HIPAA Notice of Privacy Practices

You may download the HIPAA Notice of Privacy Practices in an Adobe Acrobat format by clicking here.

Big Sandy Health Care, Inc.
HIPAA Notice of Privacy Practices
Effective Date: 01/01/2014

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, please contact:
Big Sandy Health Care, Inc.
1709 Ky. Rt. 321
Prestonsburg, Ky. 41653
(606) 886-8546


OUR OBLIGATIONS:


We are required by law to:
•  Maintain the privacy of protected health information

•  Give you this notice of our legal duties and privacy practices regarding health information about you

•  Follow the terms of our notice that is currently in effect

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION:

The following describes the ways we may use and disclose health information that identifies you
(“Health Information”). Except for the purposes described below, we will use and disclose Health
Information only with your written permission. You may revoke such permission at any time by
contacting (in writing) our administrative offices at the address listed above.

For Treatment. We may use and disclose Health Information for your treatment and to provide you
with treatment-related health care services. For example, we may disclose Health Information to
doctors, nurses, technicians, or other personnel, including people outside our office, who are
involved in your medical care and need the information to provide you with medical care.

For Payment. We may use and disclose Health Information so that we or others may bill and receive
payment from you, an insurance company or a third party for the treatment and services you
received. For example, we may give your health plan information about you so that they will pay for
your treatment.

For Health Care Operations. We may use and disclose Health Information for health care operations
purposes. These uses and disclosures are necessary to make sure that all of our patients receive
quality care and to operate and manage our office. For example, we may use and disclose information
to make sure the obstetrical or gynecological care you receive is of the highest quality. We also
may share information with other entities that have a relationship with you (for example, your
health plan) for their health care operation activities.

Appointment Reminders, Treatment Alternatives and Health Related Benefits and Services. We may use
and disclose Health Information to contact you to remind you that you have an appointment with us.
We also may use and disclose Health Information to tell you about treatment
alternatives or health-related benefits and services that may be of interest to you.


Individuals Involved in Your Care or Payment for Your Care. When appropriate, we may share Health
Information with a person who is involved in your medical care or payment for your care, such as
your family or a close friend. We also may notify your family about your location or general
condition or disclose such information to an entity assisting in a disaster relief effort.

Research. Under certain circumstances, we may use and disclose Health Information for research. For
example, a research project may involve comparing the health of patients who received one treatment
to those who received another, for the same condition. Before we use or disclose Health Information
for research, the project will go through a special approval process. Even without special
approval, we may permit researchers to look at records to help them identify patients who may be
included in their research project or for other similar purposes, as long as they do not remove or
take a copy of any Health Information.

SPECIAL SITUATIONS:

As Required by Law. We will disclose Health Information when required to do so by international,
federal, state or local law, including health oversight activities, court or administrative orders
or similar proceedings.

To Avert a Serious Threat to Health or Safety. We may use and disclose Health Information when
necessary to prevent a serious threat to your health and safety or the health and safety of the
public or another person. Disclosures, however, will be made only to someone who may be able to
help prevent the threat.

Business Associates. We may disclose Health Information to our business associates that perform
functions on our behalf or provide us with services if the information is necessary for such
functions or services. For example, we may use another company to perform billing services on our
behalf. All of our business associates are obligated to protect the privacy of your information and
are not allowed to use or disclose any information other than as specified in our contract.

Organ and Tissue Donation. If you are an organ donor, we may use or release Health Information to
organizations that handle organ procurement or other entities engaged in procurement, banking or
transportation of organs, eyes or tissues to facilitate organ, eye or tissue donation and
transplantation.

Military and Veterans. If you are a member of the armed forces, we may release Health Information
as required by military command authorities. We also may release Health Information to the
appropriate foreign military authority if you are a member of a foreign military.

