NOTICE OF PRIVACY
PRACTICES
HODGEMAN COUNTY HEALTH
DEPARTMENT
NOTICE OF PRIVACY
PRACTICES
Effective Date: April
14, 2003
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.
If you have any
questions about this notice, please contact
Karen Haug, RN, BSN
Administrator, Privacy Officer
Courthouse, 500 Main / PO Box 86
Jetmore, Kansas 67854
620-357-8736, phone
620-357-8846, fax
Email
OUR PLEDGE REGARDING YOUR HEALTH INFORMATION.
Each time you visit a hospital, physician, or other
healthcare provider, a record of your visit is made. Typically, this
record contains your symptoms, examination and test results, diagnoses,
treatment, a plan for your future care or treatment, and billing-related
information. Such records are necessary for the healthcare provider to
provide you with quality care and to comply with certain legal
requirements.
We are committed to protecting the confidentiality of
our records containing information about you. This notice applies to all
records of your care created or received by the Hodgeman County Health
Department. Other healthcare providers from whom you obtain care and
treatment may have different policies or notices regarding the use and
disclosure of your health information created or received by that
provider. Also, health plans in which you participate may have different
policies or notices concerning information they receive about you.
This notice will tell you about the ways in which we
may use and disclose health information about you. We also describe your
rights and certain obligations we have regarding the use and disclosure of
health information.
We are required by law to maintain the privacy of
your health information; give you this notice of our legal duties and
privacy practices and make a good faith effort to obtain your
acknowledgment of receipt of this notice; and follow the terms of the
notice that is currently in effect.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION.
Right To Inspect and Copy. You have the right to
inspect and copy health information that may be used to make decisions
about your care. Usually, this includes medical and billing records, but
does not include psychotherapy notes. To inspect and copy your health
information, you must complete a specific form providing information we
need to process your request. To obtain this form or to obtain more
information concerning this process, please contact the person identified
on the first page of this Notice. You will be asked to complete a written
authorization form. If you request a copy of the information, we may
charge a fee for the costs of copying, mailing, or other supplies and
services associated with your request. We may require that you pay such
fee prior to receiving the requested copies.
We may deny your request to inspect and copy in
certain very limited circumstances. If you are denied access to health
information, you may request that the denial be reviewed. Another
licensed health care professional chosen by the Hodgeman County Health
Department will review 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.
Right To Request Amendment. If you believe that our
records contain 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 Hodgeman
County Health Department.
To request an amendment, you must complete a specific
form providing information we need to process your request, including the
reason that supports your request. To obtain this form or to obtain more
information concerning this process, please contact the Administrator.
We may deny your request for an amendment if you fail
to complete the required form in its entirely. 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 health information kept by or
for the Hodgeman County Health Department;
Is not part of the information that you would be
permitted to inspect and copy; or
Is accurate and complete.
If your request is denied, you will be informed of
the reason for the denial and will have an opportunity to submit a
statement of disagreement to be maintained with your records.
Right to an Accounting of Disclosures. You have the
right to request an "accounting of disclosures." This is a list of the
disclosures we made of health information about you, with certain
exceptions specifically defined by law.
To request this list or accounting of disclosures,
you must complete a specific form providing information we need to process
your request. To obtain this form or to obtain more information
concerning this process, please contact the person identified on the first
page of this Notice.
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 health 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 health 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. We are
not required to agree to your request. If we do agree, we will comply
with your request unless the information is needed to provide you
emergency treatment.
To request restrictions, you must complete a specific
form providing information we need to process your request. To obtain
this form or to obtain more information concerning this process, please
contact the person identified on the first page of this notice.
Right to Request Alternative Methods of
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 an alternative method of communications,
you must complete a specific form providing information we need to process
your request. To obtain this form or to obtain more information
concerning this process, please contact the person identified on the first
page of this Notice. 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.
To obtain a paper copy of this notice, contact the
person identified on the first page of this Notice.
