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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.
Our Legal Duty
We are required by law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect. This Notice takes effect April 14, 2003.
Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request. We reserve the right to change our privacy practices and the terms of this Notice any time. Any changes in our privacy practices and the new terms of our Notice will be effective for all health information that we maintain, including health information we created or received before we made the changes. We will post changes in the front office.
You may request a copy of our Notice at any time. For more information about our privacy practices, or additional copies of this Notice, please contact the Administrator of the Hickory County Health Department (HCHD).
Uses and Disclosures of Health Information
We use or disclose personal health information to health care providers to carry out treatment, payment or health care operations. This information will only be shared with health care providers that have signed an agreement with Hickory County Health Department. It will not be used for any other purposes without specific written consent of the individual or their parent or guardian if a minor. The confidentiality of the information will be maintained as required by applicable state and federal laws.
To persons involved in your care: We may use or disclose health information to notify or assist in the notification of a family member or personal representative of your location and your general condition. If you are present, then we will provide you with an opportunity to object to such uses or disclosures before they are made. In the event of your incapacity or emergency circumstances, we may disclose information that is directly relevant to the person's involvement in your healthcare, if we determine that it is in your best interest to do so. As required by law: We may disclose your health information when we are required to do so by federal, state, or local law.
For public health activities: We may disclose medical information about you for public health activities, including reporting births and deaths and notifying appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.
With your authorization: Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written authorization. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect.
Your Rights
Under 45 CFR 10-164, individuals have the right to:
Request restrictions on certain uses and disclosures; however, HCHD is not required to agree to a requested restriction. If state or federal law requires disclosure, the consent of the individual is not required and disclosure will be made accordingly.
Inspect and receive a copy of their health information. To do this you must make a request to the Administrator of the HCHD in written form.
Review and amend or update their health care information, if inaccurate.
Receive an accounting of disclosures. You may receive a list of disclosures HCHD made of your health information for purposes, other than treatment, payment or health care operations, and certain other activities, for a period of time up to six years, but not including dates previous of April 14, 2003.
Receive confidential communications of protected health information.
Receive a paper copy of this notice.
Request restrictions: You have the right to request that we restrict how we use or disclose your medical information for treatment, payment, or health care operations or the disclosures we make to someone who is involved in your care or the payment for your care, such as a family member or friend. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).
Confidential communication: You have the right to request that we communicate with you about your health information by alternative means. You must make your request in writing and may use forms we provide. Authorization forms will need to be signed in the event information or items need to be released to person other than you. Example and common practice would be to allow individuals to pick up lab results, vouchers, immunization records, or prescriptions.
Questions and Complaints
If you want more information about our privacy practices or have questions or concerns, please contact us. If you are concerned that we may have violated your privacy rights or if you disagree with a decision we made about use or disclosure of your personal health information, you may complain to us using the contact information listed here. You will not be penalized for filing a complaint. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.
Contact Information
Contact Officer: Alisa Carter
201 Cedar
PO Box 21
Hermitage, MO 65668
Phone: (417) 745-2138
E-mail: acarter@hickorycountymo.
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