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.

USE AND DISCLOSURE OF HEALTH INFORMATION

Hancock County Public Health Services (HCPHS) may use your health information, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations.  Your health information may be used or disclosed only after HCPHS has obtained your written consent. HCPHS have established policies to guard against unnecessary disclosure of your health information. 

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AFTER YOU HAVE PROVIDED YOUR WRITTEN CONSENT:

To Provide Treatment.  Hancock County Public Health Services may use your health information to coordinate care within HCPHS and with others involved in your care, such as your attending physician and other health care professionals who have agreed to assist the HCPHS in coordinating care.  For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. HCPHS may disclose your health care information to individuals outside of HCPHS involved in your care including family members, pharmacists, suppliers of medical equipment or other health care professionals.

To Obtain Payment. Hancock County Public Health Services may include your health information in invoices to collect payment from third parties for the care you receive. For example, HCPHS may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse

you or HCPHS.  HCPHS may also need to obtain prior approval from your insurer and may need to explain to the insurer your need for home care and the services that will be provided to you.

To Conduct Health Care Operations.  Hancock County Public Health Services may use and disclose health information for their own operations in order to facilitate the function of HCPHS and as necessary to provide quality care to all clients seen by HCPHS.  Health care operations includes such activities as: 

• Quality assessment and improvement activities. 
• Activities designed to improve health or reduce health care costs.
• Protocol development, case management and care coordination.
• Contacting health care providers and clients with information about treatment alternatives and other related functions that do not include treatment.
• Professional review and performance evaluation.
• Training programs including those in which students, trainees or practitioners in health care learn under supervision.
• Accreditation, certification, licensing or credentialing activities.
• Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs.
• Business planning and development including cost management and planning related analyses and formulary development.
• Business management and general administrative activities of HCPHS.

For example HCPHS may use your health information to evaluate their staff performance, combine your health information with other HCPHS clients in evaluating how to more effectively serve all HCPHS clients, disclose your health information to HCPHS employees and contracted personnel for training purposes, or use your health information to contact you as a reminder regarding a visit to you.

For Appointment Reminders. Hancock County Public Health Services may use and disclose your health information to contact you as a reminder that you have an appointment for a home visit.

For Treatment Alternatives.  Hancock County Public Health Services may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you. 

Marketing and Fundraising Activities. Hancock County Public Health Services may use medical information about you, only after we have received written authorization from you, in marketing and fundraising activities. We would only release contact information, such as your name, address and phone number and dates you received treatment or services from Hancock County Public Health Services. If you do not want Hancock County Public Health Services to contact you for marketing and fundraising efforts, you may notify Hancock County Public Health Services in writing.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED WITHOUT FIRST RECEIVING YOUR WRITTEN CONSENT.

When Legally Required.  Hancock County Public Health Services will disclose your health information when it is required to do so by any Federal, State or local law.

When There Are Risks to Public Health.  Hancock County Public Health Services may disclose your health information for public activities and purposes in order to:

• Prevent or control disease, injury or disability, report disease, injury, vital events such as birth or death and the conduct of public health surveillance, investigations and interventions.
• Report adverse events, product defects, to track products or enable product recalls, repairs and replacements and to conduct post-marketing surveillance and compliance with requirements of the Food and Drug Administration.
• Notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
• Notify an employer about an individual who is a member of the workforce as legally required.

To Report Abuse, Neglect Or Domestic Violence. Hancock County Public Health Services are allowed to notify government authorities if HCPHS believes a client is the victim of abuse, neglect or domestic violence. HCPHS will make this disclosure only when specifically required or authorized by law or when the client agrees to the disclosure.

To Conduct Health Oversight Activities.  Hancock County Public Health Services may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. HCPHS however, may not disclose your health information if you are the subject of an investigation and your health information is not directly related to your receipt of health care or public benefits.

In Connection With Judicial And Administrative Proceedings.  Hancock County Public Health Services may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when HCPHS makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.

For Law Enforcement Purposes.  As permitted or required by State law, Hancock County Public Health Services may disclose your health information to a law enforcement official for certain law enforcement purposes as follows:

• As required by law for reporting of certain types of wounds or other physical injuries pursuant to the court order, warrant, subpoena or summons or similar process.
• For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
• Under certain limited circumstances, when you are the victim of a crime.
• To a law enforcement official if HCPHS has a suspicion that your death was the result of criminal conduct including criminal conduct at HCPHS.
• In an emergency in order to report a crime.

To Coroners And Medical Examiners.  Hancock County Public Health Services may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.

To Funeral Directors.  Hancock County Public Health Services may disclose your health information to funeral directors consistent with applicable law and if necessary, to carry out their duties with respect to your funeral arrangements.  If necessary to carry out their duties, HCPHS may disclose your health information prior to and in reasonable anticipation of your death.

