Privacy

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 Crossroads Regional Hospital
patient, (and, in case of minors, parents or guardians as appropriate) 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 upon request to be furnished with the name of the physician or other person responsible for
conducting any specific test or other medical procedure performed by the hospital in connection with the patient's
treatment.
•        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 timeframe.
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,
Crossroads Regional Hospital, 110 John Eskew Drive, Alexandria, Louisiana, 71303 (318) 445-5111.
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 Quality Assurance Director, Crossroads Regional Hospital, 110 John
Eskew Drive, Alexandria, Louisiana, 71303 (318) 445-5111.
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 Director
for Quality and Regulations, Crossroads Regional Hospital, 110 John Eskew Drive, Alexandria, Louisiana, 71303
(318) 445-5111
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.