| Privacy Notice |
Law requires we give this Notice to explain what we do with your protected health information (PHI).
IF YOU HAVE QUESTIONS ABOUT THIS NOTICE: If you do not understand this Notice or what it says about how
we may use your PHI, please contact:
Ness County Hospital Privacy Officer
312 Custer
Ness City, Kansas 67560
WHAT IS YOUR HEALTH RECORD OR HEALTH INFORMATION? When you go to a hospital, doctor, or other
health care provider, a record is made that tells about your treatment. This record will have information about your
illnesses, your injuries, exams, laboratory results, treatment given, and notes about what might need to be done at
a later date. The hospital keeps this health information and can use this information in many different ways. What
we do with your PHI and how we can use and share this information is what the rest of this Notice describes.
RESPONSIBILITY OF THE HOSPITAL CONCERNING PHI: Law requires the Hospital must do the following when
handling your PHI:
• Keep your health information private, only giving it out when allowed by law;
• Explain our legal duty and rules about keeping your health information private; Follow the rules given in this
Notice;
• Let you know when we can’t agree with a request or demand you may make to restrict the sharing of your
health information with others.
• Help you when you want your health information sent in a different way than it usually is sent or to a different
place than it usually is sent.
YOUR HEALTH INFORMATION RIGHTS: Your PHI is the property of the doctor or hospital that wrote it. The
information contained in your health information belongs to you. You have certain rights concerning this PHI.
The following is a list explaining your rights:
• You Have the Right to Look at Your PHI and Get a Copy, Which May Help With Your Care. This information
will usually include medical and billing records. If you want to see your PHI and get a copy of the PHI, you must
provide a written request to the Contact Person. If you are disabled or ill, you can make this request over the
phone or in person. You may be charged for copies and mailing. We may refuse your request. We will notify you
in writing of any refusal as well as your rights to have that decision reviewed by a neutral person.
• You Have the Right to Ask That We Make Amendments to Your Records. If you feel your PHI is not complete
or incorrect, you can ask that we amend it. To request an amendment, your request must be in writing and
submitted to the Ness County Hospital Privacy Officer. You must provide a reason for the request. If your request is
denied, you will be informed of the reason for denial and you will have an opportunity to submit a statement of
disagreement to be maintained with your records. We may refuse your request for amendment for the following
reasons: (1) the information was not created by this Hospital; (2) it is not a part of the health information kept by or
for the Hospital; (3) it is not information you are permitted to see or copy; or (4) it is accurate and complete.
• You Have a Right to a List of Individuals to Whom We Gave Your PHI. You must give written request to be
provided a list of names that we have provided your PHI to. The time period can be no longer than six (6) years.
You cannot include dates covering the period before April 14, 2003. You can have one list each year at no cost.
You will be charged for any additional lists within the year period.
• You Have the Right to Ask for a Restriction. You have the right to ask that we restrict or limit some part of
your PHI. You can ask that we limit information about you to family members, caregivers, or friends. We are not
required to agree to your request. If you want to restrict or limit the information of your PHI, you must put your
request in writing. Tell us (1) what information you want to limit; (2) whether you want to limit our use of your PHI,
our giving out your PHI, or both; and (3) whom should not receive the PHI.
• You Have the Right to Ask for Privacy in Communications. You have the right to ask that we communicate
with you regarding your PHI only in a certain way or at a certain location. To ask for privacy in communications,
you must make written request to the Hospital. We will attempt to grant all reasonable requests. Be sure to be
specific in your request about how and where you wish to be contacted. We may charge you for this privacy
request and if you fail to pay, the privacy communication will be stopped.
• You Have the Right to a Paper Copy of This Notice. You have a right to a copy of this Notice at any time.
HOW WILL WE USE AND GIVE OUT YOUR PHI? The Hospital can use and disclose your PHI without your
permission. The following is a list of when we can do this:
• For Treatment. We may use your PHI to provide medical treatment or services. We may give your PHI to
doctors, nurses, technicians, medical students, or other staff personnel who are involved in taking care of you.
Departments of the Hospital may share your PHI to coordinate the services you need, such as prescriptions, lab
work, and x-rays. We also may disclose your PHI to professionals outside the Hospital who may be involved in your
treatment.
• For Payment. We may provide PHI regarding the treatment you receive in the Hospital, in order to bill the
appropriate party or for authorization of health benefits.
• For Health Care Operations. We may use or give out your PHI to be sure we are giving you appropriate care.
