Patient Information

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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. 


The purpose of this Notice is to advise you of your rights and how we may use and disclose medical information about you. We are required by law to: 

-Protect the privacy of this medical information which identifies you; 

-Give you this Notice of our legal duties and privacy practices with respect to medical information about you; and 

-Follow the terms of the Notice currently in effect.  

If you have any questions about this Notice, please contact the Casey County Hospital Privacy Officer. 

Organized Health Care Arrangement 

Casey County Hospital participates in a clinically integrated care setting in which patients typically receive health care from more than one health care provider. This arrangement is called an Organized Health Care Arrangement (or OCHA) under the federal laws governing the privacy of patient health information. This means that when you receive services at Casey County Hospital, you may receive certain professional services from physicians on our Medical Staff, residents, and /or medical students who are independent practitioners and not employees or agents of Casey County Hospital. These independent practitioners have agreed to abide by the terms of this Notice when providing services at Casey County Hospital. Therefore, this Notice applies to all of your health information that is created or received as a result of being a patient at Casey County Hospital. However, this Notice does not apply to the independent practitioners in their private offices.  As a result, you will also receive Notice of Privacy Practices from these independent practitioners when they provide services in their private offices. This notice also applies to all of the Casey County Hospital’s department and clinics whether they are located off-campus or on our campus. 

How we may use and disclose you medical information 

We will not use or disclose your medical information without your authorization except as described in this Notice. If you provide us written authorization, you may revoke your authorizations at any time in writing. However, that revocation will not be effective as to any medical information we disclosed prior to your revocation. We reserve the right to change the terms of this Notice and our privacy policies at any time.  We reserve the right to make the revised or changed Notice effective for heath information that we already have about you as well as any information we receive in the future.  We will promptly  change  the copy before we make an important change to your privacy policies. A current copy of the Notice will be posted in the office. The Notice will have the effective date on the first page 

Treatment - We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other hospital personnel who provide services to you. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In additions, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of the hospital also may share medical information about you in order to coordinate the care we provide to you. 

Payment - We may use and disclose medical information about you so that the treatment and service you receive may be billed to and payment may be collected from you, an insurance company, or a third party. In order to bill and collect payment from the proper party, we may provide your medical information to our business associates such as billing companies, and others that process our health care claims. For example, we need to give your health plan information about surgery you receive at the hospital so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine if your plan will cover the treatment.

Health Care Operations - We may use and disclose medical information about you in the course of the operation of the hospital. These uses and disclosures are necessary to run the hospital and make sure that all of our patients receive quality care. For example, we may use or disclose your medical information: 

-In order to review our services and to evaluate our staff’s performance: 

-To legal and other consultants who assist us in complying with laws and meeting quality and accreditations standards: 

-In order to combine it with medical information from other hospitals to see how we  are doing and see where we may make improvements in the service we offer; and  

-In order to conduct cost management and planning analysis related to managing and operating the hospital. 

Appointment Reminders - We may use and disclose your medical information to contact you to as a reminder that you have an appointment. 

Treatment Alternatives - We may use and disclose your medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you. 

Individuals Involved in your Care or Payment for your care - We may release medical information about you to a friend or family member who is involved in your medical care. We may also tell your family or friend about your condition. 

As Required by Law - We will disclose medical information about you when required to do so by federal, state or local law. 

To Avert a Serious Threat to Health or Safety - We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. 

Health-Related Benefits and Services - We may use and disclose medical information about you to tell you about health-related benefits or services that may be of interest to you. 

Military and Veterans - If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority. 

Workers Compensation - If you were injured on the job and you have filed a claim under workers’ compensation or a similar program, we may release medical information about you to facilitate your claim. 

Public Health Risks - We may disclose medical information about you for public health purposes to Public Health  Authorities, Child abuse Agencies, companies under  jurisdiction of the Food and Drug  Administration, persons who may be at risk of contracting or spreading disease, and employers under certain circumstances. Public health purposes include the following: 

-To prevent or control disease, injury or disability: 

-To report births and deaths; 

-To report child abuse or neglect; 

-To report reactions to medication or problems with products; 

-To notify people of recalls of products they may be using; 

-To notify a person who may have been exposed to a disease or may be a risk for contracting or spreading a disease or condition; and; 

-To notify the appropriate government authority if we believe a patient has been a victim of abuse, neglect or domestic violence. 

Health Oversight Activities - We may disclose medical information about you to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government program, and compliance with civil rights laws. 

Lawsuits and Disputes - If you are involved in a lawsuit or a dispute we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process to someone else involved  in the dispute, but only if efforts have been made to tell you about the request or obtain an order protecting the information requested. 

Law Enforcement - We may release medical information about you if asked to do so by law enforcement officials; 

- In response to a court order, subpoena, warrant, summons or similar process; 

- To identify or locate a suspect, fugitive, material witness, or missing person; 

- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the victim’s authorization to release the information;  

- About a death we believe may be the result of criminal conduct; 

- To facilitate the investigation of criminal conduct at our hospital; and  

- In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime. 

Coroners, Medical Examiners and Funeral Directors - We may release medical information about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors as necessary to carry out their duties. 

National Security and Intelligence Agencies - We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. 

Protective Services for the President and others - We may release medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations. 

Inmates - If you are an inmate of a correctional institution or otherwise under the custody of a law enforcement  official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution. 

