HIPAA Notice


(Please read carefully)




Healthmark of Walton, Inc. (Healthmark) understands that Private Health Information (PHI) about you and your health is personal.  Healthmark is committed, and pledges to protect your PHI.  This Health Insurance Portability Accountability Act (HIPAA) notice of privacy practices will tell you about the ways in which Healthmark may use and disclose your PHI. As well as how you can obtain access to your PHI. The HIPAA law requires Healthmark:

  • To give you this notice of its legal duties and privacy practices with respect to PHI as it relates to you;
  • To ensure that identifying PHI is kept private as it relates to you; and
  • To follow the current terms of this notice that are in effect.

Private Health information (PHI) is maintained in a Designated Record Set. The Designated Record Set includes the medical record, business record, and any other information used to make decision about the individual.



This notice describes the privacy practices of Healthmark of Walton, Inc., (Healthmark) and that of:

  • Healthmark Regional Medical Center (HRMC), Healthmark Home Health (HHH), Durable Medical Equipment (DME), Healthmark Rural Health Clinic, Inc. (HRHC).
  • Any entity, site and/or location personnel may share PHI with each other for treatment, payment or any other hospital operations as described in this notice.
  • Any health care professional (approved medical staff) authorized to enter PHI into your financial and/or medical record.
  • All department and unit personnel employed by Healthmark authorized to enter PHI into your financial and /or medical records.
  • Any member of a volunteer group allowed to help you while you are at HRMC. Healthmark creates a record of care services you receive while you are at the hospital. This record is used to provide you with the highest quality of care possible and to comply with certain legal requirements. This notice applies to all of the records that are generated by the hospital, whether made by hospital personnel or made by your health care professional such as your physician. (Your personal physician may have different policies or notices regarding his/her use and disclosure of your PHI created in the physician’s office or clinic.)



The following categories describe different ways that Healthmark may use and disclose your PHI. Not every use or disclosure in each category will be listed. However, all of the ways Healthmark is permitted to use and disclose your PHI will fall within one of the following categories:

For Treatment Healthmark may use your PHI to provide you with medical treatment or services. Healthmark may disclose PHI about you to your doctor(s), nurse(s), technician(s), medical or healthcare student(s), or other hospital personnel who are involved in your care. Healthmark may also disclose your PHI to people outside of the hospital who may be involved in your medical care after you leave the hospital, such as a family member, or others utilized by Healthmark to provide continued care related to your medical needs. For example: a doctor treating your broken leg will need to know if you have diabetes because diabetes may slow down the healing process. In addition, the doctor will need to consult the dietary department if you have diabetes so that you will receive the appropriate meals to assist with the control of your diabetes. The different departments of the hospital will also need to share PHI in order to coordinate the different things you may need, such as medications from the pharmacy, test results from the laboratory, and e-rays from the radiology department. Healthmark is obligated to disclose test results related to pre-employment and/or post-employment drug screenings to the employer who authorized the screenings.

For Payment Healthmark will disclose PHI about you so that the treatment and services you received may be billed, and payment may be collected from you, an insurance company, and/or a third party payer source. For example: Healthmark will need to give your health plan information about a procedure/surgery you received to your health plan in order to receive payment for the procedure/surgery. Healthmark may also relay PHI to your health plan concerning treatment/service you are going to receive in order to obtain prior approval or to determine whether your plan will cover the treatment/services.

For Health Care Operations Healthmark will use and disclose your PHI during daily operations. These uses and disclosures are necessary to make sure that all patients receive quality care. For example: Healthmark may use PHI to review the treatment/services and to evaluate the performances of the staff caring for you. Healthmark may combine medical information about patients to decide what additional service the hospital should offer, what services are no longer needed and whether new treatment/services are effective. Healthmark may also disclose PHI to doctors, nurses, technician, medical/healthcare students, and other hospital personnel for review and learning purposes. Healthmark may also combine your PHI with other facilities to compare quality and to see where Healthmark can make improvements in the care and services offered. Healthmark may remove information that identifies you so others may use your PHI to student health care and health care delivery without learning whom the specific patient is.

As Appointment Reminders Healthmark may use and disclose PHI to contact you as a reminder that you have an appointment for treatment or service.

Treatment Alternatives Healthmark may use and disclose PHI to inform you of possible treatment options or alternatives that may be of interest to you.

Health-Related Benefits and Services Healthmark may use and disclose PHI to inform you about health-related benefits or services that may be of interest to you.

Fund-Raising Activities Healthmark may use PHI to contact you, or to have a foundation contact you in an effort to raise money for the hospital and its operations. Only contact information, such as your name, address, phone number and dates you received treatment/services will be disclosed for such activities. If you do not want to be contacted for fund-raising efforts, you must notify HRMC Administration Office in writing immediately.

