Notice of Privacy Practices
Introduction
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TOTHIS INFORMATION. PLEASE
REVIEW ITCAREFULLY.
We are required by federal law to maintain the privacy of your medical
information and to give you our Notice of Privacy Practices (this “Notice”) that
describes our privacy practices, our legal duties and your rights concerning your
medical information.
This Notice applies to Guthrie County Hospital, our clinics, and our organized
health care arrangement. This Notice applies to and will be followed by: (1) all
employees, staff, volunteers and other personnel of the Facility and clinics, and
(2) the physicians and other practitioners who are not employed by the Facility,
but who have privileges to treat patients at the Facility and who are members of
the Facility’s organized health care arrangement (see description of the Facility’s
organized health care arrangement, below).
How We May Use And Disclose
Your Medical Information
EXCEPT WHERE SUCH USE OR DISCLOSURE IS OTHERWISE PROHIBITED BY STATE OR
FEDERAL LAW, THE FACILITY IS PERMITTED OR REQUIRED TO USE OR DISCLOSE YOUR
MEDICAL INFORMATION WITHOUT YOUR AUTHORIZATION (PERMISSION) IN THE
FOLLOWING SITUATIONS. SOME, BUT NOT ALL, SPECIFIC EXAMPLES OF THE
DIFFERENT TYPES OF DISCLOSURES HAVE BEEN LISTED.
TREATMENT. To provide you with medical treatment or services (e.g., provide
information to doctors, nurses, technicians, students or other personnel who are
involved in your care).
PAYMENT. To collect payment from you, an insurance company or a third party for
the treatment and services you receive (e.g., submitting a claim to your insurance
company).
HEALTH CARE OPERATIONS. For Facility health care operations (e.g., to evaluate
our staff and internal processes). As part of the Facility’s health care operations,
certain limited information may be used or disclosed to conduct fundraising
activities on behalf of the Facility. You have the right to request that you not
receive fundraising materials from the Facility.
APPOINTMENTS AND HEALTH CARE SERVICES. To provide you with
appointment reminders or to notify you of possible treatment alternatives or
health-related benefits or services.
FACILITY DIRECTORY. While you are an inpatient, your name, location in the
Facility, general condition (e.g., fair, serious, etc.), and religious affiliation may be
included in the Facility directory and released (except religious affiliation) to people
who ask for you by name. This information and your religious affiliation may be
given to a member of the clergy, even if they do not ask for you by name. You have
the right to request that your name not be included in the directory.
FRIENDS AND FAMILY. To a friend or family member involved in your medical
care or payment for your care. If you are available, such disclosures will be made
only if we have obtained your permission, if you do not object to the disclosure
after having the opportunity, or if it is reasonable for us, based on the
circumstances, to assume you have no objection to such disclosure. If you
are unavailable, incapacitated or in an emergency situation, the Facility may
disclose limited information to these persons if the Facility determines disclosure
is in your best interest.
HEALTH CARE PROVIDERS. To another health care provider involved in your
treatment in order for that provider to treat you, bill for its services and conduct
certain of its health care operations.
DISASTER RELIEF. To a public or private entity assisting in a disaster relief effort
(e.g., to notify your family about your location, condition or death).
PUBLIC HEALTH ACTIVITIES. To public health authorities for public health
activities as permitted or required by law (e.g., to report births, deaths, child abuse
and neglect, immunizations and communicable diseases).
ABUSE, NEGLECT AND DOMESTIC VIOLENCE. The Facility may notify the
appropriate government authority if it believes you have been the victim of abuse,
neglect or domestic violence. Unless such disclosure is required by law, the Facility
will only make this disclosure if you agree or under other limited circumstances
when such disclosure is authorized by law.
HEALTH SAFETY RISKS. Under certain circumstances, when necessary to prevent a
serious threat to your health and safety or to the health and safety of the public or another person
ORGAN DONATIONS. To organ procurement or organ, eye or tissue
transplantation organizations, or to organ donation banks to facilitate organ
or tissue donation and transplantation.
MILITARY AND NATIONAL SECURITY. If you are a member of the armed forces,
as required by military command authorities. We may also release medical
information about foreign military personnel to the appropriate foreign military
authority. The Facility may also release your medical information to authorized
federal officials for intelligence, counterintelligence, and other authorized national
security activities.
WORKER’S COMPENSATION. To persons (e.g., employers, insurance carriers,
attorneys) in order to comply with workers’ compensation laws or other similar
programs providing benefits for work-related injuries.
HEALTH OVERSIGHT ACTIVITIES. To a health oversight agency for activities
authorized by law to monitor the health care system, government programs and
compliance with civil rights laws (e.g., fraud and abuse investigations, inspections
and licensure, or disciplinary actions).
LEGAL PROCEEDINGS. If you are involved in a lawsuit or dispute, in response to
a court or administrative order. The Facility may also disclose medical information
about you in response to a subpoena or other lawful process by someone else
involved in the dispute, but only if the party seeking the information demonstrates
that reasonable efforts have been made to notify you of the request or to obtain a
protective order from the court.
LAWENFORCEMENT. To law enforcement authorities for law enforcement
purposes, such as (1) in response to a court order, subpoena, warrant, summons
or similar process, (2) to identify or locate a suspect, fugitive, material witness or
missing person, (3) if you are the victim of a crime, but only if your agreement is
obtained or in response to a subpoena, (4) about a death which is believed to be
the result of criminal conduct, (5) to report a crime that occurred on Facility
premises, and (6) 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. The facility must comply with federal and state laws in
making such disclosures.
