Notice of Privacy
Practices
Notice of
Privacy Practices
Effective:
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 our Privacy Contact who is Julie Harris.
This
notice of Privacy Practices describes how we may use and disclose your
protected health information to carry our treatment, payment or health care
operations and for other purposes that are permitted or required by law. It also describes your rights to access and
control your protected health information.
“Protected health information” is information about you, including
demographic information, that may identify you and that relates to your past,
present or future physical or mental health or condition and related health
care services.
We
are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any
time. The new notice will be effective
for all protected health information that we maintain at that time. Upon your request, we will provide you with
any revised Notice of Privacy Practices by calling the Court House at 622-2286
and requesting that a revised copy is sent to you in the mail or asking for one
the next time you are at the Court House.
1. Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health
Information Based Upon Your Written Consent
You
will be asked to sign a consent form that you will find attached to the back of
this notice. Regardless, if you sign the
consent or not, use and disclosure of your protected health information for
treatment, payment and health care operations will be used. Your protected health information may be used
and disclosed by our staff and others outside of our office that are involved
in your care and treatment for the purpose of providing health care services to
you. Your protected health information
may be used and disclosed to pay your health care bills and to support the
operation of the county.
Following
are examples of the types of uses and disclosures of your protected health care
information that we are permitted to make once you have signed our consent
form. These examples are not meant to be
exhaustive, but to describe the types of uses and disclosures that we may
undertake.
Treatment: We will use
and disclose your protected health information to provide, coordinate, or
manage your health care and any related services. This includes the coordination or management
of your health care with a third party that has already obtained your
permission to have access to your protected health information. For example, we would disclose your protected
health information, as necessary, to a home health agency that provides you
care. We will also disclose protected
health information to physicians who may be treating you when we have the
necessary permission from you to disclose your protected health
information. For example, your protected
health information may be provided to a physician to whom you have been
referred to ensure that the physician has the necessary information to diagnose
or treat you.
In
addition, we may disclose your protected health information from time-to-time
to a physician or heath care provider (e.g., a specialist or laboratory) who, at
the request of your physician, becomes involved in your care by providing
assistance with your health care diagnosis or treatment to your physician.
Payment: Your protected
health information will be used, as needed, to obtain payment for your health
care services. This may include certain
activities that your health insurance plan, Medicare, or Medicaid may undertake
before it approves or pays for the health care services we recommend for you
such as; making a determination of eligibility or coverage for insurance
benefits, reviewing services provided to you for medical necessity, and
undertaking utilization review activities.
Healthcare Operations: We may use or
disclose, as-needed, your protected health information in order to support our
own heath care operations. These are
necessary for us to operate KCHD and to maintain quality health care for our
clients. For example, we may use medical
information about you to review the services we provide and the performance of
our employees in caring for you. We may
disclose protected health information about you to train our staff. We also may use the information to study ways
to more effectively manage our organization.
We
will share your protected health information with third party “business associates”
that perform various activities (e.g.; billing) for us. Whenever an arrangement between our office
and a business associate involves the use or disclosure of your protected
health information, we will have a written contract that contains terms that
will protect the privacy of your protected health information.
We
may use or disclose your protected health information, as necessary, to provide
you with information about treatment alternatives or other health-related
benefits and services that may be of interest to you. We may use and disclose protected health
information about you to remind you of an appointment you have with us. We may also send you information about products
or services that we believe may be beneficial to you. You may request that we communicate to you in
a certain way or at a certain location, see Section 2 Right to request to receive confidential communications from us bv
alternative means or at an alternative location.
Others Involved in Your Healthcare: Unless you
object, we may disclose to a member of your family, a relative, a close friend
or any other person you identify, your protected health information that
directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a
disclosure, we may disclose such information as necessary if we determine that
it is in your best interest based on our professional judgment. We may use or disclose protected health
information to notify or assist in notifying a family member, personal
representative or any other person that is responsible for your care of your
location, general condition or death.
Finally, we may use or disclose your protected health information to an
authorized public or private entity to assist in disaster relief efforts and to
coordinate uses and disclosures to family or other individuals involved in your
health care.
Emergencies: We
may use or disclose your protected health information in an emergency treatment
situation. If this happens, we shall try
to obtain your consent as soon as reasonably practicable after the delivery of
treatment. If we have attempted to
obtain your consent but are unable to obtain your consent, we may still use or
disclose your protected health information to treat you.
