Understanding Your Health
Information -- How It Is Used And How It May Be Shared With Others: There
are laws that require we give this Notice to you about what we do with your
health information. This Notice is about the health information we keep
while you are receiving care in the Hospital.
What If You Have Questions
About This Notice? If you do not understand this Notice or what it
says about how we may use your health information, please contact:
Mitchell County Hospital Health Systems
Box 399 , Beloit , Kansas 67420
What Is Your Health Record Or
Health Information? When you go to a hospital, doctor, or other
health care provider, a record is made that tells about your treatment. This
record will have information about your illnesses, your injuries, signs of
illness, exams, laboratory results, treatment given to you, and notes about what
might need to be done at a later date. Your health information could contain
all kinds of information about your health problems. The hospital keeps this
health information and can use this information in many different ways. What
we do with your health information and how we can use and share this
information is what the rest of this Notice describes.
What Is The Responsibility Of
The Hospital When It Comes To Your Health Information? The law
requires that this Hospital must do the following when it comes to handling
your health information:
·Keep your health information private, only giving it out when
allowed by law to do so;
·Explain our legal duty and our rules about keeping your health
information private to you;
·Follow the rules given in this Notice;
·Let you know when we can't agree with a request or demand you
may make to restrict the sharing of your health information with others.
·Help you when you want your health information sent in a
different way than it usually is sent or to a different place than it usually
·We will not give out your health information without your
permission except in certain cases explained in this Notice. There are laws
that say we can give out your health information to others without your
permission. The Hospital will follow these laws. The Hospital can give out
your health information electronically (over computer networks, for example)
or by facsimile.
What Are Your Health
Information Rights? Your health information is the property of the
doctor or hospital that wrote it. The information contained in your health
information belongs to you. You have certain rights concerning this health
information. The following is a list explaining your rights:
You have the right to look at your
health information and you can get a copy of this information which may be used
to help with your care. This information will usually include medical
and billing records. Your information will not have psychotherapy notes and
information that is made to be used in a court proceeding or information
covered by special laws. If you want to see your health information and get
a copy of your health information, you must write a request to the Contact
Person. If you are disabled or ill, you can make this request over the phone
or in person. You may be charged for copies and mailing. We may refuse your
request for your health information. If we refuse you, you will be told in
writing. If we refuse, you can have the decision to not allow you to see
your health information reviewed. A neutral person will review your request
and we will do what they say.
You have the right to ask that
we make changes to your records. If you feel that your health
information is not complete or wrong, you can ask that we change it. You can
ask that we make a change to your health information for as long as we have
it. If you want to make a change to your health information, you must give a
good reason for the change. If you don=t put your request for a change in
writing and give a good reason, we may not allow the change to be made. We
may also refuse your request for change for the following reasons: (1) the
information was not created by this Hospital; (2) it is not a part of the
health information kept by or for the Hospital; (3) it is not information you
are permitted to see or copy; or (4) it is accurate and complete.
You have a right to a list of
individuals to whom we gave your health information. To request a
list of names to whom we gave your health information, you must write a
request to the Hospital. You have to include a time period in your request.
The time period can be no longer than six (6) years and you cannot request a
list of names that covers the time period before April 14, 2003. You should tell us in what form you want the list (paper copy, electronically, or
some other form). You can have one list each year at no cost. You will be
charged for any additional lists within the year period.
You have the right to ask for
a restriction. You have the right to ask that we restrict or limit
some part of your health information. You can also ask that we limit
information about you to a person who is giving you care or paying for care
like a family member or friend. For example, you could ask that we not give
out information about some treatment you have had or that we not tell certain
people specific information in your health information. We are not required
to agree to your request. There is a person called a Privacy Officer who is
the only one who can agree to your request. We will notify you if the
restriction will be applied or not. How to make a request. If you want to
restrict or limit the information in your health information that we give
out, you must put your request in writing. Tell us (1) what information you
want to limit; (2) whether you want to limit our use of your health
information, our giving out your health information, or both; and (3) whom
should not receive the health information.
You have the right to ask for
privacy in communications. You have the right to ask that we
communicate with you about your health information only in a certain way or
at a certain location. An example would be asking that you only be contacted
by us at work or only by mail. To ask for privacy in communications, you
must make your request in writing to the Hospital. We will attempt to grant
all reasonable requests and although you are not required to give reasons for
your request, we may ask you. Be sure to be specific in your request about
how and where you wish to be contacted. We may charge you for this privacy
request and if you fail to pay, the privacy communication will be stopped.
