COUNTY HEALTH DEPARTMENT, HOME HEALTH AGENCY &
HANCOCK COUNTY DENTAL CENTER
of Privacy Practices
Notice of Privacy Practices describe show medical information about you
may be used and disclosed; and how you can get access to this
information. Please review it carefully.
have questions about this Notice, please contact our office.
Will Follow This Notice
This “Notice of Privacy Practices” (aka Notice) describes the privacy
practices of the Hancock County Health Department, Home Health Agency
and Hancock County Dental Center and those of:
• Any health care professional authorized to enter information into
your medical chart.
• All divisions and units of the Department, and the operations the
Department outsources to certain of our business partners, as well as
their Business Associates.
• All of our workforce, employed or otherwise.
these entities, sites and locations follow the terms of this Notice. In
addition, these entities, sites and locations may share medical
information with each other for treatment, payment or operations
purposes described in this Notice.
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 record of the care and services you receive at our
facilities. We need this record to provide you with quality care and to
comply with certain legal requirements. This Notice applies to all of
the records of your care generated by us. Your hospital or other
physicians may have different policies or notices regarding the use and
disclosure of medical information they create.
Notice will tell you about the ways in which we may use and disclose
medical information about you. It also describes your rights, and
certain obligations we have regarding the use and disclosure of medical
We are required by law to:
• Make sure that medical information that identifies you is kept
• Make available to you this Notice of our legal duties and privacy
practices with respect to medical information about you; and
• Follow the terms of the Notice that is currently in effect. This
Notice may change, in the manner described below under “Changes To This
The following categories describe different ways that we use and
disclose your your medical information (also known as Individually
Identifiable Health Information (IIHI) and/or Protected Health
Information (PHI)). For each category of use or disclosure, we provide
examples, but not every use or disclosure in a category is listed.
However, all of the ways we are permitted to use and disclose
information will fall within one of the categories.
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 personnel who
are involved in taking care of you. For example, we may forward your
records to another specialist to assure that you receive proper care.
Also, if you were referred to us by another health care provider, it is
likely that we will report back to that provider with information about
our diagnosis and plan for treatment.
disclose medical information about you to people outside the Department
who may be involved in your medical care, such as family members, close
friends, clergy or others we use to provide services that are a part of
your care. For instance, from time-to-time we may receive calls from
concerned family members or close friends to determine if a patient has
completed his or her appointment. Unless you have advised us otherwise,
in writing, we will let them know your current status with our office.
In addition, at some time, it may be necessary for our staff to reach
you by telephone in regard to your appointment. Unless otherwise
notified by you in writing, we will contact you using numbers you have
provided and we may have to leave a voicemail message for you. In
certain circumstances, care givers from nursing homes, assisted living
centers, etc. will bring a patient to our facility. Often these care
givers are exposed to that patient’s personal health information.
We may use and disclose medical information about you so that the
treatment and services you receive from us may be billed to and
collected from you, an insurance company or health plan or other third
party. For example, we may need to give your health plan specific
information about treatment you received at our office so your health
plan will pay us or reimburse you for the treatment. In addition, we,
or our representatives, may discuss payment issues with family members
or others involved in the process of paying for medical treatment you
have received. 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 have our bills and payment
arrangements outsourced to one or more third-party service providers
who issue, process and collect bills on our behalf. Each of these is
governed by the same health care information disclosure and
confidentiality laws that we must follow.
For Health Care Operations
We may use and disclose medical information about you for our
Department operations. These uses and disclosures are necessary to run
our Department and make sure that all our patients receive quality
care. For example, we may use medical information to review our
treatment and services, and to evaluate the performance of our staff in
caring for you. We may also combine medical information about many of
our patients to decide what additional services we should offer, what
services are not needed, and whether certain new treatments are
effective. We may also disclose information to doctors, nurses,
technologists, medical students, and other members of our staff for
review and learning purposes.
We may use and disclose medical information to tell you about
health-related benefits or services that may be of interest to you.
On occasion the Department may use outside organizations to provide
business services. Business Associates that will be exposed to your
health information are required to comply with all the same HIPAA
administrative, physical and technical safeguard requirements that
apply to the Department. Also, if the business associate contracts with
a third party, they too must comply with all HIPAA rules.
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.
We may also use and disclose medical information about you in the
situations described under “Special Situations,” below.
Uses Of Medical Information
Other 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 authorization. A form for such authorizations, both those that
you request and those that we request, is available from our office. If
you give us an authorization, you may later revoke 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 covered
by your written authorization. In that case, however, we will be unable
to take back any disclosures we have already made with your permission,
and we will still be required to retain our records of the care that we
provided to you.
Situations (Including but not limited to…)
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, or
in some cases, if needed to determine benefits to the Department of
Public Health Risks
We may disclose medical information about you for public health
activities. These activities generally 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 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; and/or
• To notify the appropriate government authority if we believe a
patient has been the victim of abuse, neglect or domestic violence. We
will only make this disclosure when required or authorized by law.
We may disclose medical information 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 programs, and compliance with civil rights laws.
