A patient shall not be deprived of any constitutional or
civil rights solely because of admission to this facility.
In addition to the Rights of Patients listed in the Louisiana
Mental Health Law, every OSH patient, shall have
the following rights:
Clinical Care
• The right to be afforded considerate, safe, and respectful care, without discrimination as to
race, color, religion, national origin, or source of payment.
• The right upon request to be furnished with the name of the physician responsible for
coordinating his/her care.
• The right to obtain from the practitioner responsible for coordinating his/her care complete
and current information concerning his/her diagnosis, treatment, and prognosis.
• The right to reasonably informed participation in decisions involving his/her health care.
• The right to refuse any treatment by the hospital to the extent permitted by law.
• The right to participate in the development and implementation of his/her plan of care.
• The patient shall have the right to the appropriate assessment and management of pain.
Privacy and Confidentiality
• The right to refuse to talk with or see anyone not officially connected with the hospital or
directly involved with his/her care.
• The right to privacy and confidentiality shall extend to all records pertaining to the patient's
treatment including the source of payment for treatment except as otherwise provided by law.
Medical records pertaining to patient's diagnosis or treatment for alcohol or drug abuse maintained
by this hospital are protected from disclosure by federal statutes and regulations governing the
confidentiality of alcohol and drug abuse patient records.
• The right to have his/her medical record read only by individuals directly involved in his/her
treatment or in the monitoring of its quality and by other individuals only on his/her written
authorization except as provided by law.
Grievances
• The right to initiate a complaint or grievance. To initiate a complaint about quality of care or
other matters, the patient or patient's representative, or family member should direct a verbal or
written statement to the attending physician, nurse manager, unit chief, medical director, associate
medical directors or hospital directors. All complaints will be addressed within ten business days.
When not resolved agreeable to both parties, face to face or via telephone, the hospital will provide
the patient with written notification of its decision that contains the name of the hospital contact
person, the steps taken on behalf of the patient to investigate the grievance, the results of the
grievance process, and the date of completion.
Restraints and Seclusion
• The right to be free from seclusion and restraints, of any form, imposed as a means of
coercion, discipline, convenience, or retaliation by staff. When alternatives are not successful, the
techniques of restraint and seclusion will be utilized in a respectful and dignified manner. Seclusion
and restraint will be used in emergency situations if needed to ensure the patient's or others'
physical safety and less restrictive intervention have been determined to be ineffective.
HIPAA Privacy Notice
I. 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.
II. WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (“PHI”)
This notice explains how we use and share your protected health information (“PHI” for short). We
are required by law to protect the privacy of PHI, and to provide you with this notice and follow the
privacy practices described in it. PHI includes information that we create or receive about your past,
present, or future physical or mental health or condition, the provision of health care to you, or the
payment for health care provided to you. We may change the terms of this notice and our privacy
practices at any time. Any change we make will apply to the PHI we already have as well as to any
new PHI we create or receive. When we change our practices, we will promptly change this notice
and post it in our main reception area and on our web site at www.butler.org.
III. HOW WE MAY USE AND SHARE YOUR PHI
We may use and share PHI for many different reasons. Below, we describe the different reasons
and give you some examples.
A. Use of PHI for Treatment, Payment, or Health Care Operations. We may use and share PHI for
the following reasons:
1. For treatment. We may use and share PHI with physicians, nurses, medical students, and others
who provide you with health care services or are involved in your care. For example, if you are
being treated for diabetes, we may share PHI with your primary care physician in order to coordinate
your care.
2. For payment. We may use and share PHI in order to bill and collect payment for the treatment
and services provided to you. For example, we may share PHI with your health plan to get paid for
the health care services we provided to you. We may also share PHI with billing companies and
companies that process our health care claims.
3. For health care operations. We may use and share PHI in order to operate this hospital. For
example, we may use PHI in order to evaluate the quality of health care services that you receive, or
to evaluate the health care professionals who provide health care services to you. We may also
share PHI with our accountants, attorneys, and others in order to make sure we are complying with
the laws that affect us.
B. Other Uses of PHI.
We may also use and share your PHI for the following reasons:
1. Reports required by law. We will disclose PHI when we are legally required to do so by federal
and state law. For example, we may use PHI to make mandatory reports to various government
agencies about suspected child or elderly abuse and/or neglect, communicable diseases; problems
with medical and other products, and reactions to medications; and certain types of deaths and
injuries.
2. Health oversight. We may disclose your PHI to government agencies authorized by law to license,
audit, inspect, or investigate health care providers and the health care system.
3. Research. We may use and disclose your PHI for research purposes, provided that certain
procedures are followed. Depending on the circumstances, state law may require us to obtain your
written consent before using and disclosing your PHI for research purposes. If state law requires us
to obtain your consent, we will do so before using or disclosing your PHI for research purposes.
