Notice Of Privacy Practices



We are required by federal law to maintain the privacy of your medical information and to give you our Notice of Privacy Practices (this “Notice”) that describes our privacy practices, our legal duties and your rights concerning your medical information.

This Notice applies to Guthrie County Hospital, our clinics, and our organized health care arrangement. This Notice applies to and will be followed by: (1) all employees, staff, volunteers and other personnel of the Facility and clinics, and (2) the physicians and other practitioners who are not employed by the Facility, but who have privileges to treat patients at the Facility and who are members of the Facility’s organized health care arrangement (see description of the Facility’s organized health care arrangement, below).

How We May Use and Disclose Your Medical Information


TREATMENT To provide you with medical treatment or services (e.g., provide information to doctors, nurses, technicians, students or other personnel who are involved in your care).

PAYMENT To collect payment from you, an insurance company or a third party for the treatment and services you receive (e.g., submitting a claim to your insurance company).

HEALTH CARE OPERATIONS For Facility health care operations (e.g., to evaluate our staff and internal processes). As part of the Facility’s health care operations, certain limited information may be used or disclosed to conduct fundraising activities on behalf of the Facility. You have the right to request that you not receive fundraising materials from the Facility.

APPOINTMENTS AND HEALTH CARE SERVICES To provide you with appointment reminders or to notify you of possible treatment alternatives or health-related benefits or services.

FACILITY DIRECTORY While you are an inpatient, your name, location in the Facility, general condition (e.g., fair, serious, etc.), and religious affiliation may be included in the Facility directory and released (except religious affiliation) to people who ask for you by name. This information and your religious affiliation may be given to a member of the clergy, even if they do not ask for you by name. You have the right to request that your name not be included in the directory.

FRIENDS AND FAMILY To a friend or family member involved in your medical care or payment for your care. If you are available, such disclosures will be made only if we have obtained your permission, if you do not object to the disclosure after having the opportunity, or if it is reasonable for us, based on the circumstances, to assume you have no objection to such disclosure. If you are unavailable, incapacitated or in an emergency situation, the Facility may disclose limited information to these persons if the Facility determines disclosure is in your best interest.

HEALTH CARE PROVIDERS To another health care provider involved in your treatment in order for that provider to treat you, bill for its services and conduct certain of its health care operations.

DISASTER RELIEF To a public or private entity assisting in a disaster relief effort (e.g., to notify your family about your location, condition or death).

PUBLIC HEALTH ACTIVITIES To public health authorities for public health activities as permitted or required by law (e.g., to report births, deaths, child abuse and neglect, immunizations and communicable diseases).

ABUSE, NEGLECT AND DOMESTIC VIOLENCE The Facility may notify the appropriate government authority if it believes you have been the victim of abuse, neglect or domestic violence. Unless such disclosure is required by law, the Facility will only make this disclosure if you agree or under other limited circumstances when such disclosure is authorized by law.

HEALTH SAFETY RISKS Under certain circumstances, when necessary to prevent a serious threat to your health and safety or to the health and safety of the public or another person

ORGAN DONATIONS To organ procurement or organ, eye or tissue transplantation organizations, or to organ donation banks to facilitate organ or tissue donation and transplantation.

MILITARY AND NATIONAL SECURITY If you are a member of the armed forces, as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority. The Facility may also release your medical information to authorized federal officials for intelligence, counterintelligence, and other authorized national security activities.

WORKER’S COMPENSATION To persons (e.g., employers, insurance carriers, attorneys) in order to comply with workers’ compensation laws or other similar programs providing benefits for work-related injuries.

HEALTH OVERSIGHT ACTIVITIES To a health oversight agency for activities authorized by law to monitor the health care system, government programs and compliance with civil rights laws (e.g., fraud and abuse investigations, inspections and licensure, or disciplinary actions).

LEGAL PROCEEDINGS If you are involved in a lawsuit or dispute, in response to a court or administrative order. The Facility may also disclose medical information about you in response to a subpoena or other lawful process by someone else involved in the dispute, but only if the party seeking the information demonstrates that reasonable efforts have been made to notify you of the request or to obtain a protective order from the court.

LAW ENFORCEMENT To law enforcement authorities for law enforcement purposes, such as (1) in response to a court order, subpoena, warrant, summons or similar process, (2) to identify or locate a suspect, fugitive, material witness or missing person, (3) if you are the victim of a crime, but only if your agreement is obtained or in response to a subpoena, (4) about a death which is believed to be the result of criminal conduct, (5) to report a crime that occurred on Facility premises, and (6) 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. The facility must comply with federal and state laws in making such disclosures.

DECEASED INDIVIDUALS To a coroner or medical examiner as necessary to carry out their duties (e.g., to identify a deceased person or determine the cause of death), or to funeral directors as authorized by law.

