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 called "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 not 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 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 health 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 your 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 other person pursuant to applicable law.

Government Functions. 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 is 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 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 from you on or after the effective date of any revision. Revised notices will be posted on the PMC Website 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: 606-218-3542