DECEASED INDIVIDUALS. To a coroner or medical examiner as necessary to carry
out their duties (e.g., to identify a deceased person or determine the cause of
death), or to funeral directors as authorized by law.
CORRECTIONAL INSTITUTIONS. To a correctional institution where you are an
inmate or to a law enforcement official who has custody of you for certain limited
purposes (e.g., to provide you with health care).
RESEARCH. For research-related activities that meet all privacy law requirements.
LIMITED MEDICAL INFORMATION. Limited medical information to a third party
for research purposes, public health activities and Facility health care operations.
The party to whom we disclose the information is required to keep it confidential.
REQUIRED BY LAW. When required to do so by federal, state or local law (e.g., to
report child or dependent adult abuse and violent wounds).
INCIDENTAL DISCLOSURES. Occasional incidental, unintended disclosures of
your medical information which might occur during a permitted use or disclosure
(e.g., information overheard during a discussion regarding your care with you or
a member of your family). We will take reasonable steps to avoid these types of
disclosures.
BUSINESS ASSOCIATES. Some of the activities described above are performed
through contracts with outside persons or organizations, such as legal services.
It may be necessary for the Facility to provide some of your medical information to
outside business associates who assist the Facility with these activities. The Facility
requires that its business associates appropriately safeguard the privacy of your
information.
ORGANIZED HEALTH CARE ARRANGEMENT. The Facility is a clinically
integrated care setting where patients receive care from Facility personnel and from
independent doctors and other practitioners who provide care to patients at the
Facility (collectively called “practitioners”). The Facility and these practitioners
need to share medical information freely to provide care to patients, and to conduct
Facility health care operations. Therefore, the Facility and the practitioners have
agreed to follow uniform information practices when using or disclosing medical
information related to inpatient or outpatient hospital services. This arrangement
is called an “organized health care arrangement” and only covers information practices
for services rendered through the Facility. It does not cover the
information practices of the practitioners in their offices or at other care
settings. It does not alter the independent status of the Facility and the
practitioners or make them jointly responsible for the clinical services
provided by them. In other words, the Facility is not responsible for
(1) the negligence (or mistakes) of the independent practitioners providing
care at the Facility; or (2) any violations of your privacy rights by the
YOU AND YOUR AUTHORIZATION. The Facility must also disclose your medical
information to you, as described later in this Notice. Uses and disclosures of
medical information not covered by this Notice or the laws that apply to us will
be made only with your written permission. If you give us permission to use or
disclose medical information about you, you may revoke (take back) that
permission, in writing, at any time. If you revoke your permission, we will no
longer use or disclose medical information about you for the reasons set forth in
your written authorization. We are unable to take back any disclosures we have
already made with your permission.
Your Rights
ACCESS TOMEDICAL INFORMATION. You may request to inspect and
copy much of the medical information we maintain about you, with some
exceptions. This includes most medical and billing records, but does not include
psychotherapy notes. We may charge a fee for the costs of copying, mailing,
and other supplies associated with your request.
REQUEST FOR RESTRICTIONS. You have the right to request a restriction on
how we use or disclose your medical information for treatment, payment, or health
care operations, or to certain family members or friends identified by you who are
involved in your care or the payment for your care. We are not required to agree to
your request, but will notify you if we are unable to agree.
AMENDMENT. You may request that we amend certain portions of your medical
information if you believe that it is incorrect or incomplete. We may require you to
give a reason to support your request. We are not required to make all requested
amendments, but we will give each request careful consideration. If we deny your
request, we will provide you with a written explanation of the reasons and your
rights.
ACCOUNTING. You have the right to receive a list of certain disclosures of your
medical information made by us or our business associates. You must state a time
period for your request, which may not be longer than six years and may not
include dates before April 14, 2003. The first list in any 12-month period will be
provided to you for free; you may be charged a fee for each subsequent list you
request within the same 12-month period.
CONFIDENTIAL COMMUNICATIONS. You have the right to request that
we communicate with you about medical matters in a different manner or at a
different place. We will agree to your request if it is reasonable, and you specify
an alternative means or location to contact you.
PAPER NOTICE. You are entitled to receive a written copy of this Notice at
any time.
HOW TO EXERCISE THESE RIGHTS. All requests to exercise these rights must
be in writing. We will follow written policies to handle requests, and we will notify
you of our decision or actions and your rights. Contact the clinic manager or our
Privacy Officer at the contact information at the end of this Notice for more
information or to obtain request forms.
COMPLAINTS. If you believe your privacy rights have been violated, you may file a
complaint with the Facility using the contact information at the end of this Notice.
You may also submit a complaint to the Secretary of the Department of Health and
Human Services. All complaints must be submitted in writing. You will not be
penalized or retaliated against for filing a complaint.
QUESTIONS. If you have questions about this Notice, please contact the clinic
manager or the Privacy Officer at the contact information at the end of this Notice.
About This Notice
The Facility is required to abide by the terms of the Notice currently in effect.
The Facility reserves the right to change the terms of this Notice and make the new
Notice provisions effective for all of your medical information that it maintains,
including that which it created or received while the prior Notice was in effect.
If the Facility makes a material change to its privacy practices, it will amend its
Notice. We will post a copy of the current Notice in the Facility. The Notice will
state the effective date.
Contact Information
The privacy officer for Guthrie County Hospital may be reached by mail or
by telephone:
PRIVACY OFFICER
Guthrie County Hospital
710 N 12th St.
Guthrie Center, IA 50115
phone 641-332-2201