NOTICE OF
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.
If you have any questions
about this Notice of Privacy Practices contact Calhoun
County
’s Privacy Officer:
Russell
Wood, Privacy Officer,
123
1st Ave. SW, Hampton, IA 50441.
(641)
456-4090
This Notice of
Privacy Practices describes how Calhoun
County
may use and disclose your protected health information to carry out 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.
Calhoun
County
is required to abide by the terms of this Notice of Privacy Practices. Calhoun
County
may change the terms of this notice, at any time.
The new notice will be effective for all protected health information
that Calhoun
County
maintains at that time. Upon
request, Calhoun
County
will provide you with any revised Notice of Privacy Practices.
PERMITTED
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Your protected health information may be used and disclosed by
Calhoun
County
for the purpose of providing or accessing health care services for you.
Your protected health information may also be used and disclosed to pay
your health care bills and to support the business operation of Calhoun
County
.
The following
categories describe ways that Calhoun
County
is permitted to use and disclose health care information.
Examples of types of uses and disclosures are listed in each category.
Not every use or disclosure for each category is listed; however, all of
the ways Calhoun
County
is permitted to use and disclose information falls into one of these
categories:
1)
Treatment:
Calhoun County may 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, Calhoun
County
would disclose your protected health information, as necessary, to a home
health agency that provides care to you. Another
example is that protected health information may be provided to a facility to
which you have been referred to ensure that the facility has the necessary
information to treat you.
2)
Payment
Calhoun County may use and disclose health care information about you so
that the treatment and services you receive may be billed to and payment may be
collected from you, an insurance company or a third party.
Calhoun County may also discuss your protected health information about a
service you are going to receive to determine whether you are eligible for the
service, and for undertaking utilization review activities.
For example, authorizing a service may require that your relevant
protected health information be discussed with a provider to determine your need
and eligibility for the service.
3)
Healthcare
Operations
Calhoun County may use or disclose, as-needed, your protected health
information in order to support its business activities.
These activities include, but are not limited to, quality assessment
activities, employee review activities, licensing and conducting or arranging
for other business activities. For
example, Calhoun
County
may use or disclose your protected health
information, as necessary, to contact you to remind you of your appointment or
to provide information about alternate services or other health-related
benefits.
Calhoun
County
may share your protected health information with third party “business
associates” that perform various activities (e.g., billing, transcription
services) for Calhoun
County
. Whenever an arrangement between
Calhoun
County
and a business associate involves the use or disclosure of your protected
health information, Calhoun
County
will have a written contract that contains terms that will protect the privacy
of your protected health information.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION REQUIRING YOUR
WRITTEN AUTHORIZATION
Other uses and disclosures of your protected health information
will be made only with your written authorization, unless otherwise permitted or
required by law as described below. You
may revoke this authorization, at any time, in writing, except to the extent
that Calhoun
County
has taken an action in reliance on the use or disclosure indicated in the
authorization.
Calhoun
County
may use and disclose your protected health information in the following
instances. You have the opportunity
to agree or object to the use or disclosure of all or part of your protected
health information. If you are not
present or able to agree or object to the use or disclosure of the protected
health information, then Calhoun
County
may, using professional judgment, determine whether the disclosure is in your
best interest. In this case, only
the protected health information that is relevant to your health care will be
disclosed.
1)
Others
Involved in Your Healthcare
Unless you object, Calhoun
County
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, Calhoun
County
may disclose such information as necessary if Calhoun
County
, based on its professional judgment, determines that it is in your best
interest. Calhoun
County
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, Calhoun
County
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.
2)
Emergencies
Calhoun
County
may use or disclose your protected health information in an emergency treatment
situation. If this happens, Calhoun
County
shall try to obtain your acknowledgment of receipt of the Notice of Privacy
Practices as soon as reasonably practicable after the delivery of treatment.
OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES THAT MAY BE MADE
WITHOUT YOUR AUTHORIZATION OR
OPPORTUNITY
TO OBJECT
Calhoun
County
may use or disclose your protected health information in the following
situations without your consent or authorization.
These situations include:
1)
Required
By Law
Calhoun
County
may use or disclose your protected health information to the extent that the
law requires the use or disclosure. You
will be notified, as required by law, of any such uses or disclosures.
2)
Public
Health
Calhoun
County
may disclose your protected health information for public health activities and
purposes to a public health authority that is permitted by law to collect or
receive the information. The
disclosure will be made for the purpose of controlling disease, injury or
disability. Calhoun
County
may also disclose your protected health information, if directed by the public
health authority, to a foreign government agency that is collaborating with the
public health authority.
3)
Communicable
Diseases
Calhoun
County
may disclose your protected health information, if authorized by law, to a
person who may have been exposed to a communicable disease or may otherwise be
at risk of contracting or spreading the disease.
4)
Health
Oversight
Calhoun
County
may disclose your protected health information to a health oversight agency for
activities authorized by law, such as audits, investigations and inspections.
Oversight agencies seeking this information include government agencies
that oversee the health care system, government benefit programs, other
government regulatory programs and civil rights laws.
5)
Abuse
or Neglect
Calhoun
County
may disclose your protected health information to a public health authority
that is authorized by law to receive reports of child abuse or neglect.
In addition, Calhoun
County
may disclose your protected health information if it believes that you have
been a victim of abuse, neglect or domestic violence to the governmental entity
or agency authorized to receive such information.
In this case, the disclosure will be made consistent with the
requirements of applicable federal and state laws.
6)
Food
and Drug Administration
Calhoun
County
may disclose your protected health information to a person or company required
by the Food and Drug Administration to report adverse events, product defects or
problems, biologic product deviations, track products; to enable product
recalls; to make repairs or replacements, or to conduct post marketing
surveillance, as required.