The Department may disclose proof of immunization to a school where law
requires a school to have such information. Written authorization for
this disclosure is not required, however, the Department will obtain
agreement to this release, which may be oral, from a parent, guardian
or other person acting in loco parentis for the individual, or from the
individual himself or herself, if the individual is an adult or
It is a violation of Department Policy to use patient PHI for
Marketing, Research or to sell PHI in any way. Under no circumstances
will the Department engage in these activities.
It is a violation of Department Policy to use patient PHI for
fundraising purposes. The Department will not contact patients to
conduct fundraising activities using PHI as a source of identification.
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, but only if efforts have been made to tell you
about the request or to obtain an order protecting the information
We may release medical information if asked to do so by a law
• In response to a court order, subpoena, warrant, summons or similar
• To identify or locate a suspect, fugitive, material witness, or
• 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 our practice; 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.
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.
A decedent’s PHI is protected for 50 years after the individual’s
death. After that point, the information is no longer considered PHI.
Security, Intelligence and Federal Protective Service Activities
We may release medical information about you to authorized federal
officials for intelligence, counterintelligence, and other national
security activities authorized by law, and to authorized federal
officials where required to provide protection to the President of the
United States, other authorized persons or foreign heads of state or
conduct special investigations.
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 where
necessary for the institution to provide you with health care; to
protect your health and safety or the health and safety of others; or
for the safety and security of the correctional institution.
Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we maintain
Right to Inspect and Copy
You have the right to inspect and request a copy of medical information
that may be used to make decisions about your care. Usually, this
includes medical and billing records, but does not include
request an electronic copy of your PHI that is maintained
electronically. The Department will provide an electronic copy in the
form requested, if readily producible, or if not, in a readable
electronic form and format as agreed by you and the Department.
must submit any request to inspect and copy your medical records to our
staff, in writing. (A form for that request is available from our
office.) If you request a copy of your information, we may charge a fee
for the costs of copying, mailing or other supplies associated with
deny your request in certain very limited circumstances. If you are
denied access to medical information, you may request that the denial
be reviewed. Another health care professional chosen by our staff 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 that review.
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 our Department. You must submit any request for an amendment to our
staff, in writing. (A form for that request is available from our
office.) Your written request must provide a reason that supports your
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 our Department.
• Is not part of the information which you are permitted to inspect and
• Is accurate and complete.
Right to an Accounting of Disclosures
You have the right to request an “accounting of disclosures.” This is a
list of the disclosures we have made of medical information about you,
with some exceptions. The exceptions are governed by federal health
privacy law, and may include:
• Many routine disclosures for treatment, payment and operations; and
• Disclosures to you.
must submit any request for an accounting of disclosures to our office,
in writing. (A form for that request is available from our office.)
Your written request must state a time period, which may not be longer
than six years. The first report you request within a 12-month period
will be free. For additional reports, we may charge you for the costs
of providing the report. We will notify you of the cost involved, and
you may choose to withdraw or modify your request at that time before
any costs are incurred.
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 medical service you received. Also, you
have the right to designate a personal representative who will then
have the ability to access your personal health information, just as
you do. You may also ask us to be selective in the way we communicate
personal health information to you. For example, you may request that
we not contact you by telephone at your office or you may designate a
mailing address other than your home. Such requests must be made in
writing. (A form for such requests is available from our office.)
Please note that we are not required to agree to your requests.
However, if we do agree, we will comply with your request unless the
information is needed to provide you emergency treatment.
have the right to restrict the disclosure of PHI (for payment or health
care operations) to a health plan when you pay out-of-pocket, in full,
and request such a restriction. The Department must honor such a
request unless otherwise required by law. This restriction does not
apply to follow-up visits if they are not paid for in full out of
must submit any request for restrictions to our staff, in writing. (A
form for each request is available from our office.) Your written
request must tell us:
• What information you want to limit;
• Whether you want to limit our use, disclosure or both; and
• To whom you want the limits to apply, for example, disclosures to
Right to a Paper Copy of This Notice
You may ask us to give you a paper copy of this “Notice of Privacy
Practices” at any time by contacting our office.
Right to Receive a Breach Notice
Should the Department experience an impermissible use or disclosure of
PHI and that exposure poses a significant risk of financial,
reputational, or other harm to an individual, the Department will
provide individual notice to all persons affected by the breach.
If you believe your privacy rights have been violated, you may file a
complaint with our office or with the Secretary of the Department of
Health and Human Services. To file a complaint with our office, contact
our office. (A form for this purpose is available from our office.) You
will not be penalized for filing a complaint.
Department’s Right to Make Changes to This Notice
The Department reserves the right to change this Notice. When we do, we
may make the changed Notice effective for medical information we
already have about you, as well as information we receive in the
future. We will post a copy of the current Notice in our facilities.
Each Notice will contain on the first page, in the top right-hand
corner, its effective date. Also, each time you register at our office
for medical services, a copy of the current Notice in effect will be
available to you in the waiting area.
County Health Department
Home Health Agency
Hancock County Dental Center
671 Wabash Avenue
Carthage, IL 62321