For Organ, Eye Or Tissue Donation.  Hancock County Public Health Services may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating the donation and transplantation.

For Research Purposes.  Hancock County Public Health Services may, under very select circumstances, use your health information for research. Before HCPHS discloses any of your health information for such research purposes, the project will be subject to an extensive approval process.  Hancock County Public Health Services will always request your written authorization before granting access to your individually identifiable health information.

In the Event of A Serious Threat To Health Or Safety.  Hancock County Public Health Services may, consistent with applicable law and ethical standards of conduct, disclose your health information if HCPHS, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.

For Specified Government Functions.  In certain circumstances, Federal regulations may authorize Hancock County Public Health Services to use or disclose your health information to facilitate specified government functions relating to military and veterans, national security and intelligence activities, protective services for the President and others, medical suitability determinations and inmates and law enforcement custody.

For Worker's Compensation.  Hancock County Public Health Services may release your health information for worker's compensation or similar programs

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION

Other than is stated above, Hancock County Public Health Services will not disclose your health information other than with your written authorization.  If you or your representative authorizes HCPHS to use or disclose your health information, you may revoke that authorization in writing at any time. 

YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION

• You have the following rights regarding your health information that Hancock

County Public Health Services maintain:

• Right to request restrictions.  You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on Hancock County Public Health Services disclosure of your health information to someone who is involved in your care or the payment of your care.  However, HCPHS is not required to agree to your request.  If you wish to make a request for restrictions, please contact the Privacy Officer.
• Right to receive confidential communications.  You have the right to request that Hancock County Public Health Services communicate with you in a certain way.  For example, you may ask that HCPHS only conduct communications pertaining to your health information with you privately with no other family members present.  If you wish to receive confidential communications, please contact the Privacy Officer at 641 923 3676.  Hancock County Public Health Services will not request that you provide any reasons for your requests and will attempt to honor your reasonablerequests for confidential communication.
• Right to inspect and copy your health information. You have the right to inspect and copy your health information, including billing records.  A request to inspect and copy records containing your health information may be made to the Privacy Officer at 641-923-3676.  If you request a copy of your health information, HCPHS may charge a reasonable fee for copying and assembling costs associated with your request.
• Right to amend health care information.  You or your representatives have the right to request that Hancock County Public Health Services amend your records, if you believe that your health information is incorrect or incomplete.  That request may be made as long as the information is maintained by Hancock County Public Health Services. A request for an amendment of records must be made in writing to the Privacy Officer, Hancock County Public Health Services, 545 State Street, Garner, IA 50438. HCPHS may deny the request if it is not in writing or does not include a reason for the amendment.  The request also may be denied if your health information records were not created by HCPHS, if the records you are requesting are not part of HCPHS’ records, if the health information you wish to amend is not part of the health information you or your representatives are permitted to inspect and copy, or if, in the opinion of HCPHS, the records containing your health information are accurate and complete.
• Right to an accounting.  You or your representatives have the right to request an accounting of disclosures of your health information made by HCPHS for any reason other than for treatment, payment or health operations. The request for an accounting must be made in writing to the Privacy Officer, Hancock County Public Health Services, 545 State Street, Garner, IA 50438. The request should specify the time period for the accounting starting on or after October 1, 2002. 
• Accounting requests may not be made for periods of time in excess of six (6) years. HCPHS would provide the first accounting you request during any 12-month period without charge.  Subsequent accounting requests may be subject to a reasonable cost-based fee.
• Right to a paper copy of this notice.  You or your representatives have a right to a separate paper copy of this Notice at any time even if you or your representatives have received this Notice previously.  To obtain a separate paper copy, please contact the Privacy Officer at 641 923 3676.

DUTIES OF Hancock County Public Health Services

Hancock County Public Health Services is required by law to maintain the privacy of your health information and to provide to you and your representatives this Notice of its duties and privacy practices.  Hancock County Public Health Services is required to abide by the terms of this Notice as may be amended from time to time.  Hancock County Public Health Services reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all health information that it maintains. If HCPHS changes this Notice, HCPHS will provide a copy of the revised Notice to you or your appointed representatives. You or your personal representatives have the right to express complaints to Hancock County Public Health Services and to the Secretary of DHHS if you or your representatives believe that your privacy rights have been violated.  Any complaints to HCPHS should be made in writing to the Privacy Officer, Hancock County Public Health Services, 545 State Street, Garner, IA, 50438. Hancock County Public Health Services encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint. 

CONTACT PERSON

Hancock County Public Health Services has designated the Privacy Officer as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards.  You may contact this person at 545 State Street, Garner, IA, 50438.

This Notice is effective October 1, 2002.

IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT: Privacy Officer, Hancock County Public Health Services, 545 State Street, Garner, IA, 50438;  phone-641 923 3676.