We may use your PHI to decide on additional services we should offer, or to see if new treatments work. We may
give your PHI to doctors, nurses technicians, medical students, and other hospital workers for their review and
studies. Other reasons we may use and disclose your PHI: to see how well we are doing in helping our patients; to
help reduce health care costs; to develop questionnaires and surveys; to help with care management; to make sure
we are doing our job well and successfully; to better train people so they can get the skills they need to best
perform their special skills; to help insurance companies better serve you in their policy making; to help those that
check on hospitals and ensure that we are doing our job correctly; to help us plan and develop the business part of
health care including fund-raising and advertising so that we are profitable.
• Appointment Reminders. We may contact you for appointment reminders. We may leave a message on your
answering machine or voice mail system unless you tell us not to.
• Treatment Alternatives. We may use or give out PHI to let you know about treatments that may be offered,
so you can make good choices about your health care.
• Health Related Benefits and Services. We may use and give out PHI to tell you about health benefits or
services that may be of interest to you.
• Fund-raising Activities. We may use your PHI to contact you to help our Hospital raise money. We may also
give your PHI to the foundation to assist in fund-raising activities. For fund-raising activities, we will only give out
basic contact information such as name, address, phone number, and the dates you were treated at the Hospital.
If you do not want the Hospital to contact you for its fund-raising purposes, you must tell the Hospital.
• Hospital General Public Disclosure. We may give out limited information about you which will be available
to the public. While you are at the Hospital as a patient, the information we give out may be your name, hospital
room number, and your general condition (example, "fair," "stable," etc.). The above information can be given
out to the public who ask for you by name. We may provide your name to clergy members. If you do not want this
information given out, you must inform the Hospital in writing.
• Individuals Involved in Your Care or Payment for Your Care. We may provide PHI about you to friends or
family members who are involved in your medical care. We may give out your PHI to person(s) who are helping
pay for your care. We may tell your family or friends about your condition and that you are in the Hospital. We
may give out your PHI as part of a disaster relief effort so your family knows about your condition and location.
How much of your PHI we give out to another person will depend on how much they are involved in your care.
• Research. We may give out your PHI to researchers who want to do scientific research about how well certain
drugs or treatments work. We will follow steps to make sure research is valid. If a researcher wants your name,
address, or other information about you, we will almost always ask permission from you before they contact you.
• As Required by Law. Federal, state, and local laws may require us to give out certain kinds of PHI. Things
like wounds from weapons, abuse, communicable diseases, and neglect are examples of such information and we
do not need your permission to give out this information.
• To Avoid a Serious Threat to Health or Safety. We may use or give out your PHI if your health and safety is
at risk or in danger. We also will give out your PHI if the health of the public or another individual is at risk. If we
give this information out, it will be given to someone who may be able to prevent the threat.
• Organ and Tissue Donation. If you are an organ donor, we may give out your PHI to people who deal with
organ collection, eye or tissue transplants, or to a donation bank.
• Military and Veterans. If you are a member of the armed forces, we may give out your PHI as required by
those military authorities in command. If you are a member of the military of another country, we may release your
PHI to the authority in command in your country.
• Worker’s Compensation. If you are involved in an injury that happens while you are at work, we may give out
your PHI so your medical bills can be paid by your employer. This is called worker’s compensation.
• Public Health Risks. We may give out your PHI without your permission if there is a danger to the public’s
health. Some general examples of these dangers: to avoid disease, injury or disability; to report births and deaths;
to report child abuse and neglect; to report reactions to drugs and other health products; to report a recall of health
products or medications; to tell a person they have been exposed to a disease or may get a disease or spread the
disease; to tell a government authority if we believe a patient has been abused, neglected, or the victim of
violence; to let employers know about a workplace illness or workplace safety; to report trauma injury to the state.
• Health Oversight Activities. We may give out your PHI without your permission to agencies who license the
hospital.
• Lawsuits and Disputes. If a court orders that we give out your PHI, we may give out your PHI. Other reasons
that may cause us to release your PHI would be if there is an order to appear in court, a discovery request, or other
legal reason by someone involved in a dispute.
• Law Enforcement. We may give out your PHI if asked for by a police official for the following reasons: for a
court order, subpoena, warrant, or summons; to find a suspect, fugitive, witness, or missing person; to find out about
the victim of a crime if we cannot get the person’s ok; about a death we believe may be the result of a crime;
about some crime that happens at the Hospital; in emergencies to report a crime, the place where the crime
happened, the victim of the crime, or the identity, description or whereabouts of the person who committed the
crime.
