Mercy Notice of Privacy Practices

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 applies to the Mercy hospital, clinics and services listed under the Contact Information to the right (Collectively “Mercy”).

Mercy’s Duties

By law, Mercy must keep protected health information (“PHI”) private. The federal government defines protected health information as any information, whether oral, electronic or paper, which is created or received by Mercy and relates to a patient's health care or payment for the provision of medical services. This includes not only the results of tests and notes written by doctors, nurses and other clinical personnel, but also certain demographic information (such as your name, address and telephone number) that is related to your health records.

Mercy is required by law to give you this notice and to follow the terms and conditions of the notice that is currently in effect.

The Health Care Providers Covered By This Notice

This notice covers Mercy and Mercy personnel, volunteers, students, and trainees. The notice also covers other health care providers that come to Mercy's facilities to care for patients (such as physicians, physician assistants, therapists, and other health care providers not employed by Mercy), unless these other health care providers give you their own notice of privacy practices that describes how they will protect your medical information. Mercy may share your medical information with these other health care providers for treatment, payment and health care operations purposes. This arrangement is only for sharing information and not for any other purpose.

Use and Disclosure of (PHI):

Below is a list of the most common circumstances in which Mercy may use or share your PHI:

For Treatment:We may need to use or share PHI about you with people involved in your care. For example, a doctor may need to look at your medical history before treating you.

For Payment: We may use and disclose your protected health information to bill and receive payment for thecare and treatment that you received. For example, we may share your medical information with your insurance company about a service you received at Mercy so that your insurance company can pay us or reimburse you for the service.

For Health Care Operations: We can use and disclose protected health information about you for our operations. For example, we may share PHI about you to evaluate our doctors’ and nurses’ performance in caring for you.

For Research:We may share your PHI with researchers with your authorization or when their research has been approved by an institutional review board (IRB) that has reviewed the research proposal and established protocols (waiver of permission) to ensure the privacy of your protected health information.

Other Uses and Disclosures of PHI:

Mercy may also use or share PHI in the following circumstances:

  • When it is needed for public health activities;we are required or permitted by law to report the occurrence of communicable diseases.
  • When reporting information about victims of abuse, neglect or domestic violence;
  • When sharing information for the purpose of health oversight activities;we may share your PHI with the agency that oversees health care system programs, such as Medicare and Medicaid.
  • When sharing information for judicial and administrative proceedings;we may share your PHI in response to a legal order or other lawful process.
  • When sharing information for law enforcement purposes;we may share your PHI with the police or other law enforcement officials as required or permitted by law or in compliance with a court order or subpoena.
  • We may share PHI about deceased persons with medical examiners, coroners, and funeral directors;
  • When sharing or using protected health information for organ and tissue donation purposes;we may share your PHI with organizations that facilitate organ, eye, or tissue procurement, banking or transplantation.
  • When we believe in good faith that sharing PHI is necessary to avert a serious health or safety threat;
  • When sharing PHIis necessary to comply with workers’ compensation laws or related purposes;
  • When required by state, federal or other law; we may use and share your PHI when required to do so by any other law not already referred to above.
  • We may share protected health information about you with a public or private entity that is authorized by law or its charter to assist in disaster relief efforts (e.g., the American Red Cross).

Permissive Uses or Disclosures

Mercy may use or share your PHI for any of the purposes described in this section unless you specifically request that we do not. Your written request must be submitted to your care provider or to the appropriate Health Information Management Office listed in this Notice.

  • We may contact you to remind you of an appointment.
  • We may contact you to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
  • We may include certain limited information about you in our patient directory. This information may include your name, location in the facility, your general condition (e.g. fair, stable, etc.) and your religious affiliation (if provided). The directory information, except for your religious affiliation, may be shared with people who ask for you by name.
  • We may contact you to seek private support for the Mercy mission and provide information about Mercy-sponsored activities including fundraising programs and events.  If you wish that your information not be used for such purposes, please contact the Mercy Foundation office listed at the top right of this notice.
  • We may share PHI about you with a friend, family member, personal representative, or any individual you identify who is involved in your care. We can tell these individuals of your condition and that you are at Mercy for treatment or services. We can also give this information to someone who will help or is helping to pay for your care.