You have the right to a paper
copy of this notice. You have a right to a copy of this Notice at any
time. Even if you get this Notice over e-mail, you still can get a paper
copy of it. You can request a copy from the Hospital or you can go to our
web site, www.mchks.com,
and obtain one there.
How Will We Use And Give Out
Your Health Information? The Hospital can use and disclose your
health information without your permission. The following is a list of when
we can do this:
For Treatment. We may
use your health information to provide you with medical treatment or
services. We may give your health information to other doctors, nurses,
technicians, medical students, or other staff personnel who are involved in
taking care of you. For example, a doctor treating you for a broken bone may
need to know if you have diabetes because diabetes may slow the healing
process. In addition, the doctor may need to tell the dietitian if you have
diabetes so that we can arrange for meals. Different departments of the
Hospital may share your health information in order to coordinate the
different services you need, such as prescriptions, lab work, and x-rays. We
also may disclose your health information to treaters outside the Hospital
who may be involved in your treatment while you are in the Hospital or after
you leave the Hospital.
For Payment. We may
use and give out your health information about the treatment you receive here
in the Hospital so that you or the insurance company or even a third party
can be billed. For example, we may give your health insurance company
information about your surgery so that your insurance plan will pay us or pay
you for the surgery. Sometimes we may have to tell your insurance company
before your surgery to get an Aok from them so that they will cover the
For Health Care Operations.
We may use or give out your health information to make sure we are giving you
the best care possible. For example, we may use your health information to
see how well our staff takes care of you. We may combine your health care
information with other individual=s information to decide on additional
services we should offer to our patients and to see if new treatments really
work. We may also give your health care information out to doctors, nurse’s
technicians, medical students, and other hospital workers for their review
and for their studies. We may also combine information we have with other
hospitals to compare and see how we are doing and how we can provide better
treatment. We may remove information from your health information so others
who look at your health information cannot see your name. This way, we can
study information without knowing the individual names. Here are some other
reasons we may use and disclose your health care information: to see how well
we are doing in helping our patients; to help reduce health care costs; to
develop questionnaires and surveys; to help with care management; to make
sure we are doing our job well and successfully; to better train people so
they can get the skills they need to best perform their special skills; to
help insurance companies better serve you in their policy making; to help
those that check up on hospitals and ensure that we are doing our job
correctly; to help us plan and develop the business part of health care
including fund-raising and advertising so that we are profitable. For
example, if you have surgery we may use your surgery information to see how
long you were in the operating room so we can see how to schedule operations
We may give out your health information to contact you, a relative, or a
friend to remind you that you have an appointment at our Hospital. We may
leave a message on your answering machine or voice mail system unless you
tell us not to.
We may use or give out your health information to let you know about
treatments that may be offered to you so you can make good choices about your
Health Related Benefits and
Services. We may use and give out health information to tell you about
health benefits or services that may be of interest to you.
We may use your health information to contact you to help our Hospital raise
money. We may also give out your health information to a foundation so they
can help the Hospital raise money. For fund-raising activities, we will only
give out basic contact information such as name, address, phone number, and
the dates you were treated at the Hospital. If you do not want the Hospital
to contact you for its fund-raising purposes, you must tell the Hospital.
Hospital General Public
Disclosure. We may give out limited information about you which will
be available to the public. While you are here at the Hospital as a patient,
the information we give out may be your name, room number in the Hospital,
and your general condition (for example, Afair,@ Astable,@ etc. and your
religion. All the above information except your religion can be given out to
the public who ask for you by name. Your religion may be given to a minister,
priest, or rabbi even if they don=t ask for you by name. This is so your
relatives, friends, and religious persons can visit you in the Hospital. If
you do not want this information given out, you must write the Hospital or by
writing this on the admission form.
Individuals Involved in Your
Care or Payment for Your Care. We may give out health information
about you to one of your friends or family members who is in some way
involved in your medical care. We may give out your health information to another
person who is helping pay for your care. We may tell your family or friends
about your condition and that you are in the Hospital. Also, we may give
out your health information as part of a disaster relief effort so your
family knows about your condition and location. How much of your health
information we give out to another person will depend on how much they are
involved in your care.
for special reasons, we may give out your health information to researchers
who want to do scientific research about how well certain drugs or treatments
work. If a researcher wants to do a study involving you and your
information, we will follow steps to make sure research is approved that will
benefit all people. The research must be worthwhile. We may give out health
information to researchers to help them find the patients they need for their
research study. This information we give them will usually not leave the
Hospital. If a researcher wants your name, address, and other information
about you, we will almost always ask permission from you before they contact
As Required by Law.
Federal, state, and local laws may require us to give out certain kinds of
health information. Things like wounds from weapons, abuse, communicable
diseases, and neglect are examples of such information and we do not need
your permission to give out this information.