• Coroners, Medical Examiners and Funeral Directors. We may give out your PHI to a coroner or medical
examiner to identify a person who has died or determine the cause of death. We may also give out PHI to funeral
directors so they can carry out their duties.
• National Security and Intelligence Activities. We may give out your PHI to federal authorities for
intelligence, counter-intelligence, and other situations involving our national safety.
• Protective Services for the President and Others. We may give out PHI to federal officials so they can
protect the President or other officials or foreign heads of state or so they may conduct special investigations.
• Inmates. If you are an inmate of a prison or placed under the charge of a law enforcement official, we may
give out PHI (1) to the prison to provide you with health care; (2) to protect the health and safety of you and others;
or (3) for the safety of the prison.
• Redisclosure. When we use or give out your PHI, it may contain information we received from other hospitals
and doctors.
GIVING PERMISSION AND REVOKING PREVIOUS PERMISSION TO USE OR DISCLOSE YOUR PHI: Except as
stated in this Notice, in order for us to give out your PHI, you have to complete a written authorization form. If you
want, you can later revoke this authorization. You can do this at any time. Your request to later stop permission to
give out your health information must be in writing and sent to the Hospital. It is not possible for us to take back
any information we have already given out about you that we made with your permission.
WHAT SHOULD YOU DO IF YOU HAVE A COMPLAINT CONCERNING YOUR HEALTH INFORMATION? If you
believe your right to privacy has been violated, you can write a complaint and give it to the Hospital or the U.S.
Department of Health and Human Services. To find out how exactly to file a complaint with either the Hospital or
the U.S. Department of Health and Human Services, ask the Hospital. THERE IS NO PENALTY FOR FILING A
COMPLAINT.
IF CHANGES ARE MADE TO THIS NOTICE: We will give you a copy of this Notice the first time we treat you and
whenever you request it. We have the right to change this Notice at any time. We have the right to make the
changed Notice apply to health information we already have about you as well as any information we receive in
the future. We will post a copy of the newest Notice in the Hospital. You will find the date the Notice takes effect
at the top of the first page below the title. You can get a copy of this Notice at any time by contacting the Contact
Person listed above.
IF YOU HAVE QUESTIONS ABOUT THIS NOTICE: If you do not understand this Notice or what it says about how
we may use your PHI, please contact:
Ness County Hospital Privacy Officer
312 Custer
Ness City, Kansas 67560
WHAT IS YOUR HEALTH RECORD OR HEALTH INFORMATION? When you go to a hospital, doctor, or other
health care provider, a record is made that tells about your treatment. This record will have information about your
illnesses, your injuries, exams, laboratory results, treatment given, and notes about what might need to be done at
a later date. The hospital keeps this health information and can use this information in many different ways. What
we do with your PHI and how we can use and share this information is what the rest of this Notice describes.
RESPONSIBILITY OF THE HOSPITAL CONCERNING PHI: Law requires the Hospital must do the following when
handling your PHI:
• Keep your health information private, only giving it out when allowed by law;
• Explain our legal duty and rules about keeping your health information private; Follow the rules given in this
Notice;
• Let you know when we can’t agree with a request or demand you may make to restrict the sharing of your
health information with others.
• Help you when you want your health information sent in a different way than it usually is sent or to a different
place than it usually is sent.
YOUR HEALTH INFORMATION RIGHTS: Your PHI is the property of the doctor or hospital that wrote it. The
information contained in your health information belongs to you. You have certain rights concerning this PHI.
The following is a list explaining your rights:
• You Have the Right to Look at Your PHI and Get a Copy, Which May Help With Your Care. This information
will usually include medical and billing records. If you want to see your PHI and get a copy of the PHI, you must
provide a written request to the Contact Person. If you are disabled or ill, you can make this request over the
phone or in person. You may be charged for copies and mailing. We may refuse your request. We will notify you
in writing of any refusal as well as your rights to have that decision reviewed by a neutral person.
• You Have the Right to Ask That We Make Amendments to Your Records. If you feel your PHI is not complete
or incorrect, you can ask that we amend it. To request an amendment, your request must be in writing and
submitted to the Ness County Hospital Privacy Officer. You must provide a reason for the request. If your request is
denied, you will be informed of the reason for denial and you will have an opportunity to submit a statement of
disagreement to be maintained with your records. We may refuse your request for amendment for the following
reasons: (1) the information was not created by this Hospital; (2) it is not a part of the health information kept by or
for the Hospital; (3) it is not information you are permitted to see or copy; or (4) it is accurate and complete.
