include your name, location in the medical center, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for 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 do not ask for you by name. This is so your family, friends and clergy can visit you in the medical center 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 friend or family member who is 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 medical center. 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.

Incidental Disclosures. Certain incidental disclosures of your medical information occur as a byproduct of lawful and permitted use and disclosure of your medical information. For example, a visitor may inadvertently overhear a discussion about your care occurring at the nurses’ station. Such incidental disclosures are not considered violations of patient privacy.

Disclosures to Business Associates. MRMC contracts with outside companies that perform business services for us, such as billing companies, management consultants, quality assurance reviewers, accountants or attorneys. In certain circumstances, we may need to share your medical information with a business associate so it can perform a service on our behalf. The medical center limits disclosure of your information to a business associate to the amount of information that is the minimum necessary for the company to perform services for the medical center. In addition, we have a written contract in place with the business associate requiring it to protect the privacy of your medical information.

Customer Service. As part of our customer service program, we may use medical information about you to contact you by mail or phone after discharge to discuss your opinion of the services provided during your encounter with our medical center.

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 receive one medication to those who received another for the same condition. We use and share your information for research only as allowed by state and federal rules. Each research project is approved through a special process that balances the research needs with the patient’s need for privacy. In most cases, if the research involves your care or the sharing of your medical information, we will first explain to you how your information will be used and ask your consent to use the information. We may access your medical information before the approval process to design the research project and provide the information needed for approval.

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

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, is only to someone able to help prevent the threat.

Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.

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

Public Health Risks. We may disclose medical information about you for public health activities. These activities generally include the following:

  • To prevent or control disease, injury or disability;
  • To report births and deaths;
  • To report child abuse or neglect;
  • To report reactions to medications or problems with products;
  • To notify people of recalls of products they may be using;
  • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
  • To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

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.

Lawsuits and Disputes. 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 to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement. We may release medical information if asked to do so by a law enforcement official (1) in response to a court order, subpoena, warrant, summons or similar process; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime if, under certain circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct at the medical center; and (6) 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 medical center to funeral directors as necessary to carry out their duties.

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 who conduct special investigations.

Inmates. If you are an inmate at a correctional institution or under the custody of law enforcement officials, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.


You have the following rights regarding medical information we maintain about you:

Right to Inspect and Obtain a Copy of Your Medical Information. You have the right to inspect and obtain a copy of your medical information. Usually, this includes medical and billing records, but does not include psychotherapy notes. You must make your request in writing to Health Information Management at the address listed at the end of this Notice. Also, if you are a current patient, you may ask a nurse to review your medical record with you. If you request a copy of your medical record, it will be provided to you at no cost. You may request a paper copy or an electronic copy. There may be a fee associated with record requests from third parties (such as law firms).

There may be limited situations when we may deny your request to inspect and copy your information. If you are denied access to medical information, you will receive any such denial in writing along with instructions on how you may request that the denial be reconsidered. Another licensed health care professional chosen by the medical center reviews 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.

Breach Notification. You have the right to be notified in the event of a breach of your unsecured protected health information.

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 medical center.

To request an amendment, please submit your request in writing to the Privacy Officer. In addition, please 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:

  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  • Is not part of the medical information kept by or for the medical center;
  • Is not part of the information which you would be permitted to inspect and copy; or
  • Is accurate and complete.

Right to Accounting of Disclosures. You have the right to request an “accounting of disclosures.” If we deny your request for amendment, we will do so in writing. We will also inform you of how you may submit a written statement of disagreement with the denial, and a description of how you can make a complaint with your provider and the Secretary of HHS. This is a list of the disclosures we made of medical information about you.

To request this list or accounting of disclosures, please submit your request in writing to the Privacy Officer. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper; electronically). 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.

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.

There may be limited situations where we are unable to comply with your request for restrictions. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

You may also restrict disclosure of your protected health information to a health plan when you have paid for services out-of-pocket in full.

To request restrictions, please make your request in writing to the Privacy Officer. In your request, please 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.

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, please make your request in writing to the Privacy Officer. 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 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. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

You may also obtain a copy of this notice at our website,


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 post a copy of the current notice in the medical center. The effective date of the notice is listed on the first page.


If you believe your privacy rights have been violated, you may file a complaint with the medical center or with the Secretary of the Department of Health and Human Services. To file a complaint with the medical center, contact:

Privacy Officer

Maury Regional Medical Center

1224 Trotwood Avenue

Columbia, TN  38401

Phone 931.381.1111

All complaints must be submitted in writing.

The quality of your care will not be jeopardized nor will you be penalized for filing a complaint.


Other uses and disclosures of medical information not covered by this notice or the laws that apply to use will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

Effective Date: June 1, 2016




© 2008 Maury Regional Medical Center