Required By Law: We may use or
disclose protected health information about you when we are required to do so
by law.
Public Health Activities: We
may use or disclose your protected health information for public health
activities and purposes. This includes
reporting protected health information to a public health authority that is
authorized by law to collect or receive the information for purposes of
preventing or controlling disease, injury or disability. Or, one that is authorized to receive reports
of child abuse or neglect.
Health Oversight: We
may disclose protected health information to a health oversight agency for
activities authorized by law, such as audits, investigations, inspections,
licensure and disciplinary actions.
These and similar types of activities are necessary for appropriate
oversight of the health care system, government benefit programs, and entities
subject to various government regulations.
Donations: If memorials
are established for donations to our agency, the memorial may be published in a
newsletter.
Legal Proceedings: We may
disclose protected health information in the course of any judicial or
administrative proceedings in response to an order of the court or
administrative tribunal. We also may
disclose protected health information about you in response to a subpoena,
discovery request, or other legal process but only if efforts have been made to
tell you about the request or to obtain an order protecting the information to
be disclosed.
Law Enforcement: We may also disclose
protected health information, so long as applicable legal requirements are
met. These law enforcement purposes
include:
1. legal processes and otherwise required by law
2. limited information requests for
identification and location purposes
3. pertaining to victims of a crime
4. suspicion that death has occurred as a result
of criminal conduct
5. in the event that a crime occurs on county
premises
6. medical emergency (not on the county’s
premises) and it is likely that a crime has occurred
Coroners, Funeral Directors, and
Organ Donation: We may disclose protected health information
to a coroner or medical examiner for identifications purposes, determining
cause of death or for the coroner or medical examiner to perform other duties
authorized by law. We may also disclose
protected health information to a funeral director, as authorized by law, in
order to permit the funeral director to carry out their duties. We may disclose such information in
reasonable anticipation of death.
Protected health information may be used and disclosed for cadaveric
organ, eye, or tissue donation purposes.
Research: We may
disclose protected health information for research. Before we disclose protected health
information, the research will have been approved through an approval process
that evaluates the needs of the research project with our needs for privacy of
your protected health information. We
may, however, disclose protected health information about you to a person who
is preparing to conduct research to permit them to prepare for the project, but
no protected health information will leave KCHD during that person’s review of
the information.
Criminal Activity: Consistent
with applicable federal and state laws, we may disclose your protected health
information, if we believe that the use of disclosure is necessary to prevent
or lessen a serious and imminent threat to the health or safety of a person or
the public. We may also disclose
protected health information if it is necessary for law enforcement authorities
to identify or apprehend an individual.
Military Activity and National
Security: When the appropriate conditions apply, we may
use or disclose protected health information of individuals who are Armed
Forces personnel:
1. for activities deemed necessary by
appropriate military command authorities
2. for the purpose of a determination by the
Department of Veteran Affairs of your eligibility for benefits
3. to foreign military authority if you are a
member of the foreign military service
We
may also disclose your protected health information to authorized federal
officials for national security and intelligence activities, including
protective services to the President, certain federal officials, or foreign
heads of state.
Inmates: We may use or
disclose your protected health information if you are an inmate of a
correctional facility and your physician created or received your protected
health information in the course of providing you care.
Worker’s Compensation: Your protected
health information may be disclosed by us as authorized to comply with workers’
compensation laws and other similar legally-established programs.
Required Uses and Disclosures: Other uses and
disclosures will be made only with your written authorization. You may revoke such an authorization at any
time by notifying KCHD in writing of your desire to revoke it. However, if you revoke such an authorization,
it will not have any affect on actions taken by us in reliance on it.
2. Your Rights
You
have the following rights with respect to your protected health information and
a brief description of these rights and how you may exercise those follows:
You have the right to inspect and
copy your protected health information: You may inspect and obtain a copy
of protected health information that is contained in medical, billing and any
other records we use in making decisions about you for as long as we maintain
the protected health information. Under
federal law, however, you may not inspect or copy the following records:
1. psychotherapy notes
2. information compiled in reasonable
anticipation of, or use in, a civil, criminal, or administrative action or
proceeding
3. protected health information that is subject
to law that prohibits access to protected health information
If
we deny your request, we will inform you of the basis for the denial, how you
may have our denial reviewed, and how you may complain. If you request a review of our denial, it
will be conducted by a licensed health care professional designated by us who
was not directly involved in the denial.
We will comply with the outcome of that review.
