NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW
Pikeville Medical Center (hereinafter PMC) and the members of its medical staff who may provide treatment to you at this facility and the corporations or
other legal entities through which those physicians may render such treatment (hereinafter collectively “Physicians”) use health information about you for
treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. Your health information is
contained in a medical record that is the physical property of PMC.
PMC is required by law to maintain the privacy of your Protected Health Information (PHI) and to provide you with this notice explaining PMC’s privacy
practices with regard to your and/or your legal dependent’s health information and the manner in which PMC may use and disclose your and/or your legal
dependent’s PHI for treatment, payment, and for health care operations, as well as for other purposes that are permitted or required by law. You have
certain rights regarding the privacy of your protected PHI and PMC also describes those rights in this notice. PMC is obligated to abide by the terms of
this notice, and to maintain the privacy of your PHI for a period of 50 years following your death.
What is Protected Health Information?
Protected Health Information consists of individually identifiable health information, which may include demographic information PMC collects from you or
creates or receives that relates to: (1) your past, present or future physical or mental health or condition; (2) the provision of health care to you; or
(3) the past, present or future payment for the provision of health care to you.
This Notice of Privacy Practices became effective on April 1, 2004, and was amended on August 5, 2011, and on September 6, 2013.
How PMC May Use or Disclose Your Protected Health Information
PMC and the Physicians may use and disclose your health information to provide you with medical treatment or services, coordinate or manage your health
care and any related services. PMC may disclose your health information to another provider who has been requested to be involved in your care. For
example, information obtained by a health care provider will record information in your record that is related to your treatment. This information is
necessary to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and
how you respond to the actions. Additionally, PMC and the Physicians may disclose your PHI to others who may assist in your care, such as your spouse,
children or parents.
PMC and the Physicians may use and disclose PHI to others for purposes of receiving payment for treatment and services that you receive. For example, a
bill may be sent to you or a third-party-payor, such as an insurance company or health plan. The information on the bill will likely contain information
that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.
For Health Care Operations.
PMC and the Physicians may use and disclose health information about you for operational purposes. For example, your health information may be disclosed to
members of the medical staff, risk or quality improvement personnel, Business Associates and others to:
evaluate the performance of the medical staff, hospital employees, and others;
assess the quality of care and outcomes in your cases and similar cases;
learn how to improve our facilities and services;
determine how to continually improve the quality and effectiveness of the health care we provide; and
perform billing, consulting, or transcription, or other services for our facility.
PMC and the Physicians may disclose your PHI to other health care providers and entities to assist in their health care operations. For Example, PMC and
the Physicians may disclose your PHI to your health plan for quality assessment and outcomes evaluations and to coordinate your care through disease
management and other wellness programs.
For Appointment Reminders
PMC and the Physicians may use your information to provide appointment reminders or information about treatment alternatives or other health-related
benefits and services that may be of interest to the individual. Please let us know if you do NOT wish to be called.
Unless you instruct PMC otherwise PMC may use information to contact you to raise funds for the hospital. To Opt Out, please inform the
admitting clerk, your nurse, or call the privacy officer at 606-218-3954. Additionally, any written fundraising communications from PMC must
state, clearly and conspicuously, your opportunity and the manner in which you may elect not to receive further communications.
PMC may use and disclose patient health information without obtaining an authorization for the purpose of marketing if the marketing communication is made
face-to-face by an employee of PMC, or the communication is a promotional gift of nominal value provided by PMC.
Required by Law.
PMC and the Physicians may use and disclose health information about you as required by law. For example, PMC and the Physicians may disclose health
information for the following purposes:
for judicial and administrative proceedings pursuant to legal authority;
to report information related to victims of abuse, neglect, or domestic violence; and
to assist law enforcement officials in their law enforcement duties.
Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to
prevent or control disease, injury, or disability, or for other oversight activities, including but not limited to maintaining vital records, reporting
reactions to drugs or problems with products or devices or notifying individuals if a product or device they may be using has been recalled.
Health Information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties. PMC may also disclose PHI to family
members of deceased individuals or others who were involved in the deceased individual’s health care or payment for health care prior to death, unless
disclosing such information would be inconsistent with the deceased individuals’ prior expressed preference to PMC.
Proof of Immunization for School
. PMC may disclose proof of immunization to a school when legally required for attendance. No HIPAA authorization is required, but PMC must receive either
written or oral permission from the adult student, parent or guardian of a child, or other person acting on the student’s behalf.
Your health information may be used or disclosed for cadaveric organ, eye, or tissue donation purposes.
PMC and the Physicians may use your health information for research purposes, when an institutional review board or privacy board that has reviewed the
research proposal and established protocols to ensure the privacy of our health information has approved the research.
Health and Safety.
Your health information may be disclosed to avert a serious threat to the health and safety of you or any person pursuant to applicable laws.
Your health information may be disclosed for specialized government functions such as protection of public officials or reporting to various branches of
the armed services.
Your health information may be used and disclosed in order to comply with the laws and regulations related to Workers’ Compensation.
Other uses and disclosures will be made only with your written authorization and you may revoke the authorization except to the extent PMC has taken in
reliance on such. The following uses and disclosures of your PHI will be made only with your written authorization: 1) uses and disclosures of PHI for
marketing purposes if PMC receives financial remuneration from a third party in exchange for making the marketing communication, 2) disclosures that
constitute a sale of your PHI, 3) most uses and disclosures of psychotherapy notes, and 4) any other uses and disclosures not described in this Notice. An
authorization for marketing will tell you financial remuneration is involved, and an authorization for sale of PHI will tell you the disclosure will result
in financial remuneration to PMC.