Hospital Directory Healthmark will include certain limited PHI about you in a census directory while you are a patient in the hospital. This information will include your name, location in the hospital, and your physician’s name. The census directory information, except your physician’s name may be disclosed to your family, friends, and clergy who may inquire about you while you are in the hospital. In addition certain Phi may be disclosed to an entity assisting in a disaster relief effort so that your loved ones may be notified about your condition, status and location.

Research Healthmark may disclose your PHI under certain circumstances for research purposes. For one example: A research project may involve comparing the health and recovery of all patients who received one medication to individuals who received another medication for the same condition. All research projects are subjected to a special approval process. Healthmark will make a concerted effort to obtain your specific permission if the researcher will have access to specific identifying information, such as your name and address.

As Required By Law Healthmark will disclose your Private Health Information (PHI) when required by local, state and federal law.

To Avert a Serious Threat to Health or Safety Healthmark will uses and disclose your PHI when necessary to prevent a serious threat to your health and safety, another individual’s health and safety, or the general public’s health and safety. Any disclosure will be to an authorized individual who may be able to help prevent a threat.

Organ and Tissue Donation Healthmark will release your PHI to organizations that handle organ or tissue procurement as necessary to facilitate the donor process in the event of death.

Corners, Medical Examiners and Funeral Directors Healthmark will release PHI, in the event of death, to a coroner or medical examiner or his/her representative as required by law, and to funeral directors or his/her representatives as necessary to carry out his/her duties.

Military and Veterans Healthmark will release your PHI as required by military command authorities if you are in the military or are a veteran.

Worker Compensation Healthmark will release specific PHI to workers’ compensation carriers, or to the individual’s employer, as the information relates to a work-related injury or illness treated by a Healthmark facility.

Health Regulatory Agencies Activities Healthmark will disclose your PHI to a healthy regulatory agency for activities as required by law. These activities are necessary for government agencies to monitor the health care system; local, state, and federal participation in programs; and in compliance with civil right laws. For example: audits, investigations, inspections, and licensures.

Public Health Risk Healthmark will release your PHI for public health and safety activities. These activities may include but are not necessarily limited to 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 equipment or products.
  • To notify an individual who may have been exposed to a communicable disease or condition or who may be at risk for contracting or spreading a communicable disease or condition
  • To notify the appropriate government authority if it is believed an individual has been the victim of abuse, neglect or domestic violence. This type of disclosure would only be made as the law requires and/or if the victim agrees.

Lawsuits and Disputes Healthmark will disclose your PHI in response to a court or administrative order, a subpoena, discovery request or any other lawful process if you are involved in a lawsuit or a dispute. Healthmark requires authorization from you to release PHI unless the law allows for an exemption.

Law Enforcement Healthmark will release PHI to law enforcement officials under the following circumstances:

  • In response to a court order, warrant summons or similar process
  • To identify or locate a suspect, fugitive, material witness, or missing person
  • In response to a death believed to be the result of criminal conduct
  • In response to criminal conduct at the hospital
  • To report a crime, the location of a crime or victims, to give the identity, or a description or location of a person who may have committed a crime.

National Security and Intelligence Activities Healthmark will disclose your PHI to authorized federal officials of intelligence, counterintelligence and other  national security agencies as authorized by law in order to assist in providing protection to the President of the United States of America, other authorized persons; or foreign heads of state, or to conduct special investigations.

Inmates Healthmark will disclose your PHI to the correctional institution or law enforcement official for the following reasons:

  • For the institution to provide health care
  • In order to protect your health and safety, or the health and safety of others
  • For the safety and security of the correctional institution



As an adult you have the following right regarding your PHI obtained at Healthmark (A minor or an individual requesting PHI on a person who is incapacitated must have the authorization of the legal guardian/next of kin/surrogate.)

Right to inspect and Copy Your Private Health Information (PHI) You have the right to inspect and/or copy your PHI that is used to make decisions about your care. This right includes the right to inspect and/or copy billing records, and all medical records. Healthmark will make a diligent effort to have you PHI for your review as follows: Within 30 days if the information is on site and within 60 days if the information is not on site. Healthmark will maintain the right to extend the request an additional 30 days in extenuating circumstances. The time periods stated is in the event the request is for personal use only and all of the PHI is not complete, thus giving Healthmark the opportunity to ensure that all of your PHI has been gathered. Your request to inspect and/or copy may be denied in certain circumstances. If you request is denied you may request, in writing, that the denial be reviewed, Healthmark will choose an appropriate professional to conduct a review of the denial. Healthmark will comply with the outcome of the review. If the outcome of the denial request for the review were upheld Healthmark would add an amended notation in the medical record as to why the denial stands. In order to inspect and/or obtain a copy of your PHI you must submit, in writing, a request to Healthmark Regional Medical Center, 4413 US Highway 331 South, DeFuniak Springs, FL 32435 to the attention of the Health Information Management Department. Healthmark will charge a fee based on what is allowable by the state law, for any expenses incurred by the copying and/or mailing associated with your request.

