As required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPPA) this notice describes how health information about you (as an employee or as a client of this agency) may be used and disclosed, and how you can get access to this information.

PLEASE REVIEW THIS NOTICE CAREFULLY

If you have any questions about this notice please contact the Privacy Officer:
Angela Smith , Payroll/Benefits Coordinator
309 Spangler Drive
Richmond, Ky 40475
859-624-2046

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “ Protected health information” (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. Our agency is dedicated to maintaining the privacy of your protected health information.

We are required to abide by the terms of this Notice of Privacy Practices. We may revise or amend the terms of our notice, at any time. The new notice will be effective for all protected health information that we have at that time and for the future information. We will post our current Notice in our office in a visible location at all times and upon your request, we will provide you with any revised Notice.

Disclosures

1. Uses and Disclosures to carry out treatment, payment or health care operations:

We may use and disclose your Protected Health Information (PHI) for the following reasons:

Treatment: We will use and disclose your PHI to provide, coordination, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. Individuals who work for our agency may use or disclose your PHI in order to treat you or to assist others in your treatment. Additionally, we may disclose your PHI to others who may assist in your care, such as your spouse, children or parents. Finally, we may also disclose your PHI to other health care providers for purposes related to your treatment.

Payment: Your protected health information will be used as needed to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for health care services such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan obtain approval for the hospital admission.

Healthcare Operations: We will share your protected health information with third party “ business associates” that perform various activities involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

Treatment Options and Services (when applicable): We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.  However, we will get written authorization from you for further marketing purposes.

2. Uses and disclosures that you can agree or object to:

We may use and disclose your protected health information in the following instances, which you have the opportunity to object to.

Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

Emergencies: We may use or disclose your protected health information in an emergency treatment situation. If this happens, your physician or this agency shall allow you to object to future disclosures as soon as reasonably practicable after the delivery of treatment.

3. Uses and disclosures that will obtain your written authorization for:

Psychotherapy Notes: We may only disclose your psychotherapy notes for limited purposes such as carrying out treatment. For other purposes we will obtain your written
consent.

Marketing: For most marketing purposes we will obtain your written consent.

4. Uses and disclosures for which an authorization or opportunity to agree or object to is not required:

We may use or disclose your protected health information in the following situations:

Required By Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.

Public Health: We may disclose your protected health information for public health activities and purpose to a public health authority that is required or permitted by law to receive the information. The disclosure will be made for the purpose of controlling or reporting disease, injury or disability. We may also disclose your protected health information, if directed by the
public health authority, to a foreign government agency that is collaborating with the public health authority.

Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise
be at risk of contracting or spreading then disease or condition.

Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive authorizes to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.

Maintenance of Vital Records: We may report data such as births and deaths.

Health Oversights: we may disclose protected health information to a health oversight agency for activities authorized by law, such as adults, investigations, and inspections.  Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required law, (2) limited information request for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the agency, and (6) medical emergency (not on the agency’s premises) and it is likely that a crime has occurred.

Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.  We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend and individual.

Military Action and National Security: When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits; or (3) to a foreign military authority if you are a member of that foreign ,military services. We may also disclose your protected information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.

Workers’ Compensation: Your protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally-established
programs.

Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or
determine our compliance with the requirements of Section 164.500 et. Seq.

Disclosures required by Kentucky State law: We will disclose information limited to the relevant requirements of the law.

Your Rights:

Following is a statement of your rights with respect to your protected health information and a brief description of how you may excise these rights.

You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained
in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other records that the
agency uses for making decisions about you. This may not include psychotherapy notes.

Employees must submit a request in writing to the Benefits Coordinator: 309 Spangler Dr. Richmond, Ky 40475 (859-624-2046) in order to inspect and / or obtain a copy of your PHI, or if you have questions about access to your medical records. Clients or their personal representatives may also make a request for PHI by contacting the Privacy Officer at the same address and phone number listed above.

You have the right to request a restriction of your protected health information: This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. This agency is not required to agree  to a restriction that you may request. If this agency believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If this agency does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with the Privacy Officer. You may also request applicable restrictions of your PHI by completing a Request for Limitation and Restrictions of Protected Health Information form and submitting it to the agency’s Privacy Officer: 309 Spangler Dr. Richmond, KY 40475. This form may be obtained by calling the Privacy Officer @ 859-624-2046.

You have the right to request that our agency communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to the Privacy Officer @ 859-624-2046 specifying the requested method of contact, or the location you wish to be contacted. Our agency will accommodate reasonable request. You do not need to give a reason for your request.

You have the right to have this agency your protected health information. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, for example if we think the information is correct, or was not created by our agency, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Officer to determine if you have questions about amending your medical record, to file an amendment, your request must be in writing and must be submitted to the Privacy Officer: 309 Spangler Dr. Richmond, Ky 40475

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.

This right applies to disclosures for purpose other than treatment, payment or healthcare operation as described in this Notice of Privacy Practices. Accounting is not required for disclosures we may have made to you, incidental disclosures,disclosures you have authorized, disclosures for a facility directory, disclosures to family members or friends involved in your care, or disclosures made to carry out treatment, payment or health care operations. You have the right to receive specific information regarding disclosures that occurred after April 14, 2003 up to a six year timeframe. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations.

In order to obtain an accounting of disclosures, you must submit your request in writing to the Privacy Officer, 309 Spangler Dr. Richmond, Ky 40475

You have a right to a paper copy of this notice. You are entitled to receive a paper copy of our notice of privacy practices even if you have agreed to receive an electronic copy of the
Notice. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact the Privacy Officer at 309 Spangler Dr. Richmond, Ky 40475

You have a right to file a complaint if you believe your privacy rights have been violated.  You may file a complaint with our agency or with the Secretary of the Department of Health
and Human Services. To file a complaint with our agency, contact the Privacy Officer @ 309 Spangler Dr. Richmond, Ky 40475(859-624-2046). All complaints must be submitted in writing. You will not be penalized for filing a complaint.

This notice was published and becomes effective on April 14, 2003.

ACKNOWLEDGEMENT OF NOTICE
Kentucky River Foothills Development Council, Inc.
Acknowledge of Receipt of Notice of Privacy Practices

I,__________________________, have received a copy of Kentucky River Foothill’s Development Council’s Notice of Privacy Practices.

__________________________________________________________________________
Signature of Employee & Date

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