WASHINGTON
COUNTY HEALTH DEPARTMENT
NOTICE OF PRIVACY PRACTICES
Dear Client,
WASHINGTON COUNTY HEALTH
DEPARTMENT
NOTICE OF PRIVACY
PRACTICES
Effective Date:
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.
OUR PLEDGE REGARDING YOUR 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 acknowledgement 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 WASHINGTON 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 WASHINGTON 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 person identified on
the first page of this Notice.
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 WASHINGTON 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.
You may obtain
a copy of this notice at our website, www.washingtoncountyks.net
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 WASHINGTON COUNTY HEALTH DEPARTMENT, you may file a complaint with
WASHINGTON COUNTY HEALTH DEPARTMENT or with the Secretary of the Department of
Health and Human Services. To file a
complaint with WASHINGTON 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.
We
also may disclose health information about you to people outside WASHINGTON
COUNTY HEALTH DEPARTMENT who may be involved in your medical care after you
leave WASHINGTON 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 WASHINGTON 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 WASHINGTON 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 WASHINGTON COUNTY HEALTH
DEPARTMENT. Unless you direct us to do
otherwise, we may leave messages on your telephone answering machine
identifying WASHINGTON 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. We may also use the mail
to send a reminder to you at your last known address.
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 WASHINGTON
COUNTY HEALTH DEPARTMENT and its operations.
We may disclose health information to a foundation related to WASHINGTON
COUNTY HEALTH DEPARTMENT so that the foundation may contact you in raising
money for WASHINGTON 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 WASHINGTON
COUNTY HEALTH DEPARTMENT. If you do not
want WASHINGTON 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 WASHINGTON 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
WASHINGTON 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;
·
to 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 WASHINGTON COUNTY
HEALTH DEPARTMENT; and
·
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 WASHINGTON 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.
ACKNOWLEDGEMENT.
You
will be asked to provide a written acknowledgement 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
acknowledgement from you. However, your
receipt of care and treatment from WASHINGTON COUNTY HEALTH DEPARTMENT is not
conditioned upon your providing the written acknowledgement.