• You Have a Right to a List of Individuals to Whom We Gave Your PHI. You must give written request to be
provided a list of names that we have provided your PHI to. The time period can be no longer than six (6) years.
You cannot include dates covering the period before April 14, 2003. You can have one list each year at no cost.
You will be charged for any additional lists within the year period.
• You Have the Right to Ask for a Restriction. You have the right to ask that we restrict or limit some part of
your PHI. You can ask that we limit information about you to family members, caregivers, or friends. We are not
required to agree to your request. If you want to restrict or limit the information of your PHI, you must put your
request in writing. Tell us (1) what information you want to limit; (2) whether you want to limit our use of your PHI,
our giving out your PHI, or both; and (3) whom should not receive the PHI.
• You Have the Right to Ask for Privacy in Communications. You have the right to ask that we communicate
with you regarding your PHI only in a certain way or at a certain location. To ask for privacy in communications,
you must make written request to the Hospital. We will attempt to grant all reasonable requests. Be sure to be
specific in your request about how and where you wish to be contacted. We may charge you for this privacy
request and if you fail to pay, the privacy communication will be stopped.
• You Have the Right to a Paper Copy of This Notice. You have a right to a copy of this Notice at any time.
HOW WILL WE USE AND GIVE OUT YOUR PHI? The Hospital can use and disclose your PHI without your
permission. The following is a list of when we can do this:
• For Treatment. We may use your PHI to provide medical treatment or services. We may give your PHI to
doctors, nurses, technicians, medical students, or other staff personnel who are involved in taking care of you.
Departments of the Hospital may share your PHI to coordinate the services you need, such as prescriptions, lab
work, and x-rays. We also may disclose your PHI to professionals outside the Hospital who may be involved in your
treatment.
• For Payment. We may provide PHI regarding the treatment you receive in the Hospital, in order to bill the
appropriate party or for authorization of health benefits.
• For Health Care Operations. We may use or give out your PHI to be sure we are giving you appropriate care.
We may use your PHI to decide on additional services we should offer, or to see if new treatments work. We may
give your PHI to doctors, nurses technicians, medical students, and other hospital workers for their review and
studies. Other reasons we may use and disclose your PHI: to see how well we are doing in helping our patients; to
help reduce health care costs; to develop questionnaires and surveys; to help with care management; to make sure
we are doing our job well and successfully; to better train people so they can get the skills they need to best
perform their special skills; to help insurance companies better serve you in their policy making; to help those that
check on hospitals and ensure that we are doing our job correctly; to help us plan and develop the business part of
health care including fund-raising and advertising so that we are profitable.
• Appointment Reminders. We may contact you for appointment reminders. We may leave a message on your
answering machine or voice mail system unless you tell us not to.
• Treatment Alternatives. We may use or give out PHI to let you know about treatments that may be offered,
so you can make good choices about your health care.
• Health Related Benefits and Services. We may use and give out PHI to tell you about health benefits or
services that may be of interest to you.
• Fund-raising Activities. We may use your PHI to contact you to help our Hospital raise money. We may also
give your PHI to the foundation to assist in fund-raising activities. For fund-raising activities, we will only give out
basic contact information such as name, address, phone number, and the dates you were treated at the Hospital.
If you do not want the Hospital to contact you for its fund-raising purposes, you must tell the Hospital.
• Hospital General Public Disclosure. We may give out limited information about you which will be available
to the public. While you are at the Hospital as a patient, the information we give out may be your name, hospital
room number, and your general condition (example, "fair," "stable," etc.). The above information can be given
out to the public who ask for you by name. We may provide your name to clergy members. If you do not want this
information given out, you must inform the Hospital in writing.
• Individuals Involved in Your Care or Payment for Your Care. We may provide PHI about you to friends or
family members who are involved in your medical care. We may give out your PHI to person(s) who are helping
pay for your care. We may tell your family or friends about your condition and that you are in the Hospital. We
may give out your PHI as part of a disaster relief effort so your family knows about your condition and location.
How much of your PHI we give out to another person will depend on how much they are involved in your care.
• Research. We may give out your PHI to researchers who want to do scientific research about how well certain
drugs or treatments work. We will follow steps to make sure research is valid. If a researcher wants your name,
address, or other information about you, we will almost always ask permission from you before they contact you.
