I. 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.

II. OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a medical record of the care and services you receive at Hardin Memorial Hospital. We need this medical record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the medical records of your care generated by the hospital, or its entities whether made by hospital personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your medical information created in the doctor's office or clinic.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:

III. HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
We use and disclose health information for many different reasons. For some of these uses or disclosures, we need your specific authorization. Below, we describe the different categories of our uses and disclosures and give you some examples of each category.
a. 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, healthcare students, or other hospital personnel who are involved in taking care of you in our facilities. 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 addition, 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 different things you need, such as prescriptions, lab work and x-rays. We also may disclose medical information about you to request “secured” status. Likewise, unless you object, your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don’t ask for you by name. If you do not desire a clergy visit, please tell us at the time of registration.
b. Payment. We may use and disclose medical information about you so that the treatment and services you receive in our facilities may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about surgery you received in our facilities 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 whether your plan will cover the treatment. We may also provide your medical information to our business associates, such as billing companies, claims processing companies, and others that process our health care claims.
c. Health Care Operations. We may use and disclose medical information about you for hospital operations. 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 to:
- review our treatment and services and to evaluate the performance of our staff in caring for you;
- consultants and others who assist us in complying with laws and meeting quality and accreditation standards;
- combine medical information about many hospital patients to decide what additional services the hospital should offer, what services are not needed, and whether certain new treatments are effective;
- doctors, nurses, technicians, healthcare students, and other hospital personnel for review and learning purposes;
- combine with medical information from other hospitals to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.
d. Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care scheduled.
e. Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
f. Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
g. Fundraising Activities. We may use medical information about you to contact you in an effort to raise money for the hospital and its operations. We may disclose medical information to a foundation related to the hospital so that the foundation may contact you in raising money for the hospital. We only would release contact information, such as your name, address and phone number and the dates you received treatment or services at the hospital. If you do not want the hospital to contact you for fundraising efforts, you must notify Hardin Memorial Hospital Administration in writing.
h. Hospital Directory. We may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name, unless you tell us you request “secured” status. Likewise, unless you object, your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don’t ask for you by name. If you do not desire a clergy visit, please tell us at the time of registration.
i. Individuals. Involved in Your Care or Payment for Your Care. We may release medical information about you to a friend or family member that you indicate is involved in your medical care or the payment of your health care, unless you object. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
j. Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another,for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with an individual's need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved by our Institutional Review Board (IRB). We may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs so long as the medical information they review does not leave our facility. We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the hospital.
k. As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law.
l. 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.
m. Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
n. 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.
o. Workers' Compensation. We may release medical information about you for Workers' Compensation or similar programs. These programs provide benefits for work-related injuries or illness.
p. Public Health Risks. We may disclose medical information about you for public health activities. These activities generally include the following disclosures:
- to prevent or control disease, injury or disability;
- to report births and deaths;
- to report child abuse or neglect;
- to report reactions to medications 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 at risk for contracting or spreading a disease or condition;
- to notify the appropriate government authority if we believe an individual has been the victim of abuse, neglect or domestic violence. We will only make this disclosure when required or authorized by law.
q. Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include but are not limited to audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
r. 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 by someone else involved in the dispute, if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
s. Law Enforcement. We may release medical information if asked to do so by law enforcement official:
- 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 person's agreement;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct at the 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.
t. Coroners, Medical Examiners and Funeral Directors. We may release medical information 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 individuals to funeral directors as necessary to carry out their duties.
u. National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
v. Protective Services for the President and Others. We may disclose 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.
w. Inmates. If you are an inmate of a correctional institution or 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.
x. Other Uses. Other uses and disclosures of medical information not described by this notice or required by law will be made only through a written authorization. If you provide us an authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care that we provided to you.

IV. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI
You have the following rights regarding medical information we maintain about you:
a. Right to Inspect and Copy. You have the right to inspect and receive copies of 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. To inspect and/or receive a copy of medical information that may be used to make decisions about you, you must submit your request in writing to Hardin Memorial Hospital – Health Information Management Services, 913 North Dixie Avenue, Elizabethtown KY 42701. You may also come to the hospital to Health Information Management Services and complete a request for your medical records. We will respond to your request within 30 days of the request if you have requested your information in person or by mail. Kentucky law provides you with one free copy. A fee will be charged for any subsequent copies. You will be notified before any charges are applied. We may deny your request to inspect and/or receive copies in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the hospital will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
b. Right 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 the hospital. To request an amendment, your request must be made in writing and submitted to Hardin Memorial Hospital – Health Information Management Services, 913 North Dixie Avenue, Elizabethtown KY 42701. In addition, you must provide a reason that supports your request. We will respond within 60 days of your request. 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 by or for the hospital;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you don’t file one, you have the right to request that your request and our denial be attached to all future disclosures of your medical information. If we approve your request, we will make the amendment to your information, tell you that we have done it, and make a reasonable effort to tell others that need to know about the change to your information.
c. Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you. The list will not include uses or disclosures made for treatment, payment, or health care operations, disclosures authorized by you pursuant to a signed authorization, disclosures made directly to you, to your family, or in our hospital directory. The list also won’t include uses and disclosures made for national security purposes, to corrections of law enforcement personnel, or disclosures made before April 14, 2003. To request this list or accounting of disclosures, you must submit your request in writing to Hardin Memorial Hospital – Health Information Management Services, 913 North Dixie Avenue, Elizabethtown KY 42701. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). We will provide the list to you at no charge unless you make more than one request in the same year. We will notify you of the cost involved for subsequent requests and you may choose to withdraw or modify your request at that time before any costs are incurred.
d. 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 or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had. If we agree we will comply with your request unless the information is needed to provide you emergency treatment. Hardin Memorial Hospital has no obligation or legal duty to agree to any requested restriction. To request restrictions, you must make your request in writing to Hardin Memorial Hospital – Health Information Management Services, 913 North Dixie Avenue, Elizabethtown KY 42701. In your request, you must 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.
e. 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 location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to Hardin Memorial Hospital – Health Information Management Services, 913 North Dixie Avenue, Elizabethtown KY 42701. We will not 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.
f. Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our website, www.hmh.net. To obtain a paper copy of this notice, call 270-706-1691 or visit our facility and request a copy.

V. COMPLAINTS REGARDING YOUR PHI
If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with the hospital, contact the Patient Advocates Office at 270-706-1327. All complaints should be submitted in writing. You will not be penalized for filing a complaint.

VI. CHANGES MADE TO THE NOTICE ON PHI
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you, as well as any information we receive in the future. The notice will contain the effective date on the first page. In addition, each time you register at or are admitted to the hospital for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.

VII. ADDITIONAL INFORMATION
If you have questions or would like further information about matters covered by this notice, please contact a Patient Advocate at 270-706-1327.

To view printable PDF version of the privacy notice, CLICK HERE