COMPLAINTS.
If you believe your rights with respect to health
information about you have been violated by the Hodgeman County Health
Department, you may file a complaint with the Hodgeman County Health
Department or with the Secretary of the Department of Health and Human
Services. To file a complaint with the Hodgeman County Health Department,
contact the person identified on the first page of this Notice. All
complaints must be submitted in writing.
You will not be penalized for filing a complaint.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION
ABOUT YOU WITHOUT YOUR SPECIFIC AUTHORIZATION.
The following categories describe different ways that
we are permitted to use and disclose health information without a specific
authorization from you. If you desire to restrict our use of your health
information for any of these purposes, you need to submit a request for
restrictions in the manner described above.
For Treatment. We may use information about
you to provide you with medical treatment or services. We may disclose
health information about you to nurses, technicians, or other personnel
who are involved in taking care of you at the Hodgeman County Health
Department. Different departments of the Hodgeman County Health
Department also may share health information about you in order to
coordinate the different things you need, such as prescriptions, lab work,
and x-rays.
We also may disclose health information about you to
people outside the Hodgeman County Health Department who may be involved
in your medical care after you leave the Hodgeman County Health
Department, such as family members, friends, or others we use to provide
services that are part of your care. We will give you an opportunity,
however, to restrict such communications.
We may disclose health information about you to other
health care providers who request such information for purposes of
providing medical treatment to you.
For Payment. We may use and disclose health
information about you so that the treatment and services you receive at
the Hodgeman County Health Department may be billed to and payment may be
collected from you, an insurance company, or other third party. For
example, we may need to give your health plan information about treatment
you received so your health plan will pay us or reimburse you for the
treatment. 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 will cover the treatment.
We also may provide information about you to other
health care providers to assist them in obtaining payment for treatment
and service provided to you by that provider. We may also provide
information to a health plan for purposes of arranging payment for
treatment and services provided to you.
For Health Care Operations. We may use and
disclose health information about you for our internal operations. These
uses and disclosures are necessary to run the Hodgeman County Health
Department and make sure that all of our patients receive quality care.
For example, we may use health information to review our treatment and
services and to evaluate the performance of our staff in caring for you.
We may also combine health information about many 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 doctors, nurses, technicians, medical students, and other
personnel for review and learning purposes. We may also combine the
health information we have with health information from other health care
providers 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 health information so others may use
it to study health care and health care delivery without learning who the
specific patients are.
We may disclose health information about you to
another health care provider or health plan with which you also have had a
relationship for purposes of that provider’s or plan’s internal
operations.
Appointment Reminders. We may use and
disclose health information to contact you as a reminder that you have an
appointment for treatment or medical care at the Hodgeman County Health
Department. Unless you direct us to do otherwise, we may leave messages
on your telephone answering machine identifying the Hodgeman County Health
Department and asking for you to return our call. Unless we are
specifically instructed by you otherwise in a particular circumstance, we
will not disclose any health information to any person other than you who
answers your phone except to leave a message for you to return the call.
Surveys. We may use and disclose health
information to contact you to assess your satisfaction with our services.
Treatment Alternatives. We may use and
disclose health information to tell you about or recommend possible
treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services. We may
use and disclose health information to tell you about health-related
benefits or services that may be of interest to you, or to provide you
with promotional gifts of nominal value.
Fundraising Activities. We may use health
information about you to contact you in an effort to raise money for the
Hodgeman County Health Department and its operations. We may disclose
health information to a foundation related to the Hodgeman County Health
Department so that the foundation may contact you in raising money for the
Hodgeman County Health Department. We only would release contact
information, such as your name, address and phone number and the dates you
received treatment or services at the Hodgeman County Health Department.
If you do not want the Hodgeman County Health Department to contact you
for fundraising efforts, you must notify the person identified on the
first page of this Notice in writing.