Uses and Disclosures Requiring Your Written Permission (Authorization)

  • Use or Disclosure with Your Permission. For any purpose other than the ones described in this notice, we may only use or share your PHI when you grant us written permission (authorization). For example, you will need to give us your written permission before we send your PHI to your life insurance company.
  • Marketing. We must obtain your written permission prior to using your PHI to send marketing materials. For example, we may not sell your PHI without your written authorization. We may, however, communicate with you about products or services related to your treatment, case management, care coordination, or alternative treatments, therapies, health care providers or care settings without your permission.

Revoking Your Authorization

If you give us written permission (authorization) to use or share your protected health information, you can change your mind and take back your authorization at any time, as long as you do so in writing. If you revoke your authorization, we will no longer use or disclose the information, but we will not be able to take back any information that we have already shared.

Patient Rights with Respect to PHI

  • Right to Request Restrictions: You have the right to request that we restrict use or disclosure of your PHI for treatment, payment, or health care operations. With one exception, we are not required to agree to your request. If you ask Mercy not to share your information with your health plan we will not disclose your PHI to the health plan if you pay the full cost for your care in advance.
  • Right to Request Confidential Communication: You have the right to request PHI in a certain form or at a specific location. Your request must be in writing. For instance, you can request that we not contact you at work, and you can tell us how and/or where you want to receive information. We will accommodate reasonable requests. If your request for confidential communication is approved, we will honor your request until you tell us in writing that you revoke the request for the confidential communication.
  • Right to Inspect and Copy Your Protected Health Information: You have the right to review and/or ask for a copy of your PHI,including medical records, billing records and other records. Your request must be in writing. If you request copies of information, we may charge a fee for costs associated with your request, including the cost of copies, postage or other supplies. You also have a right to an electronic copy of your information.



    In rare circumstances we may deny access to your protected health information. If access is denied, you can request that the denial be reviewed. A licensed health care professional chosen by Mercy will review your request and make a final decision as to whether the information should be released.
  • Right to Request Amendment to Your Protected Health Information(PHI): You have a right to request that your PHI be amended (changed) if you believe that it is incorrect or incomplete. Your request must be in writing. You must obtain the request form from the Health Information Management Office or your provider, submit the completed form and provide the reason that you want the amendment.



    Mercy can deny your request if: (1) it is not in writing or it does not include a reason why the information should be changed; (2) the information you want to change was not created by Mercy; (3) the information is not part of the medical record kept by Mercy; (4) the information is not part of the information that you are permitted to inspect or copy; or (5) the information contained in the record is accurate and complete.
  • Right to an Accounting of Disclosures: You have the right to receive an accounting of disclosures of medical information that we have made, with some exceptions. Your request must be in writing and must state the time period for the requested information. Mercy will not provide this information for a time period greater than six (6) years from the date of your request. You have the right to receive one (1) free accounting every twelve (12) months. If you request more than one (1) accounting in any twelve (12) month period, we may charge you a reasonable fee for the costs of providing that list.
  • Right to Receive a Copy of the Notice of Privacy Practices: You have the right to a paper copy of this Notice and may print a copy from this website. If you want a paper copy of this Notice mailed to you or to  exercise any of your rights outlined above, please send a written request to the Director of Health Information Management for the Mercy Location where you received your health care services listed at the top right of this notice.

Privacy Complaints

If you have any questions about the content of this Notice, if you believe that we have violated any of your privacy rights or did not follow the information contained in this Notice of Privacy Practices or if you have concerns about the privacy of your protected health information, please contact the Privacy Officer for the Mercy provider where you obtained health care services listed at the top right of this Notice.

You may also file a complaint with the Office for Civil Rights (“OCR”). We will not retaliate against you for filing a complaint with Mercy or with the OCR.