Workers’ Compensation. We may release Health Information for workers’ compensation or similar
programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks. We may disclose Health Information for public health activities. These
activities generally include disclosures to prevent or control disease, injury or disability;
report births and deaths; report child abuse or neglect; report reactions to medications or
problems with products; notify people of recalls of products they may be using; a person who may
have been exposed to a disease or may be at risk for contracting or spreading a disease or
condition; and the appropriate government authority if we believe a patient has been the victim of
abuse, neglect or domestic violence. We will only make this disclosure if you agree or when
required or authorized by law.

Health Oversight Activities. We may disclose Health Information to a health oversight agency for
activities authorized by law. These oversight activities include, for example, audits,
investigations, inspections, and licensure. These activities are necessary for the government to
monitor the health care system, government programs, and compliance with civil rights laws.

Data Breach Notification Purposes. We may use or disclose your Protected Health Information to
provide legally required notices of unauthorized access to or disclosure of your health
information.


Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose Health
Information in response to a court or administrative order. We also may disclose Health Information
in response to a subpoena, discovery request, or other lawful process by someone else involved in
the dispute, but only if efforts have been made to tell you about the request or to obtain an order
protecting the information requested.

Law Enforcement. We may release Health Information if asked by a law enforcement official if the
information is: (1) in response to a court order, subpoena, warrant, summons or similar process;
(2) limited information to identify or locate a suspect, fugitive, material witness, or missing
person; (3) about the victim of a crime even if, under certain very limited circumstances, we are
unable to obtain the  person’s agreement; (4) about a death we believe may be the result of
criminal conduct; (5) about criminal conduct on our premises; and (6) in an emergency to report a
crime, the location of the crime or victims, or the identity, description or location of the person
who committed the crime.

Coroners, Medical Examiners and Funeral Directors. We may release Health Information to a coroner
or medical examiner. This may be necessary, for example, to identify a deceased person or determine
the cause of death. We also may release Health Information to funeral directors as necessary for
their duties.

National Security and Intelligence Activities. We may release Health Information to authorized
federal officials for intelligence, counter-intelligence, and other national security activities
authorized by law.

Protective Services for the President and Others. We may disclose Health Information to authorized
federal officials so they may provide protection to the President, other authorized persons or
foreign heads of state or to conduct special investigations.

Inmates or Individuals in Custody. If you are an inmate of a correctional institution or under the
custody of a law enforcement official, we may release Health Information to the correctional
institution or law enforcement official. This release would be if necessary: (1) for the
institution to provide you with health care; (2) to protect your health and safety or the health
and safety of others; or (3) the safety and security of the correctional institution.

USES AND DISCLOSURES THAT REQUIRE US TO GIVE YOU AN OPPORTUNITY TO OBJECT AND OPT

Individuals Involved in Your Care or Payment for Your Care. Unless you object, we 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, we may disclose such information as necessary
if we determine that it is in your best interest based on our professional judgment.

Disaster Relief. We may disclose your Protected Health Information to disaster relief organizations
that seek your Protected Health Information to coordinate your care, or notify family and friends
of your location or condition in a disaster. We will provide you with an opportunity to agree or
object to such a disclosure whenever we practically can do so.

YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR OTHER USES AND DISCLOSURES

The following uses and disclosures of your Protected Health Information will be made only with your
written authorization:

1.    Uses and disclosures of Protected Health Information for marketing purposes; and

2.    Disclosures that constitute a sale of your Protected Health Information

3.   Use or Disclosure of Psychotherapy Notes. Written authorization is required if our practice
intends to use or disclose psychotherapy notes.

 

Other uses and disclosures of Protected Health Information not covered by this Notice or the laws
that apply to us will be made only with your written authorization. If you do give us an
authorization, you may revoke it at any time by submitting a written revocation to our Privacy
Officer and we will no longer disclose Protected Health Information under the authorization. But
disclosure that we made in reliance on your authorization before you revoked it will not be
affected by the revocation.

YOUR RIGHTS:

You have the following rights regarding Health Information we have about you:

Right to Inspect and Copy. You have a right to inspect and copy Health Information that may be used
to make decisions about your care or payment for your care. This includes medical and billing
records, other than psychotherapy notes. To inspect and copy this Health Information, you must make
your request, in writing, to: Big Sandy Health Care, Inc. (address listed above).

