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 CAREFULLY.
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.
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
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.
Payment. 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
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
· 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.
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.
Raising. 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.
For Marketing. 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
· to report information related to victims of abuse,
neglect, or domestic violence; and
· to assist law enforcement officials in their law
Public Health. 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.
Decedents. 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.
Organ/Tissue Donation. Your health
information may be used or disclosed for cadaveric organ, eye, or tissue
Research. 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.
Government Function. Your health
information may be disclosed for specialized government functions such as
protection of public officials or reporting to various branches of the armed
Your health information may be used and disclosed in order to comply
with the laws and regulations related to Workers’ Compensation.
Other Uses. 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.
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.
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
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
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
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
it is the opinion of the health care provider that the information is accurate
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
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
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
Contact Information for
Requests for Inspection
If you have any questions, requests for inspection or complaints, please
Pikeville Medical Center, Inc.
911 Bypass Road
Pikeville, Kentucky 41501
Privacy Hotline: 606-218-3954
As a patient at Pikeville Medical Center, we respect your right:
Each patient should receive a copy of these patient rights at the time of admission or treatment. Continuous monitoring will be conducted to assure no patient right is violated. Advance directives are encouraged upon admission.
- to be viewed as an individual with unique health care needs to which we will respond to in a considerate and positive manner respective of your personal values, beliefs, and dignity.
- to participate in the development and implementation of an individualized plan of care with consideration of the psychosocial, cultural, spiritual, and personal values, beliefs or preferences that influence the perceptions of illness embraced by you and your family or significant others.
- to make informed decisions regarding your care; to information about your health status and to accept or refuse treatment (to the extent permitted by law) after being informed of the expected benefits, potential discomforts, risks, alternative therapies, and procedures to be followed. Refusal of treatment does not compromise your access to hospital services.
- to have a family member or representative of your choice and your own physician notified of your admission to the hospital.
- to make end of life decisions (by having an advanced directive, such as a living will) about your care and treatment, and to designate a surrogate decision-maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy.
- to know the identity and professional status of the staff responsible for your care. This includes the association with any other healthcare or educational institutions involved in your care.
- to receive care in a safe setting, personal privacy, and confidentiality of information, within the requirements of the law.
- to designate representation if you are a minor, unable to communicate your wishes regarding treatment, medically incapable of understanding the proposed treatment or procedure, or determined to be legally incompetent.
- to comfort measures provided with dignity, including, but not limited to, medication administration, spiritual counseling, and nursing care.
- to receive appropriate information about and give informed consent prior to being involved/enrolled in any clinical research investigations, or clinical trials.
- to request a transfer to another facility, when medically appropriate and legally permissible.
- to be cared for in an environment that is free from all forms of abuse or harassment.
- to ask and be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or payers that may influence your treatment or care.
- to ask and be informed of:
? hospital policies & practices that relate to patient care, treatment and responsibilities.
? available resources for resolving disputes, grievances, and conflicts, such as ethics committees, patient representatives, or other mechanisms available.
? the hospital’s charges for services and available payment methods.
- to receive, subject to your consent (or your support person, when appropriate) visitors whom you designate, including, but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member or friend, and your right to deny or withdraw consent at any time.
- to be informed about any restrictions or limitation on visitation due to your medical condition or environment. PMC does not restrict or limit visitation due to color, race, national origin, religion, sex, gender identity, sexual orientation or disability.
What to do if You Have Questions or ConcernsQuestions and concerns regarding your individual plan of care are usually best addressed with your physician, nurse, or other healthcare provider since they are most familiar with healthcare needs. Concerns related to the overall quality of your care and treatment at our facility, should they arise, are best addressed directly with the floor, Department Director, the House Administrator, or the Risk Manager. If you need to contact the Chief Nursing Officer
(CNO) or the Risk Manager, pick up your room phone and dial “0”, and ask the operator to connect you to the Chief Nursing Officer or Risk Manager.
Risk Manager: 606-218-4629
Chief Nursing Officer: 606-218-4806
Administrative Staff: 606-218-3994
The administration and staff at Pikeville Medical are committed to providing quality health care for you and your family and will make every reasonable effort to address your concerns in a timely and appropriate manner if given the opportunity. The hospital allows the patient to voice complaints and recommend changes freely without being subject to coercion, discrimination, reprisal or unreasonable interruption of care. However, you do have the
right to file a complaint with appropriate agency regardless of whether or not you utilize the hospital grievance process. Those agencies may be reached at the numbers and addresses listed: Pike County Dept. Of Protection & Permanency, Pike County Courthouse, Main Street, Pikeville, Kentucky 41501 (606) 433-7596, Office of Inspector General, Division of Licensing & Regulation, Kentucky Cabinet for Health Services , Region C, 100 State Police
Road, London, KY 40741, (606)330-2030, and the Joint Commission, 1 Renaissance Blvd, Oakbrook Terrence, IL 60181, (800) 994-6610.
Thank you for choosing Pikeville Medical Center as your healthcare provider. We value your patronage and look forward to Serving you again in the future should the need arise.
Pikeville Medical Center | 911 Bypass Road | Pikeville, KY | 41501
Our mission is to provide quality regional health care in a Christian environment.
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