Business Associates. There are some services
provided in our organization through contracts or arrangements with
business associates. For example, we may contract with a copy service to
make copies of your health record. When these services are contracted, we
may disclose your health information to our business associate so they can
perform the job we’ve asked them to do. To protect your health
information, however, we require our business associates to appropriately
safeguard your information.
Individuals Involved In Your Care or Payment For
Your Care. We may release health 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. In addition, we may
disclose health information about you to an organization assisting in a
disaster relief effort so that your family can be notified about your
condition, status, and location.
Research. Under certain circumstances, we may
use and disclose health information about you for research purposes. For
example, a research project may involve comparing the health and recovery
of all patients who received one medication to those who received another,
for the same condition. All research projects, however, are subject to a
special approval process. This process evaluates a proposed research
project and its use of health information, trying to balance the research
needs with patients' need for privacy of their health information. Before
we use or disclose health information for research, the project will have
been approved through this research approval process, but we may, however,
disclose health information about you to people preparing to conduct a
research project, for example, to help them look for patients with
specific medical needs, so long as the health information they review does
not leave the Hodgeman County Health Department. We will almost always
ask for your specific permission if the researcher will have access to
your name, address, or other information that reveals who you are, or will
be involved in your care at the Hodgeman County Health Department.
As Required By Law. We will disclose health
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 health 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, would
only be to someone able to help prevent the threat.
Organ and Tissue Donation. If you are an
organ donor, we may use or disclose health 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 health information about you as required
by military command authorities. We may also release health information
about foreign military personnel to the appropriate foreign military
authority.
Employers. We may release health information
about you to your employer if we provide health care services to you at
the request of your employer, and the health care services are provided
either to conduct an evaluation relating to medical surveillance of the
workplace or to evaluate whether you have a work-related illness or
injury. In such circumstances, we will give you written notice of such
release of information to your employer. Any other disclosures to your
employer will be made only if you execute a specific authorization for the
release of that information to your employer.
Workers' Compensation. We may release health
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 health
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;
-
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
health 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 health information about you in
response to a court or administrative order. We may also disclose health
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 health
information if asked to do so by a law enforcement official:
-
In response to a court order, subpoena, warrant,
summons or similar process;
-
To identify or locate a suspect, fugitive, material
witness, or missing person;
-
About the victim of a crime if, under certain
limited circumstances, we are unable to obtain the person's agreement;
-
About a death we believe may be the result of
criminal conduct;
-
About criminal conduct at the Hodgeman County
Health Department;
-
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 health 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 health information about patients
of the Hodgeman County Health Department to funeral directors as necessary
for them to carry out their duties.
National Security and Intelligence Activities.
We may release health 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 health information about you to authorized federal
officials so they may provide protection to the President, other
authorized persons, or foreign heads of state, or to conduct special
investigations.
Inmates/Persons In Custody. If you are an
inmate of a correctional institution or under the custody of a law
enforcement official, we may release health 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.
OTHER USES OF HEALTH INFORMATION.
Other uses and disclosures of health information not
covered by this notice or the laws that apply to us will be made only with
your written authorization. If you provide us authorization to use or
disclose health information about you, you may revoke that authorization,
in writing, at any time. If you revoke your authorization, we will no
longer use or disclose health information about you for the reasons
covered by your written authorization. Of course, 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.
CHANGES TO THIS NOTICE.
We reserve the right to change this notice. We
reserve the right to make the revised or changed notice effective for
health information we already have about you as well as any information we
receive in the future. We will post a copy of the current notice at our
facility and on our website. The notice will contain on the first page
the effective date.
ACKNOWLEDGMENT.
You will be asked to provide a written acknowledgment
of your receipt of this Notice. We are required by law to make a good
faith effort to provide you with our Notice and obtain such acknowledgment
from you. However, your receipt of care and treatment from the Hodgeman
County Health Department is not conditioned upon your providing the
written acknowledgment.
DEPARTMENT