7)
Legal
Proceedings
Calhoun
County
may disclose protected health information in the course of any judicial or
administrative proceeding, in response to an order of a court or administrative
tribunal (to the extent such disclosure is expressly authorized), in certain
conditions in response to a subpoena, discovery request or other lawful process.
8)
Law
Enforcement
Calhoun
County
may also disclose protected health information, so long as applicable legal
requirements are met, for law enforcement purposes. 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, and
(6) medical emergency (not on Calhoun County’s premises) and it is likely that
a crime has occurred.
9)
Coroners,
Funeral Directors, and Organ Donation
Calhoun
County
may disclose protected health information to a coroner or medical examiner for
identification 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.
10)
Research
Calhoun
County
may disclose your protected health 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.
11)
Criminal
Activity
Consistent with applicable federal and
state laws, Calhoun
County
may disclose your protected health information, if it believes that the use or
disclosure is necessary to prevent or lessen a serious and imminent threat to
the health or safety of a person or the public.
Calhoun
County
may also disclose protected health information if it is necessary for law
enforcement authorities to identify or apprehend an individual.
12)
Military
Activity and National Security
When the appropriate conditions apply,
Calhoun County 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 Veterans Affairs of your eligibility for benefits, or (3)
to foreign military authority if you are a member of that foreign military
service. Calhoun
County
may also disclose your protected health information to authorized federal
officials for conducting national security and intelligence activities,
including for the provision of protective services to the President or others
legally authorized.
13)
Workers’
Compensation
Your protected health information may
be disclosed by Calhoun
County
as authorized to comply with workers’ compensation laws and other similar
legally established programs.
14)
Inmates
Calhoun
County
may use or disclose your protected health information if you are an inmate of a
correctional facility and Calhoun
County
created or received your protected health information in the course of
providing care to you.
15)
Required
Uses and Disclosures
Under the law, Calhoun
County
shall make disclosures to you and when required by the Secretary of the
Department of Health and Human Services to investigate or determine Calhoun
County
’s compliance with the requirements of 45 C.F.R. section 164.500 et. seq.
YOUR RIGHTS
The following are a list of your rights with respect to your
protected health information and a brief description of how you may exercise
these rights:
RIGHT TO INSPECT AND COPY YOUR PROTECTED HEALTH INFORMATION
This means you may inspect and obtain a copy of protected health
information about you that is contained in a designated record set for as long
as Calhoun
County
maintains the protected health information.
A “designated record set” contains medical and billing records and
any other records that Calhoun
County
uses in making decisions about you.
Under federal law, however, you may not inspect or copy the
following records; psychotherapy notes; information compiled in reasonable
anticipation of, or use in, a civil, criminal, or administrative action or
proceeding, and protected health information that is subject to law that
prohibits access to protected health information.
Depending on the circumstances, a decision to deny access may be
reviewable. In some circumstances, you may have a right to have this decision
reviewed. Please contact the Calhoun
County Privacy Officer if you have questions about access to your medical
record.
RIGHT TO REQUEST A RESTRICTION OF YOUR PROTECTED HEALTH INFORMATION
This means you may ask Calhoun
County
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 as described in this Notice of Privacy Practices.
Your request must state the specific restriction requested and to whom
you want the restriction to apply.
Calhoun
County
is not required to agree to a restriction that you may request.
If Calhoun
County
believes that it is in your best interest to permit use and disclosure of your
protected health information, your protected health information will not be
restricted. If Calhoun
County
does agree to the requested restriction, it may not use or disclose your
protected health information in violation of that restriction unless it is
needed to provide emergency treatment. With
this in mind, please discuss any restriction you wish to request with Calhoun
County
. You may request a restriction in
writing to the Calhoun County Privacy Officer.
RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS FROM CALHOUN
COUNTY
BY ALTERNATIVE MEANS OR AT AN ALTERNATIVE LOCATION
Calhoun
County
will accommodate reasonable requests. Calhoun
County
may also condition this accommodation by asking you for information as to how
payment will be handled or specification of an alternative address or other
method of contact. Calhoun
County
will not request an explanation from you as to the basis for the request.
Please make this request in writing to the Calhoun County Privacy
Officer.
RIGHT TO REQUEST AN AMENDMENT TO YOUR PROTECTED HEALTH INFORMATION
This means you may request an amendment of protected health
information about you in a designated record set for as long as Calhoun
County
maintains this information. In
certain cases, Calhoun
County
may deny your request for an amendment. If
Calhoun
County
denies your request for amendment, you have the right to file a statement of
disagreement with Calhoun
County
and Calhoun
County
may prepare a rebuttal to your statement and will provide you with a copy of
any such rebuttal. All
requests for amendments must be in writing.
RIGHT TO RECEIVE AN ACCOUNTING OF CERTAIN DISCLOSURES OF YOUR
PROTECTED HEALTH INFORMATION
This right applies to disclosures for purposes other than
treatment, payment or healthcare operations as described in this Notice of
Privacy Practices. It excludes
disclosures Calhoun
County
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
.
RIGHT TO OBTAIN A PAPER COPY OF THIS NOTICE
You have the right to obtain a paper copy of this notice, upon
request, even if you have agreed to accept this notice electronically.
COMPLAINTS
You may file a complaint to Calhoun
County
or to the Secretary of Health and Human Services if you believe your privacy
rights have been violated by Calhoun
County
. You may file a complaint against
Calhoun
County
by notifying the Calhoun County Privacy Officer.
Calhoun
County
will not retaliate against you for filing a complaint.
You
may contact Calhoun County Privacy Officer, Russell Wood, 123 1st
Ave. SW, Hampton IA 50441 (641)
456-4090 for further information about the
complaint process.
This
notice was published and becomes effective on
April 14, 2003
.