Your Rights Regarding Your Health Information 

You have the following rights regarding your health information: 

1. Right To Inspect And Copy. You have the right to inspect and receive copies of your medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. 

Procedure - To inspect and/or receive a copy of your medical information kept on file by us, you must submit your request in writing to: 

Casey County Hospital 

Attn: Director of Medical Records 

187 Wolford Avenue 

Liberty, KY 42539 

We will respond to your request within thirty (30) days of the request or sixty (60) days if your medical information is not available on site. We shall be granted a thirty (30) day extension upon written notice to you providing the reason for the extension of time. 

Fees - There may be a fee for the copies of your record; you will be notified before any charges are applied. 

Denials - We may deny your request to inspect and/or receive copies of your medical information if it is not in writing and in other, very limited circumstances. You will receive a written notice of denial containing the reason for denial and the procedure for review. In some circumstances another licensed health care professional chosen by Casey County Hospital may review your request and denial.  The  person conducting the review will not  be the person who denied your request. We will comply with the outcome of the review. However, in some circumstances, our denial of a request by you to inspect and/or receive copies of your information is not subject to review. 

2. Rights To Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by, or for Casey County Hospital.  

Procedure - To request an amendment, your request must be made in writing and submitted to: 

Casey County Hospital 

Attn: Director of Medical Records 

187 Wolford Avenue 

Liberty, KY 42539  

In your written request, you must provide a reason that supports your request for amendment.  

If we approve your request, we shall make this amendment to your medical information inform you that we have the amendment, and make a reasonable effort to tell others that need to know about the change to your medical information. 

Denials - We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition we may deny your request if you ask us to amend information that: 

- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment; 

- Is not part of the medical information kept for, or by Casey County Hospital;  

- Is not part of the information which you would be permitted to inspect and copy; or 

- Is accurate and complete. 

If your request for amendment is denied, we will provide you with a written statement of the basic for the denial and a description of how you may file a written statement of disagreement. If you do not file a statement of disagreement, you may request that your request for amendment and our written denial be provided with any future disclosures of your medical information. 

3. Right To An Account of Disclosures. You have a right to request an “accounting of disclosures.” This is a list of the disclosures we made regarding medical information about you. 

Exclusions - The list will not include: disclosures made for treatment, payment, or health care operations; disclosures made directly to you; disclosures authorized by you pursuant to a signed authorization; disclosures made for national security or intelligence purposes; and disclosures to correctional institutions and for law enforcement purposes. This list also will not include disclosures made before April 14, 2003. 

Procedure - To request an accounting of disclosure, you must submit your request in writing to: 

Casey County Hospital 

Attn: Director of Medical Records 

187 Wolford Avenue 

Liberty, KY 42539 

Your request must include a time period, which may not exceed six (6) years prior to the date of the request and may not include any dates prior to April 14, 2003. Your request should also indicate in which form, i.e., electronic or paper, you would like your request to be processed. We will provide the list to you at no charge, however if you make more than one request in the same year, we may charge you up to $1.00 per page for each additional request. We will notify you of the cost involved and you may choose to withdraw or modify your request at the same time before any costs are incurred. 

4. Right To Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care, like a family member or friend. For example, you can ask that we not use or disclose information about a surgery you have had. However, we are not required to grant your request. If we do grant your request we will comply with your request unless the information is needed to provide you emergency medical treatment. 

Procedure - To request restrictions you must make your request in writing to: 

Casey County Hospital 

Attn: Director of Medical Records 

187 Wolford Avenue 

Liberty, KY 42539 

In your request, tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse. 

5. Right To Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain locations. For example, you may request that we only contact you at work or by mail. Any such request must be in writing and addressed to: 

Casey County Hospital 

Attn: Director of Medical Records 

187 Wolford Avenue 

Liberty, KY 42539 

We will ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. 

6. Right To Paper Copy Of This Notice. To obtain a paper copy or this notice, send your request to: 

Casey County Hospital 

Attn: Director of Medical Records 

187 Wolford Avenue 

Liberty, KY 42539 

Reporting Violations Of Your Privacy Rights 

If you believe your privacy rights have been violated, you may file a complaint with our company or the Department of Health and Human Services. To file a complaint with our company, please contact the Privacy Officer. All complaints must be submitted in writing to: 

Casey County Hospital 

Attn: Privacy Officer 

187 Wolford Avenue 

Liberty, KY 42539 

You will not be penalized for submitting a complaint 

Nondiscrimination Policy 

As a recipient of federal financial assistance, the Casey County Hospital does not exclude, deny benefits to, or otherwise discriminate against any person on the grounds of race, color  or national origin, sex, creed or on the basis of disability or are in admission to, participation in, or receipt to the services  and benefits of any of its program and activities or in the employment  therein ,whether carried out by Casey County Hospital directly or through a contractor or any other entity with whom Casey County Hospital arranges to carry out its programs and activities. 

This statement is in accordance with the provision of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Regulation of the U.S. Department of Health and Human Services issued pursuant to the Acts, Title 45 code Federal Regulations Part 80, 84, and 91. (Other federal laws and regulations provide similar protection against discrimination on grounds of sex and creed.) 

In case of questions concerning this policy, or in the event of a desire to file a complaint alleging violations of the above, please contact: 

Cinda L. Meyer, Assistant Administrator 

Coordinator, Section 504 

(606) 787-6275 

Kentucky Relay 1-800-826-7653