JOHNSON COUNTY HEALTHCARE CENTER'S
NOTICE OF PRIVACY PRACTICES
Johnson County Memorial Hospital, Family Medical Center, Amie Holt Care Center,
Susie Bowling Lawrence Hospice and Johnson County Home Health
497 West Lott, Buffalo, WY 82834

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 JCHC’S PRIVACY OFFICER, 497 WEST LOTT, BUFFALO, WY 82834, (307) 684-6138.

A. JOHNSON COUNTY HEALTHCARE CENTER 'S COMMITMENT TO YOUR PRIVACY

Johnson County Healthcare Center (JCHC) is dedicated to maintaining the privacy of your medical information. In conducting our business, we will create records regarding you, the treatment and services we provide to you. We call your medical and financial information "Protected Health Information”. We are required by law to maintain the privacy of protected health information and to provide individuals with notice of our legal duties and privacy practices with respect to protected health information. We are also required to make a "Good Faith Effort" to obtain your written acknowledgement of receipt of JCHC’s Notice of Privacy Practices on your first visit after we put our notice into effect, however we are not required to get your signature after changes have been made to our notice, but we are required to post our notice and you may request a copy of our notice at any time.

These records are our property. However, we are required by law:

• To maintain the confidentiality of your protected health information.
• To provide you with this notice of our legal duties and privacy practices concerning your protected health information.
• To follow the terms of our notice of privacy practices in effect at the time.

To summarize, this notice provides you with the following important information:

• How we may use and disclose your protected health information.
• Your privacy rights in your protected health information.
• Our obligations concerning the use and disclosure of your protected health information.
  

CHANGES TO THIS NOTICE

The terms of this notice apply to all records containing your protected health information that are created or retained by us. We reserve the right to revise, change or amend our notice of privacy practices. Any revision or amendment to this notice will be effective for all of the information that we already have about you, as well as any of your protected health information that we may receive, create or maintain in the future. JCHC will post a copy of our current notice near the hospital business office, in the emergency waiting room, clinic waiting room, general waiting room and on our website http://buffalohealthcare.vcn.com.

B. HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI):
We may disclose your protected health information for a variety of reasons. We have a limited right to use and/or disclose your health information for treatment, payment or for the operations of JCHC. For other uses, you must give us your written authorization to release your protected health information unless the law permits or requires us to make the use or disclosure without your authorization.

Should it become necessary to release your protected health information to an outside party, we will require the party to have a signed agreement with us that the party will extend the same degree of privacy protection to your information as we do.

The privacy law permits us to make some uses or disclosures of your protected health information without your consent or authorization. The following categories describe the different ways in which we may use and disclose your protected health information. Please note that each particular use or disclosure is not listed below. However, the different ways we are permitted to use and disclose your protected health information do fall within one of the categories. UNLESS YOU TELL US OTHERWISE your medical and financial or protected health information may be used in the following ways:

Uses and disclosures of Protected Health Information that are permitted for treatment, payment and health care operations:

Treatment. We may use and disclose your protected health information to treat you. For example, we may ask you to undergo laboratory tests (such as blood or urine test), and we may use the results to help us reach a diagnosis or your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. Many of the people who work for JCHC may use or disclose your protected health information in order to treat you or to assist others in your treatment. Additionally, we may disclose your protected health information to others that may assist in your care, such as your physician, therapists, spouse, children or parents. Unless you request otherwise, certain treatments may be provided along with other patients present. For example, exercises in physical therapy may be provided in a “bull pen” environment unless you request otherwise.

Payment. We may use and disclose your protected health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your protected health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your protected health information to bill you directly for services and items. In addition, we may provide your protected health information to our business associates, such as collection agencies. Whenever an arrangement between JCHC and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

Health Care Operations. We may use and disclose your protected health information to operate our business. These uses and disclosures are important to ensure that you receive quality care and that JCHC is well run. As examples of the ways in which we may use and disclose your information for our operations, we may use your protected health information to evaluate the quality of care you received from us or to conduct cost-management and business planning activities for JCHC. Further, we may disclose your information to doctors, nurses, medical students and other personnel for review and learning purposes.