Changes to This Notice

We reserve the right to change or modify the information contained in this Notice at any time. If we change the Notice, we may make the new terms effective for all PHI that we maintain. Any changes that we make will comply with appropriate federal, state and other laws. Mercy will make the most recent copy of this Notice available to our patients and post it in our facilities. You can also call or write any Privacy Officer listed at the end of this Notice to obtain the most recent version of this Notice.

Mercy Entity Privacy Officer Contact Information Health Information Contact Information
East Communities
Mercy Hospital St. Louis

14528 South Outer Forty Rd., Ste. 100

Chesterfield, MO 63017

314-364-3381

Attn: Privacy Officer

615 S. New Ballas Rd.

St. Louis, MO 63131

314-251-4622

Attn: Director of HIM

Mercy Hospital Washington

14528 South Outer Forty Rd., Ste. 100

Chesterfield, MO 63017

314-364-3381

Attn: Privacy Officer

615 S. New Ballas Rd.

St. Louis, MO 63131

314-251-4622

Attn: Director of HIM

Mercy Clinics

14528 South Outer Forty Rd., Ste. 100

Chesterfield, MO 63017

314-364-3381

Attn: Privacy Officer

615 S. New Ballas Rd.

St. Louis, MO 63131

314-251-4622

Attn: Director of HIM

OR

Contact your physician office

Mercy Health Services

  • Corporate Health
  • Employee
  • Assistance
  • Eye Care
  • Home Health
  • Home Infusion
  • Hospice
  • Managed
  • Behavioral Health
  • Pharmacy

