ARTESIAN VALLEY HEALTH SYSTEMS

TO INCLUDE: BREATHE E-Z, HOME HEALTH CARE, HERITAGE HEALTH SERVICES, MEADE RURAL HEALTH CLINICS AND LONG TERM CARE UNIT

NOTICE OF PRIVACY PRACTICES

This Notice of Privacy Practices is effective as of 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.

 

UNDERSTANDING YOUR MEDICAL INFORMATION - ITS USES & DISCLOSURES:
Certain laws require that you be provided "Notice" of our privacy practices that relate to your medical information. Our privacy practices are contained within this "Notice." This "Notice" applies to the protected health records of your care provided by the hospital and its employees, staff and volunteers. Your personal doctor, other health care providers, or your health insurance
plan may have different privacy policies or "notices" regarding the doctor's, others provider's, or the plan's use and disclosure of your health information that are created outside of the hospital.

CONTACT PERSON IF YOU HAVE QUESTIONS: If you have any questions about this notice or our privacy practices relating to your health information please contact the following
person:

                                    Privacy Officer
                                    Meade District Hospital
                                    Meade Kansas 67864
                                    Tel.# 620-873-5543
                                    Fax # 620-873-5597

This "Notice" contains information in the following general categories:

WHAT IS YOUR HEALTH RECORD INFORMATION?

Each time you receive medical care from a hospital, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains a history of your illnesses or injuries, symptoms, exam & laboratory results, treatment provided and treatment plans, and notes on future care. Depending on your health care situation your record may contain more or
different information. How your health information is used is described on the following pages.

WHAT ARE THE RESPONSIBILITIES OF THIS HOSPITAL WHEN IT COMES TO
YOUR HEALTH INFORMATION?

This hospital is required by law to:

We will not use or disclose your health information without your authorization, except as explained in this notice or as required by law. Certain laws may require that we disclose your health information without your authorization. We are obligated to follow those laws.

WHAT ARE YOUR HEALTH INFORMATION RIGHTS?

Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to:

Inspect and Copy Your Records. You have the right to inspect and obtain a copy of certain 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, information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding, information that is subject to special laws or other information not contained in the medical or billing records.

To inspect and obtain a copy of your health information you must submit your request in writing to the contact person listed on page 1. If you request a copy of the information, we may charge a reasonable cost-based fee for copying, including labor & supplies, and the cost of postage.

We may deny your request to inspect and copy in certain very limited circumstances. Certain reasons for the denial are not reviewable and some are reviewable. If you are denied access to health information you will be told in writing. In certain circumstances, however, you may request that the denial be reviewed. If the original denial of access to the medical records was made by a licensed health care provider as allowed by law, another licensed healthcare professional chosen by the hospital 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. You will be advised in writing of this reviewing official's decision.

Right to Amend Your Records. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend / change the information. You have the right to request an amendment for as long as the information is kept by or for the hospital. To request an amendment, your request must be made in writing and submitted to the hospital's contact person listed on page 1. In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

Right to an Accounting of Disclosures. You have the right to request, in certain circumstances, an "accounting of disclosures." An "accounting" is a list of the disclosures we made of health information about you.To request this list or accounting of disclosures, you must submit your request in writing to the hospital's contact person listed on page 1. 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 or some other form). 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 on the health information we use or disclose about you for treatment, payment or healthcare 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 (1) we not use or disclose information about a surgery you had or (2) that certain people not be told of certain information.

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.

How to make a request. Torequest restrictions, you much 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 page 1 of this notice.

