As required by HIPAA, Notice of Privacy Practices forms are available in English and Spanish. This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. The Audrain County Health Department may use your health information, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. The Agency has established policies to guard against unnecessary disclosure of your health information.
Notice of Privacy Practices Regarding Your Protected Health Information. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Your health information is private. The Audrain County Health Department (ACHD) understands that the information it collects about you and your health is personal. ACHD is required by state and federal law to protect your health information from being improperly used or released. This notice will tell you what ACHD may legally do with your protected health information. It will also tell you your rights about such information kept by ACHD.
ACHD is required to provide you this notice regarding your protected health information. ACHD will follow the requirements of this notice. ACHD reserves the right to change this notice. All changes to this notice will apply to all of your protected health information. If this notice is changed, the new notice will be made available on the ACHD website, in our local office, or it will be mailed to you upon request.
In our normal business operations, ACHD may receive protected health information (PHI), which is information identifying you, your family or close contacts and which includes some indication of your medical condition. The law requires that the information be protected. ACHD is allowed to use this information and share it with others, if the protected health information is being used for the purpose of preventing or controlling disease, injury, or disability, including, but not limited to the mandated reporting of disease, injury, vital events such as birth or death and to conduct public health surveillance or interventions. ACHD is also authorized and required by law to report to the Division of Family Services suspected evidence of child abuse or neglect or to the Division of Health and Senior Services suspected evidence of elder abuse or neglect.
ACHD follows the law when we must share health information and when we can share health information, without your
permission. ACHD will share information:
• as required by law, subject to limited restrictions,
• to state and local public health authorities to report such things as contagious diseases and for birth, death and immunization records,
• to the police or military as required by law,
• for court and administrative proceedings as required by law,
• to the health oversight authorities to see that government programs are being run properly,
• to the City government to protect the City, the mayor, the government workers and for other governmental programs as indicated by law,
• to family, relatives or other close contacts or those who help in your care such as physicians, hospitals, or other public health authorities, as indicated by law, and
• gathered through surveys or questionnaires and is released only in aggregate form that prevents the identification of a patient/client or physician, unless that information is being shared with another public health authority.
Sometimes health information that can normally be released, cannot be released. For example, if state law says the information will not be released and federal law allows it to be released, it will not be released. The same is true if federal law says the information cannot be released, but state law allows it to be released. Whichever law is more restrictive is the one that will apply.
Other than the examples listed, ACHD may not share any of your information without your written permission. You can allow ACHD to share as much of your information as you wish. You can also cancel your permission for ACHD to share that information.
You have the following rights regarding your privacy and your health information:
• You have the right to request that ACHD limit the information it shares about you, but ACHD does not have to agree to such requests.
• You have the right to receive your information from ACHD privately. ACHD will provide it to whatever address you choose and in the form you choose.
• You have the right to inspect and copy your information that ACHD has.
• You have the right to ask that the information in ACHD’s files be changed. However, there are limits regarding what may be changed.
• You have the right to receive a list of the parties outside ACHD that have received your information.
• You also have the right to request this notice on paper, electronically or both.
These protections and rights became effective April 14, 2003. If you have any questions or complaints, or want to make a request, contact:
Audrain County Health Department
1130 S. Elmwood Drive
Mexico, MO 65265
HIPAA entitles every person the right to access his or her medical records, receive copies of them, and request amendments to them. To ensure information is released according to the owner’s wishes, facilities are required to verify the identity of the requestor and confirm that he or she is authorized to access or transfer the records.
If you are having the records sent to another person, you will need to provide their name and contact information.
The first step will be completing an Authorization for Disclosure of Protected Health Information form. You can print this form and bring it to our office, or mail it to ACHD at 1130 South Elmwood, Mexico, MO 65265. You can also email the completed form to email@example.com.