HCC Privacy Practice Statement

The Sauk County Health Care Center must maintain the privacy of your personal health information and give you this notice that describes our legal duties and privacy practices concerning your personal health information. In general, when we release your health information, we must release only the information we need to achieve the purpose of the use or disclosure. However, all of your personal health information will be available for release to you, to a provider regarding your treatment, or due to a legal requirement. We must follow the privacy practices described in this notice. However, we reserve the right to change the privacy practices described in this notice, in accordance with the law. Changes to our privacy practices would apply to all health information we maintain. If we change our privacy practices, we will give you a revised copy of the privacy notice by mail or log on to our website www.co.sauk.wi.us\hcc\mainpg.htm

Without your written authorization, we can use your health information for the following purposes:

1. Treatment. For example, a doctor may use the information in your medical record to determine which treatment option, such as a drug or surgery, best addresses your health needs. The treatment selected will be documented in your medical record, so that other health care professionals can make informed decisions about your care.
2. Payment. In order for an insurance company to pay for your treatment, we must submit a bill that identifies you, your diagnosis, and the treatment provided to you. As a result, we will pass such health information on to an insurer in order to help receive payment for your medical bills.
3. Health Care Operations. We may need your diagnoses, treatment, and outcome information in order to improve the quality or cost of care we deliver. These activities may include evaluating the performance of your doctors, nurses, and other health care professionals, or examining the effectiveness of the treatment provided to you when compared to patients in similar situations.
4. As required or permitted by law. We must report some of your health information to legal authorities, such as law enforcement officials, court officials, or government agencies. For example, we may have to report abuse, neglect, domestic violence or certain physical injuries, or to respond to a court order.
5. For public health activities. We may be required to report your health information to authorities to help prevent or control disease, injury, or disability. This may include using your medical record to report certain diseases, injuries, birth or death information, information of concern to the Food and Drug Administration, or information related to child abuse or neglect. We may also have to report to your employer certain work-related illnesses and injuries so that your workplace can be monitored for safety.
6. For health oversight activities. We may disclose your health information to authorities so that they can monitor, investigate, inspect, discipline or license those who work in the health care system or for government benefit programs.
7. For activities related to death. We may disclose your health care information to coroners, medical examiners and funeral directors so they may carryout their duties related to your death, such as identifying the body, determining cause of death, or in the case of funeral directors, to carry out funeral preparation activities.
8. For organ, eye, or tissue donation. We may disclose your health information to people involved with obtaining, sorting or transplanting organs, eyes or tissue of cadavers for donation purposes.
9. For research. Under certain circumstances, and only after a special approval process, we may use and disclose your health information to help conduct research. Such research might try to find out whether a certain treatment is effective in curing an illness.
10. To avoid a serious threat to health or safety. As required by law and standards of ethical conduct, we may release your health information to the proper authorities if we believe, in good faith, that such release is necessary to prevent or minimize a serious and approaching threat to you or the publics' health or safety.
11. For military, national security, or incarceration/law enforcement custody. If you are involved with the military, national security or intelligence activities, or you are in the custody of law enforcement officials or an inmate in a correctional institution, we may release your health information to the proper authorities so they may carry out their duties under the law.
12. For worker' compensation. We may disclose your health information to the appropriate persons in order to comply with the laws related to workers' compensation or other similar programs.
13. Sauk County Health Care Center Directory. Unless you object, we may use your information, such as your name and location in our facility. Information about your religious affiliation will be disclosed to your clergy.
14. To those involved with your care or payment of your care. If people such as family members, relatives, or close personal friends are helping care for you or helping you pay your medical bills, we may release important health information about you to those people. The information released to these people may include your location within our facility, your general condition, or death. You have the right to object to such disclosure, unless you are unable to function or there is an emergency. In addition, we may release your health information to organizations authorized to handle disaster relief efforts so those who care for you can receive information about your location or health status. We will allow you to agree or disagree orally to such release, unless there is an emergency.
15. Special Consent. Special consent is required for information related to: Mental health, Developmental Disabilities, alcohol and drug abuse and HIV.
16. Fund Raising. Sauk County Health Care Center may contact you as part of a fund-raising effort.

NOTE: Except for the situations listed above, we must obtain your specific written authorization for any other release of your health information. If you sign an authorization form, you may withdraw your authorization at any time, as long as your withdrawal is in writing. If you wish to withdraw your authorization, please submit your written withdrawal to Medical Records.

YOUR HEALTH INFORMATION RIGHTS

You have several rights with regard to your health information. If you wish to exercise any of the following rights, please contact Medical Records at the Sauk County Health Care Center. Specifically, you have the right to:

1. Inspect and copy your health information. 
   With a few exceptions, you have the right to inspect and obtain a copy of your health information that is in a designated record set for as long as we maintain the protected health information. A " record set" contains medical and billing records and any other records that we use for making decisions about your health care coverage. However, this right does not apply to psychotherapy notes or information gathered for judicial proceedings. In addition, we may charge you a reasonable fee if you want a copy of your health information.
2. Request to correct your health information. 
   If you believe your health information is incorrect, you may ask us to correct information. You will need to make such requests in writing to medical records and give a reason as to why your health information should be changed. However, if we did not create the health information that you believe is incorrect, or if we disagree with you and believe your health information is correct, we may deny your request.
3. Request restrictions on certain uses and disclosures. 
   You have the right to ask for restrictions on how your health information is used or to whom your information is disclosed, even if the restriction affects your treatment or our payment or health care operation activities. Or, you may want to limit the health information provided to family or friends involved in your care or payment of medical bills. You may also want to limit the health information provided to authorities involved with disaster relief efforts. However, we are not required to agree in all circumstances to your requested restriction.
4. As applicable, receive confidential communication of health information. 
   You have the right to ask that we communicate your health information to you in different ways or places. For example, you may wish to receive information about your health status in a special, private room or through a written letter sent to a private address. We must accommodate reasonable requests.
5. Receive a record of disclosures of your health information. 
   In some limited instances, you have the right to ask for a list of the disclosures of your health information we have made during the previous six years. The request cannot include dates before April 14, 2003. This list must include the date of each disclosure, who received the disclosed health information, a brief description of the health information disclosed, and why the disclosure was made. We must comply with your request for a list within 60 days, unless you agree to a 30-day extension, and we may not charge you for the list unless you request such list more than once per year.
6. Obtain a paper copy of this notice.
   Upon your request, you may at any time receive a paper copy of this notice, even if you earlier agreed to receive this notice electronically.
7. Complain. 
   If you believe your privacy rights have been violated, you may file a complaint with us and with the Federal Department of Health and Human Services. We will not retaliate against you for filing such a complaint. To file a complaint with either entity, please contact the Sauk County Health Care Center Compliance Officer, or designated person, who will provide you with the necessary assistance and paperwork.

Again, if you have any questions or concerns regarding your privacy rights or the information in this notice, please notify the:

Sauk County Health Care Center
Medical Records Department
(608) 524-7500

This notice of medical information privacy is effective: April 14, 2003