Right to Request Confidential 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 confidential communications, you must make your request in writing to the Contact Person listed on page 1. We will not ask you the reason for your request. We may ask you for clarification so we can understand your request. You are not required to give an explanation. 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 you may contact the hospital's contact person listed on page 1. You may also obtain a copy of this notice at our website, www.meadehospital.com

Your Rights Regarding Electronic Health Information Exchange: We participate in an electronic health information exchange, or HIE. New technology allows a provider or a health plan to make a single request through a health information organization, or HIO, to obtain electronic records for a specific patient from other HIE participants for purposes of treatment, payment, or health care operations. HIOs are required to use appropriate safeguards to prevent unauthorized uses and disclosures. You have two options with respect to HIE. First, you may permit authorized individuals to access your electronic health information through an HIO. If you choose this option, you do not have to do anything. Second, you may restrict access to all of your information through an HIO (except access by properly authorized individuals as needed to report specific information as required by law). If you wish to restrict access, you must complete and submit a specific form available at http://www.khie.org. You cannot restrict access to certain information only; your choice is to permit or restrict access to all of your information. If you have questions regarding HIE or HIOs, please visit http://www.khie.org for additional information. Even if you restrict access through an HIO, providers and health plans may share your information directly through other means (e.g., facsimile or secure e-mail) without your specific written authorization. If you receive health care services in a state other than Kansas, different rules may apply regarding restrictions on access to your electronic health information. Please communicate directly with your out-of-state health care provider regarding those rules.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU WITHOUT YOUR SPECIFIC AUTHORIZATION:

For Treatment. We may use health information about you to provide you with medical treatment or services. We may disclose health information about you to doctors with hospital privileges, nurses, technicians, medical students, or other hospital staff or personnel who are involved in taking care of you at the hospital. We also may disclose health information about you to people outside the hospital who may be involved in your medical care while you are in the hospital or after you leave the hospital, such as other doctors, health care workers, family members, clergy or others we use to provide services that are part of your care.

For Payment. We may use and disclose health information about you so that the treatment and services you receive at the hospital may be billed to and payment may be collected from you, an insurance company or a third party.

We may also 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 hospital operations. These uses and disclosures are necessary to run the hospital 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 improvement in the care and services we offer. We may remove information that identified you from this set of health information so other 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 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, a family member or friend involved in your health care or as authorized by you as a reminder that you have an appointment for treatment or medical care at our facility. We may also leave a reminder on your answering machine/voice mail system unless you tell us not to.

Surveys. We may use and disclose health information to contact you to assess your satisfaction without 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.

Fundraising Activities. We may use health information about you to contact you in an effort to raise money for the hospital and its operations. We may disclose health information to a foundation related to the hospital so that the foundation may contact you in raising money for the hospital. We only would release contact information, such as your name, address, phone number and the dates you received treatment or services at the hospital. If you do not want the hospital to contact you for fundraising efforts, you must notify the Contact Person in writing.

Business Associates. There are some services provided in our organization through contracts or arrangements with business associates. When 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.

Hospital Directory. We may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include you name, location in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation. This directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don't ask for you by name. This is so your family, friends and clergy can visit you in the hospital and generally know how you are doing. If you do not want to be included in the hospital directory you must tell us by notifying the Contact Person or Contact Person's designee.

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. We may also tell your family or friends your condition and that you are in the hospital. In addition, we may disclose health information about you to an entity 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 the 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 health needs, so long as the health information they review does not leave the hospital. 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 hospital.

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 Safe . 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 release 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.

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 Activities. We may disclose health information about you without your permission for public health activities. These activities generally include the following:

Health Oversight Activities. We may disclose health information without your permission 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, licensing functions, and compliance with civil rights laws.

Lawsuits and Disputes. If you are involved in a lawsuit or in 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 or as otherwise permitted by law.

Law Enforcement. We may release health information if asked to do so by a law enforcement official:

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 hospital to funeral directors as necessary 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 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 of 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.

OTHERS USES AND DISCLOSURES

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 permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. To revoke any permission already given to us or permission given to us in the future you must revoke that permission in writing by sending it to the contact Person listed on page 1. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that 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.

WHAT SHOULD YOU DO IF YOU HAVE A COMPLAINT CONCERNING YOUR
MEDICAL RECORDS?

If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with the hospital or to receive additional information as to how to file a complaint with the Department of Health and Human Services, contact the Contact Person listed on page 1. All complaints must be submitted in writing.

You will not be penalized for filing a complaint.

IF CHANGES ARE MADE 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 in the hospital. You will find the date the notice became effective at the top of the first page below the title. In addition, each time you register at or are admitted to the hospital for treatment or healthcare services, a copy of the current notice in effect will be given to you if you request it.