We have up to 30 days to make your Protected Health Information available to you and we may charge
you a reasonable fee for the costs of copying, mailing or other supplies associated with your
request. We may not charge you a fee if you need the information for a claim for benefits under the
Social Security Act or any other state of federal needs-based benefit program. We may deny your
request in certain limited circumstances. If we do deny your request, you have the right to have
the denial reviewed by a licensed healthcare professional who was not directly involved in the
denial of your request, and we will comply with the outcome of the review.

Right to an Electronic Copy of Electronic Medical Records. If your Protected Health Information is
maintained in an electronic format (known as an electronic medical record or an electronic health
record), you have the right to request that an electronic copy of your record be given to you or
transmitted to another individual or entity. We will make every effort to provide access to your
Protected Health Information in the form or format you request, if it is readily producible in such
form or format. If the Protected Health Information is not readily producible in the form or format
you request, your record will be provided in either our standard electronic format or if you do not
want this form or format, a readable hard copy form. We may charge you a reasonable, cost-based fee
for the labor associated with transmitting the electronic medical record.

Right to Get Notice of a Breach. You have the right to be notified upon a breach of any of your
unsecured Protected Health Information.

Right to Amend. If you feel that Health Information we have is incorrect or incomplete, you may ask
us to amend the information. You have the right to request an amendment for as long as the
information is kept by or for our office. To request an amendment, you must make your request, in
writing, to: Big Sandy Health Care, Inc. (address listed above).


Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures
we made of Health Information for purposes other than treatment, payment and health care operations
or for which you provided written authorization. To request an accounting of disclosures, you must
make your request, in writing, to: Big Sandy Health Care, Inc. (address listed above).


Right to Request Restrictions. You have the right to request a restriction or limitation on the
Health Information we use or disclose for treatment, payment, or health care operations. You also
have the right to request a limit on the Health Information we disclose to someone involved in your
care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request, in writing, to: Big Sandy Health Care, Inc. (address listed above). We are not
required to agree to your request unless you are asking us to restrict the use and disclosure of
your Protected Health Information to a health plan for payment or health care operation purposes
and such information you wish to restrict pertains solely to a health care item or service for
which you have paid us “out-of-pocket” in full. If we agree, we will comply with your request
unless the information is needed to provide you with emergency treatment.

Out-of-Pocket-Payments. If you paid out-of-pocket (or in other words, you have requested that we
not bill your health plan) in full for a specific item or service, you have the right to ask that
your Protected Health Information with respect to that item or service not be disclosed to a health
plan for purposes of payment or health care operations, and we will honor that request.

Right to Request Confidential Communications. You have the right to request that we communicate
with you about medical matters in a certain way or at a certain location. For example, you can ask
that we only contact you by mail or at work. To request confidential communications, you must make
your request, in writing, to: Big Sandy Health Care, Inc. (address listed above). Your request must
specify how or where you wish to be contacted. We will accommodate reasonable requests.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may
ask us to give you a copy of this notice at any time. Even if you have agreed to receive this
notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy
of this notice at our web site, www.bshc.org. A paper copy of this notice can be obtained at any
BSHC site.

CHANGES TO THIS NOTICE:

We reserve the right to change this notice and make the new notice apply to Health Information we
already have as well as any information we receive in the future. We will post a copy of our
current notice at our office. The notice will contain the effective date on the first page, in the
top right-hand corner.

COMPLAINTS:

If you believe your privacy rights have been violated, you may file a complaint with our office or
with the Secretary of the Department of Health and Human Services. To file a complaint with our office,
contact:
Big Sandy Health Care, Inc. (address and phone number listed above).
All complaints must be made in writing. You will not be penalized for filing a complaint.
For more information on HIPAA privacy requirements, HIPAA electronic transactions and code sets
regulations visit: www.hhs.gov

 

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