Pottawatomie County Health Department
Notice of Privacy Practices for Protected Health Information
Effective Date: April 14, 2003
This notice describes how medical information about you may be used and disclosed and
how you can gain access to this information. Please review it carefully. |
Overview
Pottawatomie County Health Department is permitted by federal privacy laws to make uses and
disclosures of your health information for purposes of treatment, payment, and
health care operations. Protected health information is the information we create and obtain in providing our
services to you. Such information may include documenting your symptoms, examination and test results, diagnoses,
treatment, and applying for future care or treatment. It also includes billing documents for those services.
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Examples of uses of your health information for treatment purposes are:
An employee of Pottawatomie County Health Department obtains treatment information
about you and records it in a health record. We may disclose health information about you to other health care
providers who request such information in order to provide medical treatment to you.
We may use and disclose health information by telephone for appointments, treatment, or medical care at Pottawatomie County Health Department. Unless you direct us otherwise, we may leave messages on your answering machine, voice mail, or with the person answering the telephone if you are not available.
An example of use of your health information for payment purposes:
We submit a request for payment to your health insurance company. The health insurance company requests information
from us regarding medical care given. We will provide information to them about you and the care given.
An example of use of your health information for health care operations:
We may use your health information to review our treatment and services and to evaluate the performance of our staff
in caring for you.
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| Your Health Information Rights |
The health and billing records we maintain are the physical property of Pottawatomie
County Health Department. The information in it, however, belongs to you. You have a right to:
Request a restriction on certain uses and disclosures of your health information by delivering the request
in writing to our office—we are not required to grant the request but we will comply with any request granted;
Obtain a paper copy of the Notice of Privacy Practices for Protected Health Information by making a request at the Pottawatomie County Health Department.
Request that you be allowed to inspect and copy your health records and billing record—you
may exercise this right by delivering the request in writing to our office;
Appeal a denial of access to your health information except in certain circumstances;
Request that your health care record be amended to correct incomplete or incorrect information by delivering
a written request to our office using the form we provide to you upon request. We may
deny your request if you ask us to amend information that was not created by us,
is not part of the health information kept by or for Pottawatomie County Health
Department, is not part of the information that you would be permitted to
inspect and/or 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;
Request that communication of your health information be made by alternative means or an alternative location by
delivering the request in writing to our office;
Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering
a written request to our office; an accounting will not include internal uses of information for treatment, payment,
or operations, disclosures made to you or made at your request, or disclosures made
to family members or friends in the course of providing care;
Revoke authorizations that you made previously to use or disclose information except to the extent information or action
has already been taken by delivering a written revocation to our office.
If you want to exercise any of the above rights, please contact the Pottawatomie Officer, P.O. Box 310, 320 Main, Westmoreland, KS 66549, 785-457-3719, in person or in writing, during normal business hours. They will provide you with assistance on the steps to take to exercise your rights.
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Our Responsibilities:
Maintain the privacy of your health information as required by law;
Provide you with a notice as to our duties and privacy practices as to the information we collect
and maintain about you;
Abide by the terms of this Notice;
Attempt to notify you if we cannot accommodate a requested restriction or request; and,
Accommodate your reasonable requests regarding methods to communicate health information with you.
We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices,
and to enact new provisions regarding the protected health information we maintain without prior notice.
If our information practices change, we will amend our Notice. You are entitled to receive a revised copy
of the Notice by calling and requesting a copy of our “Notice” or by visiting our office during business
hours and picking up a copy.
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To Request Information or File a Complaint:
If you have questions, would like additional information, or want to report a problem regarding the handling
of your information, you may contact the privacy officer at 785-457-3719.
Additionally, if you believe your privacy rights have been violated, you may file a written
complaint at our office by delivering the written complaint to the Privacy
Officer. You may also file a complaint by mailing it to the Secretary of Health and Human Services whose
street address is 444 SE Quincy, Topeka, KS.
We will not require you to waive the right to file a complaint with the Secretary of Health and Human Services
(HHS) as a condition of receiving treatment from Pottawatomie County Health Department.
We cannot and will not retaliate against you for filing a complaint about the privacy of your medical
information with the Secretary of HHS.
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| Other Disclosures and Uses |
Business Associates:
We have business associates with whom we may share your protected health information. For example, some services we
provide are through contracts or arrangements with business associates like Pawnee Mental Health, a dietician, and
our wellness coordinator.
To protect your health information, we require our business associates to appropriately safeguard your information.
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Notification:
Unless you object, we may use or disclose your protected health information to notify, or assist in notifying,
a family member, personal representative, or other person responsible for your care, about your location, and
about your general condition, or your death.
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| Communication with Family:
Using our best judgment, we may disclose to a family member, other relative, close personal friend, or any other
person you identify, health information relevant to that person’s involvement in your care or in payment for such
care if you do not object or in an emergency.
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| Surveys:
We may use and disclose health information to contact you to access your satisfaction with our services. |
| Disaster Relief:
We may use and disclose your protected health information to assist in disaster relief efforts.
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| Research:
We may disclose information to researchers when their research has been approved by an institutional review board
that has reviewed the research proposal and established protocols to ensure the privacy of your protected health
information. |
| Food and Drug Administration (FDA):
We may disclose to the FDA your protected health information relating to adverse events with respect to food,
supplements, products and product defects, or post-marketing surveillance information to enable product recalls,
repairs, or replacements.
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| Workers Compensation:
If you are seeking compensation through Workers Compensation, we may disclose your protected health information to
the extent necessary to comply with laws relating to Workers Compensation.
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| Public Health:
As required by law, we may disclose your protected health information to public health or legal authorities charged
with preventing or controlling disease, injury, or disability; to report reaction to medications or problems with
products; to notify people of recalls, to notify persons who may have been exposed to a disease or who are at risk
for contracting or spreading a disease or condition.
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| Abuse & Neglect:
We may disclose your protected health information to public authorities as allowed by law to report abuse or neglect.
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| 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 the medical
surveillance of the workplace or evaluate whether you have work related illness or injury. 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.
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| Correctional Institutions:
If you are an inmate of a correctional institution, we may disclose to the institution or agents thereof your protected
health information necessary for your health and the health and safety of other individuals.
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| Law Enforcement:
We may disclose your protected health information for law enforcement purposes as required by law, such as when required
by a court order, or in cases involving felony prosecutions, or to the extent an individual is in the custody of law
enforcement.
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| Health Oversight:
Federal law allows us to release your protected health information to appropriate health oversight agencies or for
health oversight activities.
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| Judicial/Administrative Proceedings:
We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed
or required by law, with your authorizations, or as directed by a proper court order.
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| Serious Threat:
To avert a serious threat to health or safety, we may disclose your protected health information consistent
with applicable law to prevent or lessen a serious, imminent threat to the health or safety of person or the public.
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| For Specialized Governmental Functions:
We may disclose your protected health information for specialized government functions as authorized by law such
as to Armed Forces personnel, for national security purposes, or to public assistance program personnel. |
| Other Uses:
Other uses and disclosures besides those identified in this Notice will be only as otherwise authorized by law or
with your written authorization and you may revoke the authorization as previously provided. |
| Changes to this notice:
We reserve the right to change this notice without prior notification. 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 noticed in The Pottawatomie County Health Department.
The notice will contain on the first page the effective date.
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| Acknowledgement:
You will be asked to provide a written acknowledgement of your receipt of this Notice of Privacy Practices.
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Pottawatomie County Health Department -
320 Main -
P.O. Box 310 - Westmoreland, KS 66549
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