4. To avoid harm. Consistent with state law, we may report PHI to the police or other appropriate
persons, in order to avoid a serious threat to the health or safety of a person or the public.
5. Appointment reminders and health-related benefits or services. We may use PHI to give you
appointment reminders; or give you information about treatment choices or other health care
services or benefits we offer.
6. Legal proceedings. We may disclose PHI pursuant to a valid court order, search warrant, and,
under certain circumstances, in response to a subpoena or other discovery request.
C. When You May Object to Our Use or Disclosure of PHI.
1. Disclosures to family or others. Unless you tell us not to, if we think it is in your best interest,
we may tell your lawyer, your guardian or conservator (if any), or a member of your family that you
are a patient at Butler.
2. Disclosures to the Mental Health Advocate. Unless you tell us not to, we may tell the Mental
Health Advocate your name and when your treatment at Butler began.
D. When Our Use or Disclosure of PHI Requires Your Prior Written Authorization. We must ask for
your written authorization for any use or disclosure of PHI not described in sections III-A, B, or C
above. If you authorize us to use or disclose your PHI, you can later withdraw the authorization and
stop any future use or disclosure of your PHI based on it.
You can remove an authorization by written request to the Correspondence Specialist, Clinical
Information Services Department, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906 (401-
455-6321).
IV. YOUR RIGHTS REGARDING YOUR PHI.
A. Your Right to Request Limits on Our Use of PHI. You may ask that we limit how we use and share
your PHI. We will consider your request but are not legally required to agree to it. If we agree to
your request, we will follow your limits, except in emergency situations.
B. Your Right to Choose How We Send PHI to You. You may ask that we send information to you at
a different address (for example, to your work address rather than your home address) or by
different means (for example, by mail instead of telephone). We will agree to your request, as long
as we can easily provide the information in the way you requested.
C. Your Right to View and Get a Copy of PHI. You have the right to view or obtain a copy of your
PHI. Your request must be in writing. However, there are some circumstances in which we may
deny your request. If we deny your request, we will tell you, in writing, our reason(s) for the denial
and explain what appeal rights, if any, you have.
If you request a copy of your PHI, we may charge a fee for it if permitted to do so by law. Instead of
providing the PHI you requested, we may offer to give you a summary or explanation of the PHI, as
long as you agree to it, and to the cost, in advance.
D. Your Right to a List of the Disclosures We Have Made. You have the right to get a list of the
disclosures we have made of your PHI. Some disclosures will not be listed, however. For example,
the list will not include disclosures made for the purpose(s) of treatment, payment, or health care
operations, or disclosures that you authorized or that were made directly to you.
We will report disclosures made within the six years prior to your request, unless you request a
shorter time frame. However, our obligation to account for disclosures begins with disclosures made
after April 13, 2003. If you ask for more than one accounting within a twelve-month period, we may
charge you a fee for every accounting provided after the first one.
For a list of disclosures, you must submit a request to the Quality Assurance Director,
OPTIMA SPECIALTY HOSPITAL, 1131 Rue de Belier Drive, Lafayette, Louisiana, 70506 (337)
991-0571.
E. Your Right to Correct or Update Your PHI. If you feel that there is a mistake in your PHI, or that
important information is missing, you may request a correction. Your request must be in writing and
include the reason for the request. Your request must be made to the OPTIMA SPECIALTY
HOSPITAL, 1131 Rue de Belier Drive, Lafayette, Louisiana, 70506 (337) 991-0571.
We may deny your request for a variety of reasons. If we deny your request, we will inform you in
writing of the reason
(s) for the denial and explain your rights regarding responding to the denial.
If we agree to your request, we will change your PHI, inform you of the change, and tell others who
need to know about the change to your PHI.
F. Your Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice,
even if you agreed to receive it electronically. You may request a paper copy at any time.
V. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO FILE A
COMPLAINT ABOUT OUR PRIVACY PRACTICES
If you have any questions about this notice, wish to file a complaint
about our privacy practices, feel that we may have violated your
privacy rights, or disagree with a decision we made about your PHI,
please contact our OPTIMA SPECIALTY HOSPITAL,
1131 Rue de Belier Drive, Lafayette, Louisiana, 70506 (337) 991-0571.
You may also send a written complaint to the Secretary of the
U.S. Department of Health and Human Services. We will not retaliate
against you for filing a complaint.
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SH
| OSH has designed the only relaxation therapy program in the State that focuses on the individualized physical and mental needs of the patient. Patients who meet the medical criteria for this program are introduced to a harmonious combination of tranquil activities and therapies that will enhance our efforts to address the emotional and mental illness challenges on a patient-by-patient basis. |
| RELAXATION THERAPY ROOM |
| THE MOST COMMON MENTAL AND EMOTIONAL DISORDERS |