Wayne County Hospital Affiliated Clinics and Practicing Members of Wayne County Hospital Medical Staff Notice of Privacy Practices

This notice describes how protected medical information about you may be used and disclosed and how you can gain access to this information. Please review carefully.

1. Wayne County Hospital, Affiliated Clinics and Practicing Members of Wayne County Hospital Medical Staff are permitted to make uses and disclosures of protected health information for treatment, payment and health care operations
2. Wayne County Hospital, Affiliated Clinics and Practicing Members of Wayne County Hospital Medical Staff are permitted or required, under specific circumstances, to use or disclose protected health information without the individual’s written authorization.
3. Other uses and disclosures will be made only with the Individual’s written authorization, and the individual may revoke such authorization
4. Wayne County Hospital, Affiliated Clinics and Practicing Members of Wayne County Hospital Medical Staff may:
   a. Contact the individual to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the individual or patient.
   b. Contact the individual/Patient to raise funds for Wayne County Hospital, Affiliated Clinics and Practicing Members of Wayne County Hospital Medical Staff, or
   c. Disclose protected health information to the sponsor of a group health plan, health issuer or HMO with respect to a group health plan.
5. The individual has:
   a. The right to request restrictions on certain uses an disclosures of protected health information. Wayne County Hospital, Affiliated Clinics and Practicing Members of Wayne County Hospital Medical Staff are not required to agree to a requested restriction, however.
   b. The right to receive confidential communications of protected health information, as applicable.
   c. The right to inspect and copy protected health information, as provided in the Privacy Regulation.
   d. The right to amend protected health information, as provided in the Privacy Regulation.
   e. The right to receive an accounting of disclosures of protected health information.
   f. The right to obtain a paper copy of the Notice from the covered entity upon request. This right extends to an individual who has agreed to receive the Notice electronically.
6. Wayne County Hospital, Affiliated Clinics and Practicing Members of Wayne County Hospital Medical Staff are required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and Privacy practices with respect to protected health information.
7. Wayne County Hospital, Affiliated Clinics and Practicing Members of Wayne County Hospital Medical Staff are required to abide by the terms of the Notice currently in effect.
8. Wayne County Hospital, Affiliated Clinics and Practicing Members of Wayne County Hospital Medical Staff reserve the right to change the terms of this Notice. The new Notice provisions will be effective for all protected health information that it maintains.
9. Wayne County Hospital, Affiliated Clinics and Practicing Members of Wayne County Hospital Medical Staff will provide individuals or patients with a revised Notice by method of public notice.
10. Individuals may complain to Wayne County Hospital, Affiliated Clinics and Practicing Members of Wayne County Hospital Medical Staff and to the Secretary of the Department of Health and Human Services, without fear of retaliation by the organization, if they believe their privacy rights have been violated.
11. Wayne County Hospital, Affiliated Clinics and Practicing Members of Wayne County Hospital Medical Staffs’ contact person for matters relating to complaints is:
    Kerry Giesken
    (641) 872-2260
    415 South East Street
    Corydon, IA 50060
    Email: kgiesken@mercydesmoines.org
12. This notice is first effective on March 24, 2003.