You have the right to request a
restriction of your protected health information: You may ask us
not to use or disclose any part of your protected health information for the
purposes of treatment, payment or healthcare operations. You may also request that any part of your
protected health information not be disclosed to family members or friends who
may be involved in your care or for notification purposes.
To
request a restriction, you may do so at the time you complete your consent form
or at any time after that. If you
request a restriction after that time, you should do so in writing to your case
manager and tell us what information you want to limit, whether you want to
limit use or disclosure or both, and to whom you want the limits to apply.
We
are not required to agree to a restriction, but if we do agree, we will follow
that restriction unless the information is needed to provide emergency
treatment. Even if we agree to a
restriction, either you or we can later terminate the restriction.
You have the right to receive
confidential communications by alternative means: You have the
right to request that we communicate protected health information about you to
you in a certain way or at a certain location.
We will not require you to tell us why you are asking for the
confidential communication. Please make
this request in writing to your case manager.
Your request must state how or where you can be contacted.
You have the right to amend your
protected health information: You have the right to ask us to amend medical
information about you. You have this
right for so long as the medical information is maintained by us.
To
request an amendment, you must submit your request in writing to your case
manager. You request must state the
amendment desired and provide a reason in support of that amendment.
We
will act on your request within sixty (60) calendar days after we receive your
request. If we grant your request, in
whole or in part, we will inform you of our acceptance of your request and
provide access and copying.
If
we grant the request, in whole or in part, we will seek your identification of
and agreement to share the amendment with relevant other persons. We also will make the appropriate amendment
to the protected health information by appending or otherwise providing a link
to the amendment.
We may deny your request to
amend medical information about you. We
may deny your request if it is not in writing and does not provide a reason in
support of the amendment. In addition,
we may deny your request to amend protected health information if we determine
that the information:
1. was not created by us, unless the person or
entity that created the information is no longer available to act on the
requested amendment
2. is not part of the medical information
maintained by us
3. would not be available for you to inspect or
copy
4. information is accurate and complete
If we deny your request, we
will inform you of the basis for the denial.
You will have the right to submit a statement of disagreeing with our
denial. We may prepare a rebuttal to
that statement. Your request for
amendment, our denial of the request, your statement of disagreement, if any,
and our rebuttal, if any, will then be appended to the medical information
involved or otherwise linked to it. All
of that will then be included with the subsequent disclosure of the
information, or, at our election, we may include a summary of any of that
information.
If you do not submit a
statement of disagreement, you may ask that we include your request for
amendment and our denial with any future disclosures of the information. We will include your request for amendment
and our denial (or summary of that information) with any subsequent disclosure
of the medical information involved.
You will also have the right
to complain about our denial of your request.
You have the right to receive an accounting of certain
disclosures we have made, if any, of your protected health information: This right
applied to disclosures for purposes other than treatment, payment or healthcare
operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to
you, to family members or friends involved in your care, or for notification
purposes. You have the right to receive
specific information regarding these disclosures that occur after April 14,
2003 and up to six (6) years after that date.
You may request a shorter timeframe.
The right to receive this information is subject to certain exceptions,
restrictions and limitations.
To request an accounting of
disclosures, you must submit your request in writing to KCCS. Your request must state a time period for the
disclosures. Usually, we will act upon
your request within sixty (60) calendar days after we receive your
request. Within that time, we will
either provide the accounting of disclosures to you or give you a written
statement of when we will provide that accounting and why the delay is
necessary.
There is no charge for the
first accounting we provide to you in any twelve (12) month period. For additional accountings, we may charge you
for the cost of providing the list. If
there will be a charge, we will notify you of the cost involved and give you an
opportunity to withdraw or modify your request to avoid or reduce the fee.
Right to obtain a paper copy of this notice: This is your
paper copy of our Notice of Privacy Practices.
Complaints: You may complain to us and to the United
States Secretary of Health and Human Services if you believe your privacy
rights have been violated by us.
To file a complaint with us,
contact Valerie Hammes @641-622-3575.
All complaints should be submitted in writing.
To file a complaint with the
United States Secretary of Health and Human Services, send your complaint to
him or her in care of: Office for Civil
Rights, US Department of Health and Human Services,
You will not be retaliated
against for filing a complaint.
You may contact our Privacy
Contact, Julie Harris, at 641-622-2721 or kcinfosys@keokukcountyia.com for
further information about the complaint process.
This notice was published and
becomes effective on April 14, 2003.