Privacy Practices

PRIVACY PRACTICES

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.

Protected Health Information. While receiving care from our facility, information regarding your medical history, treatment, and payment for your health care may be originated and/or received by us. Information which can be used to identify you and which relates to your past, present or future medical condition, receipt of health care or payment for health care (“Protected Health Information”). Throughout this notice we will refer to your protected health information as PHI. Your PHI includes information that identifies you and reports about the care and services you receive here. This notice applies to all of the records, both electronic and paper. It includes all information created by Keokuk County Health Center staff. Our staff includes physicians, other health care professionals and other departmental staff.

This notice about our privacy practices explains how, when, and why we use and share your PHI. We may not use or disclose any more of your PHI than is necessary for the purpose of the use or disclosure with some exceptions.

Our responsibilities. Federal law imposes certain obligations and duties upon us as a covered health care provider with respect to your protected health information. Specifically, we are required to:

· Provide you with notice of our legal duties and out facility’s policies regarding the use and disclosure of your protected health information (PHI);

· Maintain the confidentiality of your protected health information (PHI) in accordance with sate and federal law;

· Honor your requested restrictions regarding the use and disclosure of your protected health information (PHI) unless under the law we are authorized to release your protected health information (PHI) without your authorization, in which case you will be notified within a reasonable period of time;

· Allow you to inspect and copy your protected health information (PHI)during our regular business hours;

· Act on your request to amend protected health information (PHI) within sixty (60) days and notify you of any delay which would require us to extend the deadline by the permitted thirty (30) day extension;

· Accommodate reasonable requests to communicate protected health information (PHI) by alternative means or methods; and

· Abide by the terms of this notice.

How Your Protected Health Information May be Used and Disclosed. Generally, your Protected Health Information (PHI) may be used and disclosed by us only with your express written authorization. However, there are some exceptions to this general rule.

Treatment, Payment, or Health Care Operations.

Treatment Purposes. We may use or disclose your protected health information (PHI) for treatment purposes. During your care at our facility, it may be necessary for various personnel involved in your care to have access to your protected health information in order to provide you with quality care. For example, we may inform dietary personnel of any condition which requires you to have a special diet. In addition, we may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services which may be of interest to you.

Situations may also arise when it is necessary to disclose your protected health information (PHI) to health care providers outside our facility who may also be involved in your care. For example, we may inform your physician of medications you are currently taking.

Payment Purposes. Your protected health information (PHI) may also be used or disclosed for payment purposes. It is necessary for us to use or disclose protected health information (PHI) so that treatment and services provided by us may be billed and collected from you, your insurance company, or other third party payer. For example, we may disclose your protected health information (PHI) to your health insurance carrier to obtain prior approval for a service. We may also release your protected health information (PHI) to another health care provider or individual or entity covered by the HIPAA privacy regulations who has a relationship with you for their payment activities. For example, we may disclose information to your health insurance carrier upon its request for additional information necessary for it to determine whether a service is covered.

Patient Directory. Our facility maintains a patient directory. Unless you object, your name, location in the facility, general condition, and religious affiliation will be contained in the directory. The directory is disclosed to members of the clergy and except for religious affiliation, to other persons who specifically ask for the information by your name. You are not obligated, however, in any way, to consent to the inclusion of your information in the facility directory. Please notify facility personnel if you do not wish to be included in the directory or if you wish for information or disclosure to be limited in some way.

Notification and Communications to Individuals Involved in Your Care. Unless you have informed us otherwise, your protected health information (PHI) may be used or disclosed by us to notify or assist in notifying a family member or other person responsible for your care. In most cases, protected health information (PHI) disclosed for notification purposes will be limited to your name, location and general condition. In addition, unless you have informed us otherwise, protected health information (PHI) may be released to a family member, relative or close personal friend who is involved in your care to the extent necessary for them to participate in your care. In the event you wish for any of these uses or disclosures to be limited, please contact facility personnel.

Fundraising Activities. We may use your protected health information (PHI) for the purpose of contacting you as part of a fund-raising effort. Only demographic information and the dates health care was provided to you will be used or disclosed in connection with fundraising efforts. If you do not wish to be contacted for fundraising activities, you may contact our Administrative Assistant at 641-622-1170 to have your name removed from our fundraising list.

Authorized by Law. We may also use or disclosure your protected health information (PHI) without your authorization as permitted or required by law. Examples include: public health activities, health oversight activities, judicial and administrative proceedings, abuse reporting, law enforcement, organ donation, medical examiners and coroners, and research purposes. Information will only be used/disclosed without your authorization as permitted by the applicable state or federal law.

More Stringent Laws. Some of your protected health information (PHI) may be subject to other laws and regulations and afforded greater protection than what is outlined in this notice. For instance, HIV/AIDS, substance abuse, and mental health information are often given more protection. In the event your protected information is afforded greater protection under federal or state law, we will comply with the applicable law.

Your Rights. Federal law grants you certain rights with respect to your protected health information(PHI). Specifically, you have the right to:

· Receive notice of our policies and procedures used to protect your protected information;

· Request that certain uses and disclosures of your protected health information(PHI) be restricted; provided, however, if we may release the information without your consent or authorization, we have the right to refuse your request;

· Access to your protected health information (PHI); provided, however, the request must be in writing and may be denied in certain limited situations;

· Request that your protected health information (PHI) be amended;

· Obtain an accounting of certain disclosures by us of your protected health information (PHI) for the past six years, beginning April 14,2003 ;

· Revoke any prior authorizations or consents for the use or disclosure of protected health information (PHI), except to the extent that action has already been taken; and

· Request communications of your protected health information (PHI) are done by alternative means or at alternative locations.

Important contact information. This notice has been provided to you as a summary of how we will use your protected health information (PHI) and your rights with respect to your protected information. If you have any questions or for more information regarding your protected health information (PHI), please contact our (HIM) Health Information Management Department at 641-622-1130.

If you believe your privacy rights have been violated, you may file a complaint with our office by contacting our Privacy Officer at 641-622-1148. You may also file a complaint with the Secretary of Health and Human Services. There will be no retaliation for the filing of a complaint.

Effective Date. This notice will become effective on April 14, 2003. Please note, we reserve the right to revise this notice at any time. When we make an important change to our policies, we will change this notice and post a new notice on our Web site (http://www.keokukhealth.com). A current notice of our privacy practices may be obtained from the Business Office. You may also request a copy of our current notice at any time from the business office.