• As Required by Law. Federal, state, and local laws may require us to give out certain kinds of PHI. Things
like wounds from weapons, abuse, communicable diseases, and neglect are examples of such information and we
do not need your permission to give out this information.
• To Avoid a Serious Threat to Health or Safety. We may use or give out your PHI if your health and safety is
at risk or in danger. We also will give out your PHI if the health of the public or another individual is at risk. If we
give this information out, it will be given to someone who may be able to prevent the threat.
• Organ and Tissue Donation. If you are an organ donor, we may give out your PHI to people who deal with
organ collection, eye or tissue transplants, or to a donation bank.
• Military and Veterans. If you are a member of the armed forces, we may give out your PHI as required by
those military authorities in command. If you are a member of the military of another country, we may release your
PHI to the authority in command in your country.
• Worker’s Compensation. If you are involved in an injury that happens while you are at work, we may give out
your PHI so your medical bills can be paid by your employer. This is called worker’s compensation.
• Public Health Risks. We may give out your PHI without your permission if there is a danger to the public’s
health. Some general examples of these dangers: to avoid disease, injury or disability; to report births and deaths;
to report child abuse and neglect; to report reactions to drugs and other health products; to report a recall of health
products or medications; to tell a person they have been exposed to a disease or may get a disease or spread the
disease; to tell a government authority if we believe a patient has been abused, neglected, or the victim of
violence; to let employers know about a workplace illness or workplace safety; to report trauma injury to the state.
• Health Oversight Activities. We may give out your PHI without your permission to agencies who license the
hospital.
• Lawsuits and Disputes. If a court orders that we give out your PHI, we may give out your PHI. Other reasons
that may cause us to release your PHI would be if there is an order to appear in court, a discovery request, or other
legal reason by someone involved in a dispute.
• Law Enforcement. We may give out your PHI if asked for by a police official for the following reasons: for a
court order, subpoena, warrant, or summons; to find a suspect, fugitive, witness, or missing person; to find out about
the victim of a crime if we cannot get the person’s ok; about a death we believe may be the result of a crime;
about some crime that happens at the Hospital; in emergencies to report a crime, the place where the crime
happened, the victim of the crime, or the identity, description or whereabouts of the person who committed the
crime.
• Coroners, Medical Examiners and Funeral Directors. We may give out your PHI to a coroner or medical
examiner to identify a person who has died or determine the cause of death. We may also give out PHI to funeral
directors so they can carry out their duties.
• National Security and Intelligence Activities. We may give out your PHI to federal authorities for
intelligence, counter-intelligence, and other situations involving our national safety.
• Protective Services for the President and Others. We may give out PHI to federal officials so they can
protect the President or other officials or foreign heads of state or so they may conduct special investigations.
• Inmates. If you are an inmate of a prison or placed under the charge of a law enforcement official, we may
give out PHI (1) to the prison to provide you with health care; (2) to protect the health and safety of you and others;
or (3) for the safety of the prison.
• Redisclosure. When we use or give out your PHI, it may contain information we received from other hospitals
and doctors.
GIVING PERMISSION AND REVOKING PREVIOUS PERMISSION TO USE OR DISCLOSE YOUR PHI: Except as
stated in this Notice, in order for us to give out your PHI, you have to complete a written authorization form. If you
want, you can later revoke this authorization. You can do this at any time. Your request to later stop permission to
give out your health information must be in writing and sent to the Hospital. It is not possible for us to take back
any information we have already given out about you that we made with your permission.
WHAT SHOULD YOU DO IF YOU HAVE A COMPLAINT CONCERNING YOUR HEALTH INFORMATION? If you
believe your right to privacy has been violated, you can write a complaint and give it to the Hospital or the U.S.
Department of Health and Human Services. To find out how exactly to file a complaint with either the Hospital or
the U.S. Department of Health and Human Services, ask the Hospital. THERE IS NO PENALTY FOR FILING A
COMPLAINT.
IF CHANGES ARE MADE TO THIS NOTICE: We will give you a copy of this Notice the first time we treat you and
whenever you request it. We have the right to change this Notice at any time. We have the right to make the
changed Notice apply to health information we already have about you as well as any information we receive in
the future. We will post a copy of the newest Notice in the Hospital. You will find the date the Notice takes effect
at the top of the first page below the title. You can get a copy of this Notice at any time by contacting the Contact
Person listed above.
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