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JASPER COUNTY 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 the County’s Privacy Officer:
[Dennis Simon, Human Resource Director]
This Notice of Privacy Practices describes how the 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.
The County is required to abide by the terms of this Notice
of Privacy Practices. The County may change the terms of this notice, at any
time. The new notice will be effective for all protected health information that
the County maintains at that time. Upon request, the 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 the 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 the County.
The following categories describe ways that the 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 the County is permitted to use
and disclose information falls into one of these categories:
1) Treatment:
The 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, the 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
The 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. The
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
The 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, the 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.
The County may share your protected health information with
third party "business associates" that perform various activities (e.g.,
billing, transcription services) for the County. Whenever an arrangement
between the County and a business associate involves the use or disclosure of
your protected health information, the 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 the County has
taken an action in reliance on the use or disclosure indicated in the
authorization.
The 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 the 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, the 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, the County may disclose such information as necessary if the
County, based on its professional judgment, determines that it is in your best
interest. The 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, the 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
The County may use or disclose your protected health
information in an emergency treatment situation. If this happens, The 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
The 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
The County may use or disclose your protected health
information to the extent that the use or disclosure is required by law. You
will be notified, as required by law, of any such uses or disclosures.
2) Public Health
The 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. The 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
The 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
The 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
The 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, the 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
The 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
The 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
The 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 the
county’s premises) and it is likely that a crime has occurred.
9) Coroners, Funeral Directors, and Organ Donation
The 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
The 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, the
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. The 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, the 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 services. The 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 the
County as authorized to comply with workers’ compensation laws and other
similar legally-established programs.
14) Inmates
The County may use or disclose your protected health
information if you are an inmate of a correctional facility and the County
created or received your protected health information in the course of
providing care to you.
15) Required Uses and Disclosures
Under the law, the County must make disclosures to you and
when required by the Secretary of the Department of Health and Human Services
to investigate or determine County 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 the County maintains the protected health information. A "designated
record set" contains medical and billing records and any other records that the
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 County Privacy Contact 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 the 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.
The County is not required to agree to a restriction that you
may request. If the 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 the 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 the County. You may request a restriction in writing to the County Privacy
Officer.
RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS FROM THE COUNTY
BY ALTERNATIVE MEANS OR AT AN ALTERNATIVE LOCATION
The County will accommodate reasonable requests. The 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. The County will not
request an explanation from you as to the basis for the
request. Please make this request in writing to the County Privacy Contact.
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 the County
maintains this information. In certain cases, the County may deny your request
for an amendment. If the County denies your request for amendment, you have the
right to file a statement of disagreement with the County and the County may
prepare a rebuttal to your statement and will provide you with a copy of any
such rebuttal.
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 the 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 the County or to the Secretary of
Health and Human Services if you believe your privacy rights have been violated
by the County. You may file a complaint against the County by notifying the
County Privacy Officer. The County will not retaliate against you for filing a
complaint.
You may contact the County Privacy Officer, Dennis Simon , Human Resource Director
at (641)787-1024
for further information about the complaint process.
This notice was published and becomes effective on
April 14, 2003.
For a printable version please click the
link below:
HIPPA Privacy Statement
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