14528 South Outer Forty Rd., Ste. 100

Chesterfield, MO 63017

314-364-3381

Attn: Privacy Officer

1000 Des Peres Rd. Suite 200A

St. Louis, MO 63131

314-729-4400

Attn: Exec. Dir. Health & Post Acute Services

Mercy Health Foundation St. Louis

314-251-1800

Mercy Health Foundation Washington

636-239-8000

Central Communities

Mercy Hospital Springfield

1235 E. Cherokee St.

Springfield, MO 65804

417-820-8780

Attn: Privacy Officer

1235 E. Cherokee St.

Springfield, MO 65804

417-820-3200

Attn: Privacy Site Coordinator

Mercy Hospital Lebanon

1235 E. Cherokee St.

Springfield, MO 65804

417-820-8780

Attn: Privacy Officer

100 Hospital Drive

Lebanon, MO 65536

417-533-6054

Attn: Director of HIM

Mercy Hospital Aurora

1235 E. Cherokee St.

Springfield, MO 65804

417-820-8780

Attn: Privacy Officer

500 Porter Avenue

Aurora, MO 65625

417-678-7897

Attn: Privacy Site Coordinator

Mercy Hospital Cassville

1235 E. Cherokee St.

Springfield, MO 65804

417-820-8780

Attn: Privacy Officer

94 Main Street

Cassville, MO 65625

417-847-6084

Attn: Privacy Site Coordinator

Mercy Hospital Berryville

1235 E. Cherokee St.

Springfield, MO 65804

417-820-8780

Attn: Privacy Officer

214 Carter Street

Berryville, AR 72616

870-423-5228

Attn: Director of HIM

Mercy Hospital Mountain View

1235 E. Cherokee St.

Springfield, MO 65804

417-820-8780

Attn: Privacy Officer

100 West Hwy 60

Mt. View, MO 65548

417-934-7061

Attn: Director of HIM

Mercy Clinic Springfield

1235 E. Cherokee St.

Springfield, MO 65804

417-820-8780

Attn: Privacy Officer

3231 S. National Ave.

Springfield, MO 65807

417-890-4131

Attn: Privacy Site Coordinator OR

Contact your physician office

Mercy Clinic Rolla

1235 E. Cherokee St.

Springfield, MO 65804

417-820-8780

Attn: Privacy Officer

1605 Martin Springs Dr., Ste. 360B

Rolla, MO 65401

573-458-6868

Attn: Privacy Site Coordinator OR

Contact your physician office

Mercy Clinic Joplin

1235 E. Cherokee St.

Springfield, MO 65804

417-820-8780

Attn: Privacy Officer

3016 McClelland Blvd

Joplin, MO 65804

417-627-8994

Attn: Privacy Site Coordinator OR

Contact your physician office

Mercy Villa

1235 E. Cherokee St.

Springfield, MO 65804

417-820-8780

Attn: Privacy Officer

1100 E. Montclair

Springfield, MO 65802

417-820-8510

Attn: Privacy Site Coordinator

Mercy Health Plan

1235 E. Cherokee St.

Springfield, MO 65804

417-820-8780

Attn: Privacy Officer

3265 S. National Ave.

Suite 210

Springfield, MO 65807

417-820-3826

Attn: Privacy Site Coordinator

Mercy Home Care

  • Home Health
  • Hospice
  • Home Maker
  • Home Infusion
  • Therapy

1235 E. Cherokee St.

Springfield, MO 65804

417-820-8780

Attn: Privacy Officer

1570 W. Battlefield

Suite 110

Springfield, MO 65807

417-820-5550

Attn: Privacy Site Coordinator

Mercy Hospital Joplin

2702 N. Richard Joseph Blvd., Suite 108

Joplin, MO 64804

417-625-2171

Attn: Privacy Officer

2702 N. Richard Joseph Blvd., Suite 108

Joplin, MO 64804

417-625-2171

Attn: HIM

Mercy Hospital Hot Springs

300 Werner Street

Hot Springs, AR 71903

501-622-1011

Attn: Privacy Officer

300 Werner Street

Hot Springs, AR 71903

501-622-1011

Attn: Director of HIM

Mercy Clinic Hot Springs

P. O. Box 21850

Hot Springs, AR 71913

501-321-2293

Attn: Privacy Officer

Contact your Physician Office

Mercy Hospital Northwest Arkansas

2710 Rife Medical Lane

Rogers, AR 72758

479-338-8000

Attn: Privacy Officer

2710 Rife Medical Lane

Rogers, AR 72758

479-338-8000

Attn: Medical Records Department

Mercy Clinic Northwest Arkansas

2710 Rife Medical Lane

Rogers, AR 72758

479-338-8000

Attn: Privacy Officer

2710 Rife Medical Lane

Rogers, AR 72758

479-338-8000

Attn: Medical Records Department

Mercy Hospital Northwest Arkansas

2710 Rife Medical Lane

Rogers, AR 72758

479-338-8000

Attn: Privacy Officer

2710 Rife Medical Lane

Rogers, AR 72758

479-338-8000

Attn: Medical Records Department

Mercy Hospital Ft. Scott

401 Woodland Hills Blvd

Fort Scott, KS 66701

620-223-7092

Attn: Privacy Officer

401 Woodland Hills Blvd

Fort Scott, KS 66701

620-223-7091

Attn: HIM

Mercy Clinic Ft. Scott