Appointment Reminders. We may use and disclose your protected health information to remind you that you have an appointment or if we need to reschedule your appointment. For example, we may call you at work to reschedule an appointment if the physician is ill or called to surgery. We may also send out reminders regarding mammograms, pap smears, etc. if you have addressed a reminder card for us to send you.

Waiting Room Notification. We may call you by name after you check in when it is time for your appointment. For example, a nurse may call your name in the clinic or emergency waiting room to take you back and do an initial assessment before the doctor is ready to see you.

Treatment Alternatives/Health-Related Benefits and Services. We may use and disclose your protected health information to inform you of treatment alternatives and/or health-related benefits and services that may be of interest to you. For example, a physician may call you and talk with you about a new drug that is available to treat your disease.

Fundraising. We may use or disclose protected health information about you in order to contact you as part of a fundraising activity. However, in the course of fundraising activities, we would use or disclose only demographic information relating to you (such as your name, address and phone number). For example, we may send you information regarding fundraising activities for our Hospice. If you do not want JCHC to contact you for fundraising efforts, you may “opt out” of future fundraising efforts by notifying Susie Bowling Lawrence Hospice or JCHC’S PRIVACY OFFICER, 497 WEST LOTT, BUFFALO, WY 82834, in writing. We then will make good faith efforts not to contact you after we have received and processed your opt-out request.

Marketing. We may use your protected health information to make a marketing communication to you that occurs in a face-to-face encounter with you and/or concerning products or services of nominal value. If you do not want to receive marketing communications (other than those that are in a newsletter or other general communication device), please contact JCHC’S PRIVACY OFFICER, 497 WEST LOTT, BUFFALO, WY 82834, in writing. We then will make good faith efforts not to contact you after we have received and processed your opt-out request.

Facility Directory. We may include certain limited information about you in our facility directory while you are a patient. This information may include your name, location, your general condition and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy even if they do not ask for you by name. For example, your mother comes to the front/business office and asks for your room. We will give her your room number and may give her your general condition unless you tell us otherwise or it would put you in danger. This is so your family, friends and clergy can visit you in the hospital or care center and generally know how you are doing.

Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose to a family member, other relative, or a close personal friend or any other person you identify, protected health information directly relevant to that person’s involvement with your care or payment related to your care. We will also disclose protected health information to an individual if we reasonably infer from the circumstances, based on the exercise of professional judgment that you do not object to the disclosure.

Limited Uses When You Are Not Present or Are Incapacitated. If you are not present or cannot agree or object to disclosure of information because of incapacity or an emergency circumstance, using professional judgment, we will disclose protected health information if it is in your best interest. For example, by allowing a person to pick up x-rays or other similar forms of protected health information on your behalf.

In the Event of a Disaster. We may disclose protected health information about you to other health care providers and to an entity assisting in a disaster relief effort to coordinate care and so your family can be notified about your condition and location.

Research. We may disclose information to researchers when their research has been approved by an institutional review board (IRB) that has reviewed the research proposal and established protocols to ensure the privacy of your health information. For example, if you are receiving research chemotherapy, we will give information regarding the progress of your treatment to the institution that has been conducting the research. In most cases, we will seek your written authorization prior to engaging in research that involves use or disclosure of your protected health information. Under limited circumstances, subject to IRB review, we may use and disclose protected health information about your for research purposes without your authorization. In such situation, the IRB is required by law to evaluate proposed research projects to assure that the use or disclosure of protected health information involves no more than a minimal risk to the individual and could not practically be conducted with a review of a waiver of authorization and access to protected health information.

Use or disclosure of your protected health information that are permitted or required without your written authorization:

Required by Law. We will use or disclose protected health information about you when required by applicable law.