CORRECTIONAL INSTITUTIONS To a correctional institution where you are an inmate or to a law enforcement official who has custody of you for certain limited purposes (e.g., to provide you with health care).

RESEARCH For research-related activities that meet all privacy law requirements.

LIMITED MEDICAL INFORMATION Limited medical information to a third party for research purposes, public health activities and Facility health care operations. The party to whom we disclose the information is required to keep it confidential.

REQUIRED BY LAW When required to do so by federal, state or local law (e.g., to report child or dependent adult abuse and violent wounds).

INCIDENTAL DISCLOSURES Occasional incidental, unintended disclosures of your medical information which might occur during a permitted use or disclosure (e.g., information overheard during a discussion regarding your care with you or a member of your family). We will take reasonable steps to avoid these types of disclosures.

BUSINESS ASSOCIATES Some of the activities described above are performed through contracts with outside persons or organizations, such as legal services. It may be necessary for the Facility to provide some of your medical information to outside business associates who assist the Facility with these activities. The Facility requires that its business associates appropriately safeguard the privacy of your information.

ORGANIZED HEALTH CARE ARRANGEMENT The Facility is a clinically integrated care setting where patients receive care from Facility personnel and from independent doctors and other practitioners who provide care to patients at the Facility (collectively called “practitioners”). The Facility and these practitioners need to share medical information freely to provide care to patients, and to conduct Facility health care operations. Therefore, the Facility and the practitioners have agreed to follow uniform information practices when using or disclosing medical information related to inpatient or outpatient hospital services. This arrangement is called an “organized health care arrangement” and only covers information practices for services rendered through the Facility.

It does not cover the information practices of the practitioners in their offices or at other care settings. It does not alter the independent status of the Facility and the practitioners or make them jointly responsible for the clinical services provided by them. In other words, the Facility is not responsible for (1) the negligence (or mistakes) of the independent practitioners providing care at the Facility; or (2) any violations of your privacy rights by the independent practitioners.

YOU AND YOUR AUTHORIZATION The Facility must also disclose your medical information to you, as described later in this Notice. Uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you give us permission to use or disclose medical information about you, you may revoke (take back) that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons set forth in your written authorization. We are unable to take back any disclosures we have already made with your permission.

Your Rights

ACCESS TO MEDICAL INFORMATION You may request to inspect and copy much of the medical information we maintain about you, with some exceptions. This includes most medical and billing records, but does not include psychotherapy notes. We may charge a fee for the costs of copying, mailing, and other supplies associated with your request.

REQUEST FOR RESTRICTIONS. You have the right to request a restriction on how we use or disclose your medical information for treatment, payment, or health care operations, or to certain family members or friends identified by you who are involved in your care or the payment for your care. We are not required to agree to your request, but will notify you if we are unable to agree.

AMENDMENT You may request that we amend certain portions of your medical information if you believe that it is incorrect or incomplete. We may require you to give a reason to support your request. We are not required to make all requested amendments, but we will give each request careful consideration. If we deny your request, we will provide you with a written explanation of the reasons and your rights.

ACCOUNTING You have the right to receive a list of certain disclosures of your medical information made by us or our business associates. You must state a time period for your request, which may not be longer than six years and may not include dates before April 14, 2003. The first list in any 12-month period will be provided to you for free; you may be charged a fee for each subsequent list you request within the same 12-month period.

CONFIDENTIAL COMMUNICATIONS You have the right to request that we communicate with you about medical matters in a different manner or at a different place. We will agree to your request if it is reasonable, and you specify an alternative means or location to contact you.

PAPER NOTICE You are entitled to receive a written copy of this Notice at any time.

HOW TO EXERCISE THESE RIGHTS All requests to exercise these rights must be in writing. We will follow written policies to handle requests, and we will notify you of our decision or actions and your rights. Contact the clinic manager or our Privacy Officer at the contact information at the end of this Notice for more information or to obtain request forms.

COMPLAINTS If you believe your privacy rights have been violated, you may file a complaint with the Facility using the contact information at the end of this Notice. You may also submit a complaint to the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized or retaliated against for filing a complaint.

QUESTIONS If you have questions about this Notice, please contact the clinic manager or the Privacy Officer at the contact information at the end of this Notice.

About This Notice

The Facility is required to abide by the terms of the Notice currently in effect. The Facility reserves the right to change the terms of this Notice and make the new Notice provisions effective for all of your medical information that it maintains, including that which it created or received while the prior Notice was in effect. If the Facility makes a material change to its privacy practices, it will amend its Notice. We will post a copy of the current Notice in the Facility. The Notice will state the effective date.

Contact Information

The privacy officer for Guthrie County Hospital may be reached by mail or by telephone:


Guthrie County Hospital

710 N 12th St.

Guthrie Center, IA 50115

Phone 641-332-2201