JMHC, Inc.., d/b/a
Nicholas County Hospital
2325 Concrete Road, PO Box 232, Carlisle, KY 40311
; FAX
NOTICE OF PRIVACY PRACTICES
Effective Date: 4/14/2003
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.
WHAT IS THIS NOTICE?
This Notice of Privacy Practices is required by the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
This notice tells you:
How JMHC, Inc. also known as Nicholas County Hospital and our contracted business partners may use and give out your protected health information (PHI) to carry out treatment, for payment or health care operations and for other purposes permitted or required by law.
What YOUR rights are regarding the access and control of your protected health information (PHI.)
How JMHC protects your health information.
OUR DUTY TO PROTECT YOUR PRIVACY
Your health information is personal. JMHC is legally required to protect the privacy of your data. JMHC does so in all aspects of our business. JMHC has policies about protecting the privacy of your data. These policies comply with State and Federal laws. JMHC uses and gives out your health information only where required by law or where necessary for business.
WHERE DO YOU SEND QUESTIONS OR REQUESTS?
To submit questions about your privacy rights or to submit a written request to JMHC regarding your privacy rights, please contact the Administrator or Privacy Officer at:
NICHOLAS COUNTY HOSPITAL
2325 Concrete Road, PO Box 232
Carlisle, KY 40311
Or, you may contact JMHC by dialing .
WHAT TYPES OF INFORMATION DOES JMHC HAVE?
JMHC, contracted business associates and physicians who treat you as a hospital inpatient, swing patient, emergency patient or nursing home resident, provide health care services that create the following protected health information:
Your Individual Information, including: name, address, phone number, date of birth, social security number and employer.
Information regarding any health insurance policies you may have.
Your Medical Record.
Your billing record.
All this information is considered to be your Protected Health Information (PHI.)
JMHC’S PRIVACY RESPONSIBILITIES
JMHC is required to:
Follow the terms of this Notice.
Support your Privacy Rights under the law.
Give you a copy of this Privacy Notice and provide you with a new Notice if our privacy practices change.
Treat your data as confidential by not using or giving out your information without your written permission, except to support normal business or under the allowable circumstances given in this Notice.
Tell you what types of information we collect on you.
Release your health information without your permission in the event of an emergency.
Follow State laws regarding the release of your information in the instances where State law provides stronger protection of your information than the HIPAA law.
HOW JMHC MAY USE OR GIVE OUT YOUR INFORMATION
JMHC can use and give out your information without an Authorization (special permission from you) for our normal course of business and where required by law. This document tells you of some of the ways this can occur. All the ways JMHC may use and give out your information without your express permission will fall within one of the groups listed below.
Data for Treatment and Payment Purposes
JMHC and providers we work with receive and give out your health information for:
The coordination of your treatment.
The billing and payment of your claims.
The review of your health care and use of benefits.
Prior authorization of your requested services.
Data exchanged for your treatment and claim payment involves communications between JMHC, other health care providers, insurance carriers and other organizations necessary to provide treatment and process your health care claims. This would include the use of health information for case management and utilization review by third party payors.
Data for Health Care Operations
JMHC may use and disclose your health information for administrative and operational purposes. Members of the risk management or process improvement teams may use health information about you to assess the care and outcomes in your case and others like it to continually improve the quality of care for all patients.
Business Associates
JMHC provides some services through contracts with other providers (business associates.) To protect your health information, JMHC requires business associates to appropriately safeguard your health information.
Other Allowable Uses of Your Health Information Without Permission (Authorization)
Public Health. We may give your data to public health agencies to prevent or control disease, injury or disability; reporting abuse or neglect; and reporting domestic violence. JMHC may also report your data to the Food and Drug Administration (FDA) to notify them of problems with products and reactions to medications.
Coroners, Medical Examiners and Funeral Directors. JMHC may give protected health information to coroners, medical examiners and funeral directors, if needed.
Organ and Tissue Donation. JMHC may give your data to groups involved in finding, banking, or transplanting organs and tissues. JMHC can only give this information when you have agreed to organ and tissue donations.
Public Safety. JMHC may give your data in order to prevent a serious threat to the health or safety of a particular person or to the general public.
Security. JMHC may give your data for military, national security and prisoner care purposes.
Government Eligibility. JMHC will give data to government entities involved with your health care benefit eligibility.
Worker’s Compensation. JMHC may give your data as necessary to comply with worker’s compensation or similar laws.
Marketing. JMHC may use your data to contact you to give you information about relative health-related benefits and services. JMHC CANNOT give your information to companies for advertising or solicitation without your permission.