401 Woodland Hills Blvd

Fort Scott, KS 66701

620-223-7092

Attn: Privacy Officer

401 Woodland Hills Blvd

Fort Scott, KS 66701

620-223-7091

Attn: HIM

Mercy Hospital Independence

800 W. Myrtle

P. O. Box 388

Independence, MO 67301

620-332-3209

Attn: Privacy Officer

900 W. Myrtle

Independence, MO 67301

620-332-3211

Attn: HIM

Mercy Clinic Independence

800 W. Myrtle

P. O. Box 388

Independence, MO 67301

620-332-3209

Attn: Privacy Officer

800 W. Laurel

Independence, MO 67301

620-332-3280

Attn: Medical Records

Mercy Clinic Arma

601 E. Washington

Arma, KS 66712

620-347-4033

Attn: Privacy Officer

601 E. Washington

Arma, KS 66712

620-223-8030

Attn: Director-Physician Practice

Mercy Clinic Pleasanton

11155 Tucker Road

Pleasanton, KS 66075

913-352-8379

Attn: Privacy Officer

11155 Tucker Road

Pleasanton, KS 66075

620-223-8030

Attn: Director-Physician Practice

Mercy Clinic Cherryvale

203 W. Main

Cherryvale, KS 67335

620-336-2131

Attn: Privacy Officer

203 W. Main

Cherryvale, KS 67335

620-332-3217

Attn: Director-Physician Practice

Mercy Hospital Fort Smith

7301 Rogers Avenue

Fort Smith, AR 72917

479-314-6266

Attn: Privacy Officer

7301 Rogers Avenue

Fort Smith, AR 72917

479-314-6266

Attn: Director of HIM

Mercy Hospital Ozark

7301 Rogers Avenue

Fort Smith, AR 72917

479-314-6266

Attn: Privacy Officer

801 West River Street

Ozark, AR 72949

479-667-4138 Ext. 8220

Attn: Director of HIM

Mercy Hospital Paris

7301 Rogers Avenue

Fort Smith, AR 72917

479-314-6266

Attn: Privacy Officer

500 East Academy Street

Paris, AR 72855

479-963-5445

Director of HIM

Mercy Hospital Waldron

7301 Rogers Avenue

Fort Smith, AR 72917

479-314-6266

Attn: Privacy Officer

1341 West 6th Street

Waldron, AR 72958

479-637-4135 Ext. 341

Attn: Director of HIM

Mercy Clinic Fort Smith

7301 Rogers Avenue

Fort Smith, AR 72917

479-314-6266

Attn: Privacy Officer

Mercy Clinic Administration

5401 Ellsworth Road

Fort Smith, AR 72903

479-314-4620

Attn: Medical Records

Mercy Clinic River Valley

7301 Rogers Avenue

Fort Smith, AR 72917

479-314-6266

Attn: Privacy Officer

3501 E. W. Knight Street

Fort Smith, AR 72903

479-709-6700

Attn: Medical Records

West Communities

Mercy Hospital Oklahoma City

4300 West Memorial Rd.

Oklahoma City, OK 73120

405-752-3827

Attn: Privacy Officer

4300 West Memorial Rd.

Oklahoma City, OK 73120

405-752-3614

Attn: HIM

Mercy Hospital Ardmore

4300 West Memorial Rd.

Oklahoma City, OK 73120

405-752-3827

Attn: Privacy Officer

1011 Fourteenth Ave. NW

Ardmore, OK 73401

580-220-6622

Attn: HIM

Mercy Hospital El Reno

4300 West Memorial Rd.

Oklahoma City, OK 73120

405-752-3827

Attn: Privacy Officer

2115 Parkview

P.O. Box 129

El Reno, OK 73036

405-262-2640

Attn: HIM

Mercy Hospital Healdton

4300 West Memorial Rd.

Oklahoma City, OK 73120

405-752-3827

Attn: Privacy Officer

3462 Hospital Road

Healdton, OK

580-229-0701

Attn: Medical Records

Mercy Hospital Tishomingo

4300 West Memorial Rd.

Oklahoma City, OK 73120

405-752-3827

Attn: Privacy Officer

1000 S. Byrd St.

Tishomingo, OK 73460

580-371-2327

Attn: Medical Records

Mercy Hospital Logan County

4300 West Memorial Rd.

Oklahoma City, OK 73120

405-752-3827

Attn: Privacy Officer

200 S. Academy

P. O. Box 1017

Guthrie, OK 73044

405-282-6700

Attn: Health Information Services

Mercy Health/Love County Hospital and Clinic

4300 West Memorial Rd.

Oklahoma City, OK 73120

405-752-3827

Attn: Privacy Officer

300 Wanda

Marietta, OK 73448

580-276-3347

Attn: Health Information Services

Mercy Clinics

4300 West Memorial Rd.

Oklahoma City, OK 73120

405-752-3827

Attn: Privacy Officer

Contact you Physician Office

Texas

Mercy Ministries of Laredo

2500 Zacatecas

Laredo, TX 78046

956-721-7403

Attn: Privacy Officer

2500 Zacatecas

Laredo, TX 78046

956-718-6810, ext. 114

Attn: Director of HIM

Louisiana

Mercy Family Center New Orleans

110 Veterans, Ste. 425

Metairie, LA 70005

504-838-3235

Attn: Privacy Officer

110 Veterans, Ste. 425

Metairie, LA 70005

504-838-3232

Attn: Business Manager

Effective Date: October 2011