Public Health Activities. We may disclose your protected health information for public health activities, including generally:
· to prevent or control disease, injury or disability;
· to maintain vital records, such as births and deaths;
· to report child abuse or neglect;
· to notify a person regarding potential exposure to a communicable disease;
· to notify a person regarding a potential risk for spreading or contracting a disease or condition;
· to report reactions to drugs or problems with products or devices;
· to notify appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information; and
· to notify your employer under limited circumstances, related primarily to workplace injury, illness or medical surveillance.

Cancer Registry and Other Registries. If you have been diagnosed with cancer we may release protected health information about you to authorized cancer registries. We may also be permitted or required by law to release information to other registries. This information is aggregated with other information and is used to monitor current treatment practices and develop new protocols to treat cancer and other medical conditions.

Abuse, Neglect and Domestic Violence. We may disclose your protected health information to a government authority if we believe you are a victim of abuse, neglect or domestic violence. If we make such a disclosure, we will inform you of it, unless we think that informing you places you at risk of serious harm or, if we were to inform your personal representative it would place you at risk of serious harm and is not in your best interest.

Health Oversight Activities. We may disclose your protected health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

Lawsuits and Similar Proceedings. We may use and disclose your protected health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your protected health information in response to a discovery request, subpoena or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

Law Enforcement. We may release protected health information if asked to do so by law enforcement officials:
· regarding a crime victim in certain situations, if we are unable to obtain the person's agreement;
· concerning a death we believe might have resulted from criminal conduct;
· regarding criminal conduct at our offices;
· in response to a warrant, summons, court order, subpoena or similar legal process;
· to identify/locate a suspect, material witness, fugitive or missing person; and
· in an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator).

Coroners, Medical Examiners and Funeral Directors. We may release protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death. We may also release protected health information about patients of the hospital to funeral directors as necessary to carry out their duties.

Organ and Tissue Donation. We may use or disclose your protected health information to organizations that handle organ and tissue procurement, banking or transplantation. We are required by law to notify the Donor Alliance if any patient dies at Johnson County Memorial Hospital, unless it is a hospice patient.

Serious Threats to Health or Safety. We may use and disclose your protected health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

Incidental Disclosures. Certain incidental disclosures of your medical information may occur as a by-product of permitted uses and disclosures. For example, a visitor may inadvertently overhear a discussion about your care occurring at the nurse’s station.

Limited Data Sets. We may disclose limited protected health information to third parties for research, public health and health care operations. Before disclosing such information, we will enter into an agreement that limits the recipient’s use and disclosure of the information and prohibits the recipient from attempting to re-identify the data or contact you.

Specialized Government Functions. We may disclose your protected health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate military command authorities. In addition, we may disclose your protected health information to federal officials for intelligence and national security activities authorized by law. We also may disclose your protected health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

Furthermore, we may disclose your protected health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (i) for the institution to provide health care services to you, (ii) for the safety and security of the institution and/or (iii) to protect your health and safety or the health and safety of other individuals.

Workers' Compensation. We may release your protected health information for workers' compensation and similar programs.

Other uses and disclosures will be made only with your written authorization and you may revoke such authorization as provided by the Privacy Regulations.

You have the following rights regarding the protected health information that we maintain about you:

Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your protected health information for treatment, payment or health care operations. Additionally, you have the right to request that we limit our disclosure of your protected health information to individuals involved in your care or the payment for your care, such as family members and friends.

We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction, you must make your request in writing to JCHC’s Privacy Officer, 497 West Lott, Buffalo, WY 82834. Your request must describe in a clear and concise fashion: (i) the information you wish restricted; (ii) whether you are requesting to limit our practice's use, disclosure or both; and (iii) to whom you want the limits to apply, for example, disclosures to your spouse.

Confidential Communications. You have the right to request that we communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you by mail, rather than by telephone or at home, rather than work. To request confidential communication, you must make request in writing to JCHC’s Privacy Officer, 497 West Lott, Buffalo, WY 82834. We will accommodate reasonable requests. You do not need to give a reason for your request. Your request must specify how or where you wish to be contacted.