To Avoid a Serious Threat to
Health or Safety. We may use or give out your health information if
your health and safety is at risk or in danger. We also will give out your
health information if the health of the public or another individual is at
risk. If we give this information out, it will be given to someone who may
be able to prevent the threat.
Organ and Tissue Donation.
If you are an organ donor, we may give out your health information to people
who deal with organ collection, eye or tissue transplants, or to a donation
bank. We give your information to these people to make sure organ or tissue
donation or transplants can be made.
Military and Veterans.
If you are a member of the armed forces, we may give out your health
information as required by those military authorities in command. If you are
a member of the military of another country, we may release your health
information to the authority in command in your country.
If you are involved in an injury that happens while you are at work, we may
have to give out your health information so your medical bills can be paid by
your employer. This is called worker=s compensation.
Public Health Risks.
We may give out your health information without your permission if there is a
danger to the public=s health. Some general examples of these dangers: to
avoid disease, injury or disability; to report births and deaths; to report
child abuse and neglect; to report reactions to drugs and other health
products; to report a recall of health products or medications; to tell a
person they have been exposed to a disease or may get a disease or spread the
disease; to tell a government authority if we believe a patient has been
abused, neglected, or the victim of violence; to let employers know about a
workplace illness or workplace safety; to report trauma injury to the state.
Health Oversight Activities.
We may give out your health information without your permission to a special
group who checks up on hospitals to make sure they=re following the rules.
These special groups investigate, inspect, and license hospitals. This is
necessary for our government to know about our hospitals and that they are
following the rules and the laws.
Lawsuits and Disputes.
We may give out your health information if you are involved in a lawsuit or
dispute. If a court orders that we give out your health information even if
you are not involved in a lawsuit or dispute, we may also give out your
health information. Other reasons that may cause us to release your health
information would be if there is an order to appear in court, a discovery
request, or other legal reason by someone else involved in a dispute. There
must be an effort made to tell you about this request or an order to make
sure that the information they want is protected.
Law Enforcement. We
may give out your health information if asked for by a police official for
the following reasons: for a court order, subpoena, warrant, or summons; to
find a suspect, fugitive, witness, or missing person; to find out about the
victim of a crime if we cannot get the person=s ok; about a death we believe
may be the result of a crime; about some crime that happens at the Hospital;
in emergencies to report a crime, the place where the crime happened, the
victim of the crime, or the identity, description or whereabouts of the
person who committed the crime.
Coroners, Medical Examiners
and Funeral Directors. We may give out your health information to a
coroner or medical examiner to identify a person who has died or determine
the cause of death. We may also give out health information to funeral
directors so they can carry out their duties.
National Security and
Intelligence Activities. We may give out your health information to
federal authorities for intelligence, counter-intelligence, and other
situations involving our national safety.
Protective Services for the
President and Others. We may give out health information about you to
federal officials so they can protect the President or other officials or
foreign heads of state or so they may conduct special investigations.
Inmates. If you are an
inmate of a prison or placed under the charge of a law enforcement official,
we may give out your health information (1) to the prison to provide you with
health care; (2) to protect the health and safety of you and others; or (3)
for the safety of the prison.
Re-disclosure. When we
use or give out your health information, it may contain information we
received from other hospitals and doctors.
Giving Permission And Revoking
Previous Permission To Use Or Disclose Your Health Information: Except
as stated in this Notice, in order for us to give out your information, you
have to complete a written authorization form. If you want, you can later
choose not to let us give out your health information. You can do this at
any time. Your request to later stop permission to give out your health
information must be in writing and sent to the Hospital. It is not possible
for us to take back any information we have already given out about you that
we made with your permission.
What Should You Do If You Have
A Complaint Concerning Your Health Information? If you believe your
right to privacy has been violated, you can write a complaint and give it to
the Hospital or the U.S. Department of Health and Human Services. To find
out how exactly to file a complaint with either the Hospital or the U.S.
Department of Health and Human Services, ask the Hospital. There is no penalty for filing a complaint.
If Changes Are Made To This
Notice: We will give you a copy of this Notice the first time we treat
you and whenever you request it. We have the right to change this Notice at
any time without letting people know we are going to change it. We have the
right to make the changed Notice apply to health information we already have
about you as well as any information we receive in the future. We will post
a copy of the newest Notice in the Hospital. You will find the date the
Notice takes effect at the top of the first page below the title. You can
get a copy of this Notice at any time by contacting the Contact Person listed
above. You may get a copy of the current Notice each time you are admitted
to the Hospital for treatment.