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.
Uses and Disclosures :
We can use and disclose elements of your protected health information (PHI) in the following ways:
Without your signed authorization
Treatment : We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students or other people who are taking care of you.
Payment :We may use and disclose you medical information for payment purposes.
Health care operations : We may use and disclose your medical information for our health care operations. This might include measuring and improving service quality or for evaluating the performance of employees.
- When release is required by law, including in judicial settings and to health oversight regulatory agencies and law enforcement.
- In emergency situations or to avert serious health/safety situations.
- To medical examiners, coroners or funeral directors to aid in identifying you or to help them in performing their duties.
- To organ, tissue and other donations organization, upon or proximate to your death, if we have no indication on hand about your donation preferences (or a positive indication).
- To contact you about appointment reminders, treatment alternatives and other health related benefits and services.
- To the sponsor of your health plan
- Any Other use or disclosure by us would require us to obtain your a written authorization in addition to any other permission you will provide us.
Your rights :You have the following rights concerning your PHI:
Restrictions : You may request restricted access to all or part of your PHI. We are not required to agree to additional restrictions, but if we do, we will abide by our agreement (except in the case of an emergency). To do this, please describe in writing the restriction you are requesting and forward it to the contact indicated at the end of this notice.
Confidential communications : You May receive correspondence of confidential information by an alternate means or location. To do this, a request must be done in writing to the contact indicated at the end of this notice.
Access : You May inspect or receive copies of your protected health information. To do this, forward such request in writing to the contact indicated at the end of this notice.
Amendments : If you request changes be made to your PHI, forward you request in writing to the contact indicated at the end of this notice. We are not required to grant your request.
Accounting : If you Request an accounting of the disclosures by us of your PHI in the six years prior to your request, forward such request in writing to the contact indicated at the end of this notice.
Updates of this notice, are available at your request.
Our duties :We are required by law to maintain the privacy of your PHI. We must abide by the terms of this notice or any update of this notice.
Privacy contact : For more information about our privacy practices, please contact:
75 Hail Knob Rd
Somerset, Kentucky USA
Phone # : +1 (606)678-9617Effective date : This notice is effective 11/01/04.