Research. JMHC may give your data to persons conducting research only after all identifying information has been removed from the data.
Appointment Reminders. JMHC may use your health information to remind you of medical appointments and health screening reminders.
Health Promotion and Disease Prevention. JMHC may use your health information to tell you about disease prevention and health care.
Individuals Involved with Payment of Your Care. JMHC may give out your health information to a friend or family member who is helping with your care or with payment for your care if necessary.
Law Enforcement. JMHC will give out your data to law enforcement only where allowed by federal or state law or required under a court order.
Judicial Proceeding. JMHC must give out your health information under a court order.
When JMHC May Not Use or Disclose Your Health Information Without Authorization.
Other than for the allowed reasons listed above, JMHC will not use or disclose your health information without written permission (Authorization) from you. If you do authorize us to use or disclose your health information in other ways, you may revoke your permission in writing at any time. Once you remove your permission, JMHC will no longer be able to use or disclose your health information for the reasons stated in your original authorization.
YOUR INDIVIDUAL PRIVACY RIGHTS UNDER HIPAA
Right to Access and Copy of Health Information. You have the right to review and copy any or all portions of your health information. Your request must be in writing. If you request copies of your health information, you may be charged a fee. In certain very limited circumstances, your request to access and copy your information may be denied. If you are denied access to your health information, we will explain the reasons in writing. You may appeal the denial by contacting the Administrator at .
Right to Amend Health Information. If you feel that health information about you that we maintain in certain groups of records is inaccurate or incomplete, you have the right to request that we amend the information. You have the right to request the amendment as long as we maintain the information. Your request will need to be made in writing and include a reason supporting the request. In certain circumstances, we may deny your request to amend your information. If we deny your request, we will explain our reasons in writing. You have the right to submit a statement explaining why you disagree with our decision to deny your amendment request. We will share your statement when we disclose health information.
Right to an Accounting of Disclosures. You have the right to ask for a list of people who have asked for your health records. This will tell you every time JMHC gave out your personal health information to people or organizations, other than you, that was not a part of normal business activities (treatment, payment, operations.) To request this report, contact the Health Information Department of JM HC. You will need to fill out a request that specifies what records, the time period and how you want the records provided to you. The time period may not be longer than six years. It also may not involve dates before the law’s effective date of April 14, 2003. JMHC will respond to your request within 60 days of receipt.
Right to Request Restrictions. You have the right to ask that your protected health information not be given out or used. This is called requesting a restriction. JMHC has the right to deny any requests for restriction that prevent JMHC from conducting its required business processes. To ask for a restriction on the use of your information, send a written request to JMHC at the address on the front page. The request should include:
What information you wish to restrict and how you want it restricted.
Whether you wish to restrict the use of information, disclosure of information, or both.
Right to Withdraw Authorization for Usage and Disclosure. JMHC must have your written permission (authorization) to use or give out your information for reasons other than the special exceptions described above. We may ask you to give permission by signing a form called an Authorization. You may cancel this permission at any time. To cancel, send a letter to JMHC at the address on the front page of this Notice.
Right to Request Alternative Method of Contact. You have the right to request that we communicate with you about your health information in a certain way (phone, e-mail, etc.) or at a certain location (different address.) Your request must be in writing. JMHC will honor your request as much as possible for us to do so.
Right to Paper Copy of Notice. You have the right to a paper copy of our Notice of Privacy Practices at any time. To receive a paper copy, send a written request to JMHC at the address on the front page.
CHANGES TO THIS NOTICE OF PRIVACY PRACTICES
JMHC has the right to change this Privacy Notice at any time. If we do make changes, we will revise this Notice and promptly distribute to our patients/residents. JMHC is required by law to comply with the current version of this Notice until a new version has been distributed.
COMPLAINTS
If you believe your privacy rights have been violated, and wish to make a complaint, you may file a complaint by calling or writing:
The JMHC Administrator or Privacy Officer at the number and address on the front page.
The Secretary of Health and Human Services at:
Secretary of Health and Human Services, Room 615F
200 Independence Avenue, SW
Washington, DC 20201
Phone:
United States Office of Civil Rights by calling 866-OCR-PRIV () or TTY .
POLICY OF NON-RETALIATION
JMHC Cannot Retaliate in ANY Way if You Choose to File a Privacy Complaint or Exercise Any of Your Privacy Rights.
Under the Federal HIPAA Privacy Rule, we are required to give you our Notice of Privacy Practices and make a good faith effort, before providing services, to get your acknowledgement of receipt of this Notice. Your acknowledgement statement is included in the JMHC Patient Authorization and Assignment Form signed by you or your representative at time of registration.