If you do not object, PMC may include your name, location, and general condition in its facility Patient Directory
. This is used for requests by those who ask for you by name. If you do not object, we also disclose information from the directory and your religious
affiliation to clergy who request the same.
Your Health Information Rights
Although your health record is physical property of the facility that compiled it, the information belongs to you. You have the right to:
You have the right to request a restriction of the manner in which we use or disclose your medical information for treatment, payment, or health care
operations. For example, you could request that we not disclose information about a prior treatment to a family member or friend who may be involved in
your care or payment for care. Your request must be made in writing to the Director of Health Information Management. We are not required to agree to your
request if we feel it is in your best interest to use or disclose that information, except in the limited situation in which you or someone on your behalf
pays in full for an item or service, and you request that information concerning such item or service not be disclosed to a health insurer. If we do agree,
we will comply with your request except for emergency treatment. You may cancel the restriction at any time. In addition, we may cancel a restriction,
except as otherwise required by law, at any time as long as we notify you of the cancellation and continue to apply the restriction to information
collected before the cancellation.
Obtain a Paper Copy of this Notice
You have the right to obtain a paper copy of PMC’s Notice of Privacy Practices upon request, even if you have agreed to receive the notice electronically.
Inspect and Copy
You have the right to inspect and receive a copy of the protected health information that we maintain about you in our designated record set for as long as
we maintain that information. This designated record set includes your medical and billing records, as well as any other records we use for making
decisions about you. Any psychotherapy notes that may have been included in records we received about you are not available for your inspection or copying,
by law. Your first copy will be provided for free; however, PMC may charge you a fee for the costs of copying, mailing, or other supplies used in
fulfilling additional requests.
If you wish to inspect or copy your medical information, you must submit your request in writing to our Privacy Officer. You may mail your request, or
bring it to the Health Information Management office. We will have 30 days to respond to your request for information that we maintain at our facility. If
the information is stored off-site, we are allowed up to 60 days to respond but must inform you of this delay.
You also have the right to access your own e-health record in an electronic format and to direct PMC to send the e-health record directly to a third party.
PMC may only charge for labor costs under electronic transfers of e-health records.
Request an Amendment
You have the right to request that we amend your medical information if you feel that it is incomplete or inaccurate. You must make this request in writing
to our Privacy Officer, stating what information is incomplete or inaccurate and the reasoning that supports your request. We are permitted to deny your
request if it is not in writing or does not include a reason to support the request. We may also deny your request if:
the information was not created by us, or the person who created it is no longer available to make the amendment;
the information is not part of the record which you are permitted to inspect and copy;
the information is not part of the designated record set kept by this facility; or
if it is the opinion of the health care provider that the information is accurate and complete.
You have the right to receive confidential communications of PHI. You have the right to request the manner in which we communicate with you to preserve
your privacy. For example, you may request that we call you only at your work number, or by mail at a special address or postal box. Your request must be
made in writing and must specify how or where we are to contact you. We will accommodate all reasonable requests.
Revoke Your Authorization
Uses or disclosures of your health information not covered by this notice or the laws that apply to us may only be made with your written authorization.
You may revoke such authorization in writing at any time and PMC will no longer disclose health information about you for the reasons stated in your
written authorization. Disclosures made in reliance on the authorization prior to the revocation are not affected by the revocation.
An Accounting of Disclosures
You have the right to request a list of the disclosures of your health information we have made outside of the facility that were not for treatment,
payment, or health care operations or that do not fall within one of the other exceptions recognized by Federal Law. Your request must be in writing and
must state the time period for the requested information. You may not request information for a period of time greater than six years (our legal obligation
to retain information). Your first request for a list of disclosures within a 12-month period will be free. If you request an additional list within
12-months of the first request, we may charge you a fee for the costs of providing the subsequent list. We will notify you of such costs and afford you the
opportunity to withdraw your request before any costs are incurred.
Notification if a Breach of Your Medical Information Occurs
You have the right to be notified in the event of a breach of medical information. If a breach of your medical information occurs, and if that information
is unsecured (not encrypted), we will notify you by first class mail within 60 days of the event with the following information: 1) a brief description of
the breach, including the date of the breach and the date of discovery; 2) a description of the health information that was involved; 3) recommended steps
you can take to protect yourself from potential harm resulting from the breach; 4) a brief description of the actions PMC is taking to investigate the
breach, mitigate losses, and to protect against further breaches; and 5) contact procedures so you can obtain further information.
You may complain to PMC or to the Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated
against for filing a complaint. All complaints made to PMC must be in writing.
This Notice of Privacy Practices is intended as a Joint Notice on behalf of those persons and entities described on the first page hereof. The joint nature
of this notice is for compliance with certain requirements of the Health Insurance Portability and Accountability Act and Health Information Technology for
Economic and Clinical Health Act only, and in no way is intended to imply that any physician is an employee of PMC or that PMC is legally responsible for
the acts and omissions of the Physicians or other entities who are not their employees with respect to privacy of your health information or otherwise.
PMC reserves the right to change its information practices and to make the new provisions effective for all protected health information it maintains.
PMC is obligated to promptly revise and distribute its notice whenever there is a material change to the uses or disclosures, the individual rights,
PMC’s legal duties, or other privacy practices stated in this notice. Revised notices will be made available to you upon receiving a written request
from you on or after the effective date of any revision. Revised notices will be posted on the PMC web site and in the Medical Leader within 60 days of
a material revision.
Contact Information for Requests for Inspection
If you have any questions, requests for inspection or complaints, please contact:
Pikeville Medical Center, Inc.
911 Bypass Road
Pikeville, Kentucky 41501
Privacy Hotline: 606-218-3954
Comments, Concerns | Joint Commission Contact
Pikeville Medical Center | 911 Bypass Road | Pikeville, KY | 41501
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