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Gateway District Health Department
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.
Gateway District Health Department is
required, by law, to maintain the privacy and
confidentiality of your protected health information and to
provide our patients with notice of our legal duties and
privacy practices with respect to your protected health
information.
Disclosure of Your Health Care
Information
Treatment
We may disclose your health care
information to other healthcare professionals within our
practice for the purpose of treatment, payment, or health
care operations. (example)
"On occasions, it may be necessary to seek
consultation regarding your condition from other health care
providers associated with Gateway District Health
Department. It is our policy to provide a substitute
health care provider, authorized by Gateway District Health
Department to provide assessment and/or treatment to our
patients, without advanced notice, in the event of
your primary health care provider's absence due to vacation,
sickness or other emergency situation."
Payment
We may disclose your health information to
your insurance provider for the purpose of payment or health
care operations. (example)
"As a courtesy to our patients, we will
submit an itemized billing statement to your insurance
carrier for the purpose of payment to Gateway District
Health Department for health care services rendered. If you
pay for your health care services personally, we will, as a
courtesy, provide an itemized billing to your insurance
carrier for the purpose of reimbursement to you. The billing
statement contains medical information, including diagnosis,
date of injury or condition and codes which describes the
health care services received."
Worker's Compensation
We may disclose your health information as
necessary to comply with State Worker's Compensation Laws.
Emergencies
We may disclose your health information to
notify or assist in notifying a family member, or another
person responsible for your care about your medical
conditions or in the event of an emergency or your death.
Public Health
As required by law, we may disclosure your
health information to public health authorities for purposes
related to: preventing or controlling disease, injury or
disability, reporting child abuse or neglect, report
domestic violence, reporting to the Food and Drug
Administration problems with products and reactions to
medications and reporting disease or infection exposure.
Judicial and Administrative
Proceedings
We may disclose your health information in
the course of any administrative or judicial proceeding.
Law Enforcement
We may disclose your health information to a
law enforcement official for purposes such as identifying or
locating a suspect, fugitive, material witness person,
complying with a court order or subpoena, and other law
enforcement purposes.
Deceased Persons
We may disclose your health information to
coroners or medical examiners.
Organ Donation
We may disclose your health information to
organizations involved in procuring, banking, or
transplanting organs and tissues.
Research
We may disclose your health information to
researchers conducting research that has to be approved by
an Institutional Review Board.
Public Safety
It may be necessary to disclose your health
information to appropriate persons in order to prevent or
lessen a serious and imminent treat to the health or safety
of particular person or to the general public.
Specialized Government Agencies
We may disclose your health information for
military, national security, prisoner and government
benefits purposes.
Change of Ownership
In the event that Gateway District Health
Department is sold or merged with another organization, your
health information/record will become the property of the
new owner.
Your Health Information Rights
You have the right to request restrictions on
certain uses and disclosures of your health information.
Please be advised, however, that Gateway District Health
Department is not required to agree to the restriction that you
requested.
You have the right to have your health
information received or communicated through an alternative
method or sent to an alternative location other than the
usual method of communication or delivery, upon your
request.
You have the right to inspect and copy your
health information.
Your have a right to request that Gateway
District Health Department amend your protect health
information. Please be advised, however, that Gateway
District Health is not required to agree to amend your
protected health information. If your request to amend your
health information has been denied, you will be provided
with an explanation of our denial reason(s) and information
about how you can disagree with the denial.
You have a right to receive an accounting of
disclosures of your protected health information made by
Gateway District Health Department.
You have a right to a paper copy of this
Notice of Privacy Practices at any time upon request.
Changes to this Notice of Privacy
Practices
Gateway District Health Department reserves
the right to amend this Notice of Privacy Practices at any
time in the future, and will make the new provisions
effective for all information that it maintains. Until such
amendment is made Gateway District Health Department is
required by law to comply with this Notice.
Gateway District Health Department is
required by law to maintain the privacy practices with
respect to your health information and to provide you with
notice of its legal duties and privacy practices with
respect to your health information. If you have questions
about any part of this notice or if you want more
information about your privacy rights, please contact: James
R. Ratliff Jr. by calling this office at 606-674-6396.
If James R. Ratliff Jr. is not available you may make an
appointment for a personal conference in person or by
telephone within 2 working days.
Complaints
Complaints about your Privacy rights, or how
Gateway District Health Department has handled your health
information should be directed to James R Ratliff Jr. by
calling this office at 606-674-6396. If James R Ratliff, Jr.
is not available, you may make an appointment for a
personal conference in person or by telephone within two
working days.
If you are not satisfied with the manner in
which this office handles your complaint, you may submit a
formal complaint to:
DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
This notice is effective 04-14-03
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