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Notice of Privacy Practices
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.
Layer one is brief, and further details are provided in layer
two.
Uses and Disclosures: We 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. Continuity of care
is part of treatment and your records may be shared with other providers
to whom you are referred. Information may be shared by paper mail,
electronic mail, fax, or other methods. We may use or disclose
identifiable health information about you without your authorization in
several situations, but beyond those situations, we will ask for your
written authorization before using or disclosing any identifiable health
information about you.
Your rights: In most cases, you have the right to look at or get
a copy of health information about you. If you request copies, we will
charge you only normal photocopy fees. You also have the right to
receive a list of certain types of disclosures of your information that
we made. If you believe that information in your record is incorrect,
you have the right to request that we correct the existing information.
Complaints: If you are concerned that we have violated your
privacy rights, or you disagree with a decision we made about access to
your records, you may contact the person listed below. You also may send
a written complaint to the U.S. Department of Health and Human Services.
The person listed below can provide you with the appropriate address
upon request.
Our legal duty: We are required by law to protect the privacy of
your information, provide this notice about our information practices,
follow the information practices that are described in this notice, and
seek your acknowledgement of receipt of this notice. Before we make a
significant change in our policies, we will change our notice and post
the new notice in the waiting area. You can also request a copy of our
notice at any time. For more information about our privacy practices,
contact the person listed below.
If you have any questions or complaints, please contact:
High Country Health Care Privacy Officer, 970-668-1791
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PROVIDER NOTICE OF PRIVACY
PRACTICES
Second layer:
1. Uses and Disclosures of Protected Health Information
Following are examples of the types of uses and disclosures of your
protected health care information that the provider is permitted to make.
These examples are not meant to be exhaustive, but to describe the types of
uses and disclosures.
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Treatment: We will use and disclose your protected health information
to provide, coordinate, or manage your health care and any related services.
For example, your protected health information may be provided to a doctor to
whom you have been referred to ensure that the doctor has the necessary
information to diagnose or treat you. |
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Payment: Your protected health information will be used, as needed, in
activities related to obtaining payment for your health care services. For
example, obtaining approval for a hospital stay may require that your relevant
protected health information be disclosed to your health insurance company to
obtain approval for the hospital admission. |
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Healthcare Operations: We may use or disclose, as-needed, your
protected health information in order to support our business activities. For
example, when we review employee performance, we may need to look at what an
employee has documented in your medical record. |
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Business Associates: We will share your protected health information
with third party ‘business associates’ that perform various activities
(e.g., billing, transcription services). Whenever an arrangement between us
and a business associate involves the use or disclosure of your protected
health information, we will have a written contract that contains terms that
will protect the privacy of your protected health information. |
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Marketing: We may use or disclose certain health information in the
course of providing you with information about treatment alternatives, health-related services, or
fund-raising. You may contact us to request that these materials not be sent
to you. |
Written Authorization
Other uses and disclosures of your protected health information will be
made only with your written authorization, unless otherwise permitted or
required by law as described below. You may revoke this authorization, at any
time, in writing.
Opportunity to Object
We may use and disclose your protected health information in the following
instances. You have the opportunity to object. If you are not present or able
to object, then your provider may, using professional judgment, determine
whether the disclosure is in your best interest.
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Facility Directories: Unless you object, we will use and disclose in
our facility directory your name, the location at which you are receiving
care, your condition (in general terms), and your religious affiliation. All
of this information, except religious affiliation, will be disclosed to people
that ask for you by name. Members of the clergy will be told your religious
affiliation. |
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Others Involved in Your Healthcare: Unless you object, we may disclose
to a member of your family, a relative, a close friend or any other person you
identify, your protected health information that directly relates to that
person’s involvement in your health care. |
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Emergencies: In an emergency treatment situation, your provider shall
try to provide you a Notice of Privacy Practices as soon as reasonably
practicable after the delivery of treatment. |
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Communication Barriers: We may use and disclose your protected health
information if your provider attempts to obtain acknowledgement from you of
the Notice of Privacy Practices but is unable to do so due to substantial
communication barriers and the provider determines, using professional
judgment, that you would agree. |
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Public Health: for public health purposes to a public health authority
or to a person who is at risk of contracting or spreading your disease. |
Without Opportunity to Object
We may use or disclose your protected health information in the following
situations without your authorization or opportunity to object:
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Health Oversight: to a health oversight agency for activities
authorized by law, such as audits, investigations, and inspections. |
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Abuse or Neglect: to an appropriate authority to report child abuse or
neglect, if we believe that you have been a victim of abuse, neglect, or
domestic violence. |
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Food and Drug Administration: as required by the Food and Drug
Administration to track products. |
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Legal Proceedings: in the course of legal proceedings. |
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Law Enforcement: for law enforcement purposes, such as pertaining to
victims of a crime or to prevent a crime. |
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Coroners, Funeral Directors, and Organ Donation: for the coroner,
medical examiner, or funeral director to perform duties authorized by law and
for organ donation purposes. |
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Research: to researchers when their research has been approved by an
Institutional Review Board. |
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Soldiers, Inmates, and National Security: to military supervisors of
Armed Forces personnel or to custodians of inmates, as necessary. Preserving
national security may also necessitate sharing protected health information. |
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Workers’ Compensation: to comply with workers’ compensation laws. |
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Compliance: to the Department of Health and Human Services to
investigate our compliance. |
In general, we may use or disclose your protected health information as
required by law and limited to the relevant requirements of the law.
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2. Your Rights
Following is a statement of your rights with respect to your protected
health information and a brief description of how you may exercise these
rights.
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You have the right to inspect and copy your
protected health information. However, we may refuse to provide access to
certain psychotherapy notes or information for a civil or criminal proceeding.
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You have the right to request a restriction of
your protected health information. You may ask us not to use or disclose
certain parts of your protected health information for treatment, payment or
healthcare operations. You may also request that information not be disclosed
to family members or friends who may be involved in your care. Your request
must state the specific restriction requested and to whom you want the
restriction to apply. We are not required to agree to a restriction that you
may request, but if we do agree, then we must behave accordingly.
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You have the right to request to receive
confidential communications from us by alternative means or at an alternative
location. We will accommodate reasonable requests. We may also condition this
accommodation by asking you for information as to how payment will be handled
or specification of an alternative address or other method of contact. We will
not request an explanation from you as to the basis for the request.
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You may have the right to have your provider amend
your protected health information. You may request an amendment of protected
health information about you. If we deny your request for amendment, you have
the right to file a statement of disagreement with us, and your medical record
will note the disputed information.
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You have the right to receive an accounting of
certain disclosures we may have made. This right applies to disclosures for
purposes other than treatment, payment or healthcare operations. It excludes
disclosures we may have made to you, for a facility directory, to family
members or friends involved in your care, or for notification purposes. You
have the right to receive specific information regarding these disclosures.
The right to receive this information is subject to certain exceptions,
restrictions and limitations.
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You have the right to obtain a paper copy of this
notice from us, upon request, even if you have agreed to accept this notice
electronically. |
END of Second and Final Layer of Notice of Privacy Practices
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