If you consent, Stanton County Hospital (SCH) is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.

A nurse obtains treatment information about you and records it in a health record. During the course of your treatment, the physician determines he/she will need to consult with another specialist in the area. He/she will share the information with such specialist and obtain his/her input.

We submit a request for payment to your health insurance company. The health insurance company requests information from us regarding medical care given. We will provide information to them about you and the care given.

The state licensing authority wants to review records to assure that we have acted consistent with state law regarding your care. In doing so, it wants to take a sampling, which includes review of your chart. At the licensing authority’s request, we will provide it with a copy of your record.

The health record we maintain and billing records are the physical property of SCH. The information in it, however, belongs to you. You have a right to:

Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to SCH-we are not required to grant the request but we will comply with any request granted;

Obtain a paper copy of the "Privacy Notice" by making a request at SCH.

Request that you be allowed to inspect and copy your health record and billing record-you may exercise this right by delivering the request in writing to SCH using the form we provide to you upon request;

Appeal a denial of access to your protected health information except in certain circumstances;

Request that your health care record be amended to correct incomplete or incorrect information by delivering a written request to SCH using the form we provide to you upon request;

File a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information;

Obtain an accounting of disclosures of your protected health information as required to be maintained by law by delivering a written request to SCH using the form we provide to you upon request; an accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care;

Request that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to SCH using the form we give you upon request; and

Revoke authorizations that you make previously to use or disclose information except to the extent information or action has already been taken by delivering a written revocation to SCH.

You have a right to review this "Privacy Notice" before signing the consent authorizing

use and disclosure of your protected health information for treatment, payment, and health care operations purposes.

If you want to exercise any of the above rights, please contact:
LaDonna Sheppard, Privacy  Officer
Stanton County Hospital
404 N. Chestnut Street
Box 779
Johnson, KS 67855-0779
(620) 492-6250 ext.115
in person or in writing, during normal hours.
She will provide you with assistance on the steps to take to exercise your rights.

SCH is required to:

Maintain the privacy of your health information as required by law;

Provide you with a "Privacy Notice" as to our duties and privacy practices as to the information we collect and maintain about you;

Abide by the terms of this "Privacy Notice:’

Notify you if we cannot accommodate a requested restriction or request; and

Accommodate your reasonable requests regarding methods to communicate health information with you.

We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our "Privacy Notice". You are entitled to receive a revised copy of the "Privacy Notice" by calling and requesting a copy of our "Privacy Notice" or by visiting our office and picking up a copy.

If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact LaDonna Sheppard, Privacy Officer, (620) 492-6250 ext. 115.

Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to LaDonna Sheppard. You may also file a complaint by mailing it or e-mailing it to the Secretary of Health and Human Services whose street address and e-mail address is Office for Civil Rights, 200 Independence Ave. SW, Washington, D.C. 20201, www.hhs.gov/ocr/hipaa/.

We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services as a condition of receiving treatment from SCH . We cannot and will not retaliate against you for filing a complaint with the Secretary of Health and Human Services.

We have business associates with whom we may share your protected health information. For example, in preparing our annual financial statements, auditors may need to review samples of the medical care given. We may disclose your health information to the accounting firm to prepare this material.

Unless you notify us that you object, we may use and disclose your name, location, general condition, and religious affiliation in a hospital directory. This information may be provided to members of clergy and, except for religious affiliation, to other people who ask for you by name. We may also use your name on a nameplate next to or on your door in order to identify your room, unless you notify us that you object.

Unless you object, we may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your death.

Using our best judgment, we may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement in your care or in payment for such care if you do not object or in an emergency.

We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

We may use and disclose your protected health information to assist in disaster relief efforts.

We may disclose your protected health information to funeral directors or coroners consistent with applicable law to allow them to carry out their duties.

Consistent with applicable law, we may disclose your protected health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

We may contact you to provide you with appointment reminders, with information about treatment alternatives, or with information about other health-related benefits and services that may be of interest to you.

We may contact you as part of a fund raising effort.

We may disclose to the FDA your protected health information relating to adverse events with respect to food, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.

If you are seeking compensation through Workers Compensation, we may disclose your protected health information to the extent necessary to comply with laws relating to Workers Compensation.

As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

We may disclose your protected health information to public authorities as allowed by law to report abuse or neglect.

If you are an inmate of a correctional institution, we may disclose to the institution or agents there of your protected health information necessary for your health and the health and safety of other individuals.

We may disclose your protected health information for law enforcement purposes as required by law, such as when required by a court order, or in cases involving felony prosecutions, or to the extent an individual is in the custody of law enforcement.

Federal law allows us to release your protected health information to appropriate health oversight agencies or for health oversight activities.

We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, with your consent, or as directed by a proper court order. To avert a serious threat to health or safety, we may disclose your protected health information consistent with applicable law to prevent or lessen a serious, imminent threat to the health or safety of a person or the public.

We may disclose your protected health information for specialized government functions as authorized by law such as to Armed Forces personnel, for national security purposes, or to public assistance program personnel.

Other uses and disclosures besides those identified in this "Privacy Notice" will be made only as otherwise authorized by law or with your written authorization and you may revoke the authorization as previously provided.