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Notice of Privacy Practices

Effective: 04/01/2004

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.

Pikeville Medical Center (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 Pikeville Medical Center (PMC).

How PMC May Use or Disclose Your Health Information

For Treatment. PMC and the Physicians may use and disclose your health information to provide you with medical treatment or services. For example, information obtained by a health care provider, such as a doctor, nurse, or other person providing health services to you, 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.

For Payment. PMC and the Physicians may use and disclose your health information 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 may 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, 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; and
determine how to continually improve the quality and effectiveness of the health care we provide.

Appointments. 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.

Fund Raising. PMC may use information to contact you to raise funds for the hospital.

Required by Law. PMC and the Physicians may use and disclose information about you as required by law. For example, PMC and the Physicians may
disclose 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.

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.

Decedents. Health Information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.

Organ/Tissue Donation. Your health information may be used or disclosed for cadaveric organ, eye, or tissue donation purposes.

Research. PMC 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 or safety of you or any person pursuant to applicable law.

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 services.

Workers Compensation. Your health information may be used or disclosed in order to comply with 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.

Your Health Information Rights

You have the right to:

request a restriction on certain uses and disclosures of your health information; however, PMC and the Physicians are not required to agree to a requested restriction;
obtain a paper copy of the notice of information practices upon request;
inspect and obtain a copy of your health record;
amend your health record;
request communications of your health information by alternative means or at alternative locations;
revoke your authorization to use or disclose health information except to the extent that action has already been taken; and
receive an accounting of disclosures made of your health information.

Complaints

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 Pikeville Medical Center must be in writing.

Obligations of Pikeville Medical Center

PMC and the Physicians are required by law to:

maintain the privacy of protected health information;
provide you with this notice of its legal duties and privacy practices with respect to your health information;
abide by the terms of this notice;
notify you if we are unable to agree to a requested restriction on how your health information is used or disclosed;
accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations; and
obtain your written authorization to use or disclose your health information for reasons other than those listed above and permitted under the law.

Joint Notice

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 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 with respect to privacy of your health information or otherwise.

Pikeville Medical Center reserves the right to change its information practices and to make the new provisions effective for all protected health information it maintains. Revised notices will be made available to you upon receiving a written request form 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:

Privacy Officer
Pikeville Medical Center
911 Bypass Road
Pikeville, Kentucky 41501

Privacy Hotline: 606-432-3542

Form #: 3112 (rev 06/11) (click here for a printer friendly version)

Your Patient Rights

As a patient at Pikeville Medical Center, we respect your right:

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.

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.

What to do if You Have Questions or Concerns

Questions 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.

606-218-3500

Our mission is to provide quality regional health care in a Christian environment.

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