Right to Amend You have a right to request an amendment of your PHI in which you feel is incorrect or incomplete. Your request must be in writing and must include a reason supporting why you are requesting an amendment. The request must be submitted to Healthmark Regional Medical Center, 4413 US Highway 331 South, DeFuniak Springs, FL 32435 to the attention of the Health Information Management Department. You may request an amendment to your PHI as long as Healthmark keeps the PHI. Healthmark maintains the right to take up to 60 days to ensure the request for amendment can be honored. Your request for an amendment may be denied if it is not written and/or if it does not include a reason to support the request. In addition your request may be denied for any of the following reasons:

  • The information was not created by Healthmark or a representative of Healthmark
  • The information is not part of your PHI kept by or for Healthmark
  • The information is not part of your PHI that you would be permitted to inspect and/or copy
  • The PHI requested may be detrimental to your well-being, such as psychotherapy notes. (Your medical healthcare provider will be consulted before this type of PHI is released to you.)
  • The information is accurate and complete as it is. If your request for an amendment is denied Healthmark will make an amendment notation in the medical record indicating why the request was denied.

Right to an Accounting of Disclosures You have a right to request an “accounting of disclosures”, which is a list of discourses Healthmark has made to your PHI. Your request must be in writing and it must state a time period, no longer than six (6) years and may not include dates before October 16, 2002. Your request must indicate in what format you want the list (on paper, electronically, etc.). You may submit your request to the Health Information Management, Healthmark Regional Medical Center, 4413 US Highway 331 South, DeFuniak Springs, FL 32435. There may not be a charge for your first request, but for additional requests a fee will be charged. Healthmark will notify you of the cost involved and give you an opportunity to withdraw or modify your request before any cost is incurred.

Right to an Accounting of Disclosures You have the right to request a restriction or limitation on the PHI that might be used or disclosed by Healthmark concerning you treatment/services, payment or health care operations. You have the right to request a limit on your PHI that might be disclosed to someone who is involved in your care or the payment of your care, such as a family member or friend. For example: You may ask your medical information not be disclosed about a surgery you are going to have or have already had. Healthmark is not required to agree to your request. If Healthmark does agree with your restriction request it will comply with your request unless the PHI is needed to provide you emergency treatment or the PHI had already been disclosed. To request restrictions, you must make your request in writing to Healthmark Regional Medical Center, 4413 US Highway 331 South, DeFuniak Springs, FL 32435. Your request must relay to Healthmark personnel the following information:

  • What information you want to limit
  • Whether you want to limit Healthmark’s use and/or disclosure
  • To whom you want the limits to apply, such as disclosure to your spouse

Other uses and disclosures of your PHI not covered by this notice, or the laws that apply to Healthmark, will be made only with your written permission. If you provide permission to use or disclose your PHI, you may revoke your permission, in writing at any time. If you revoke your permission your PHI will not be used or disclosed any longer for the reasons covered by your written restriction request. Healthmark is unable to take back any disclosures that may already have been made with your permission. Healthmark is required to follow the law as it pertains to the retentions of your PHI regarding the care that was provided you.

Right to Request Confidential Communications You have the right to request Healthmark to communicate with you about your PHI in a certain way or at a certain location. For example, you can request that Healthmark only contact you at work or by mail. You do not have to give a reason for your request. Healthmark will accommodate a reasonable written request, but your request must specify how and/or where you wish to be contacted.

Right to a Paper Copy of This Notice You have a right to a paper copy of this notice. You may receive a paper copy of this notice even if you have already requested and/or received an electronic copy of the notice. To obtain a paper copy of this notice, contact Healthmark Regional Medical Center, 4413 US Highway 331 South, DeFuniak Springs, FL 32435.



Right to Change Notice Healthmark reserves the right to change this notice, and to make the revised or changed notice effective for your PHI already available, as well as, any PHI received in the future. A copy of the current notice will be posted in HRMC. The notice will contain the effective date. In addition, at the time you are registered or admitted to a Healthmark entity for treatment or health care services, you will be offered a current copy of this notice.



Filing a Complaint Concerning This Notice You have a right to file a complaint if you believe your privacy rights have been violated. You may file a complaint by contacting the Privacy Officer or the Patient Representative of Healthmark Regional Medical Center, 4413 US Highway 331 South, DeFuniak Springs, FL 32435. You may also file a complaint with the secretary of the Florida Department of Health and Human Services. All complaints must be in writing. You will not be penalized for filing a complaint. If you have any questions or concerns regarding this notice, you may contact the Privacy Officer or the Patient Representative at Healthmark Regional Medical Center.