Inspection and Copies. You have the right to inspect and obtain a copy of the protected health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to JCHC’S PRIVACY OFFICER, 497 WEST LOTT, BUFFALO, WY 82834, (307) 684-6138 in order to inspect and/or obtain a copy of your protected health information. We may charge a fee for the cost of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Reviews will be conducted not by the person that denied your request, but by another licensed health care professional chosen by us. In certain limited situations, we will have to deny your request for access but will not be able to give you a review.

Amendment. You may ask us to amend your protected health information if you believe it is incorrect or incomplete and you may request an amendment for as long as the information is kept by or for JCHC. To request an amendment, your request must be in writing and submitted to JCHC’s Privacy Officer or JCHC’s Health Information Management Director, 497 West Lott, Buffalo, WY 82834, (307) 684-6138. You must provide us with a reason that supports your request for amendment. We will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is:
· accurate and complete
· not part of the protected health information kept by or for JCHC
· not part of the protected health information which you would be permitted to inspect and copy; or
· not created by JCHC, unless the individual or entity that created the information is not available to amend the information.
If you disagree with out denial, you may submit a statement of disagreement or ask that your request become part of your record. In response, we may prepare a rebuttal as part of your record.

Accounting of Disclosures. You have the right to request an “accounting of disclosures” about your protected health information. This accounting will not include disclosures for treatment, payment or health care operations; for facility directory purposes, to persons involved in your care or for notification purposes; incidental to an otherwise permitted use or disclosure; to correctional institutions or other custodial law enforcement officials; as part of a limited data set; for national security or intelligence purposes; for other reasons allowed by law; or for disclosures that you authorized or requested.

To request this accounting, you submit your request in writing to JCHC’s Privacy Officer or JCHC’s Health Information Management Director, 497 West Lott, Buffalo, WY 82834. For an accounting of disclosures required to be maintained by federal law, your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you choose to withdraw or modify your request at that time before any costs are incurred.

Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. We will make a good faith effort to give you a paper copy of our notice of privacy practices and receive a written acknowledgement from you. You may request a paper copy of this notice at any time.

Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with JCHC or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact JCHC’S PRIVACY OFFICER, 497 WEST LOTT, BUFFALO, WY 82834, (307) 684-6138. All complaints must be submitted in writing. You also may file a complaint with the Secretary of the Department of Health. Complaints must: (1) be in writing; (2) contain the name of the entity against which the complaint is lodged; (3) describe the relevant problems; and (4) be filed within 180 days of the time you became or should have become aware of the problem. The address for the Secretary of the Department of Health for Region VIII is: Office for Civil Rights, U.S. Department of Health and Human Services, 1961 Stout Street--Room 1185 FOB, Denver, CO 80294-3538. Voice Phone (303) 844-2024. FAX (303) 844-2025. TDD (303) 844-3439.

YOU WILL NOT BE PENALIZED FOR FILING A COMPLAINT.

JOHNSON COUNTY HEALTHCARE CENTER'S
NOTICE OF PRIVACY PRACTICES SUMMARY
Johnson County Memorial Hospital, Family Medical Center, Amie Holt Care Center,
Susie Bowling Lawrence Hospice and Johnson County Home Health
497 West Lott, Buffalo, WY 82834

At Johnson County Healthcare Center (JCHC), we value our patients, residents and clients and are very careful in the way we safeguard protected health information. This Privacy Notice describes our policies concerning health information and our commitment to protect the privacy of our patients.

Protected Health Information (PHI) is patient-identifiable information, oral, electronic or paper that is created or received by JCHC and relates to an individual’s health care or payment for the provision of health care.

How We May Use and Disclose Protected Health Information About You.

Please read the attached JCHC Privacy Notice for detailed information about the following ways that we use and disclose your protected health information:

You have the following rights regarding protected health information we maintain about you:

You may obtain a copy of this notice from our Web site: by clicking HERE, or you may obtain a paper copy at the hospital business office or clinic office. You may also request a copy by writing to:
JCHC Privacy Officer
497 West Lott
Buffalo, WY 82834