This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. PLEASE READ CAREFULLY. If you have any questions, please contact our Privacy Officer at 859-626- 4241.

Who will follow this notice?

The Madison County Health Department (MCHD) provides health care to our patients, in cooperation with physicians and other professionals and organizations. The privacy practices in this notice will be followed by:

• any health care professional who treats you at any of our facilities, your home, or your child’s school
• all divisions and work units of our organization all employees, contractors or volunteers of our organization
• any business associate or partner of MCHD with whom we share health

The Madison County Health Department will protect your health information:

Protected Health Information includes information about:

• past, present, or future health information
• health care that you receive
• payment for your health care

The Health Insurance Portability and Accountability (HIPAA Law of 1996) says we must:

• protect this information to make sure it stays private
• follow the privacy practices described in this notice
• share only the minimum amount of information that is necessary

We reserve the right to revise our privacy practices and this notice at any time. If we do, we will post a new notice in the MCHD waiting rooms and distribute it to any new patients or clients we see in the clinic, home, or schools. You may ask us for a copy of the new notice or you may get it from our website at: http://www.madisoncountyhealthdept.org/. You will be asked to sign a form that documents you have received our Notice of Privacy Practices.

How we might use your Protected Health Information:

The law says the Madison County Health Department may use your Protected Health Information for these reasons:

• For use by doctors, nurses, APRNs, and other healthcare providers who need to treat you at MCHD, in your home, or your child’s school.
• To bill and get paid for the treatment we gave you. For example, we might give your information to Medicaid, Medicare, or another insurer so that we will be
• To operate within our programs standards. For example, to review the quality of the care we give you.
• To share with healthcare providers we refer to or that refer to
• To remind you of your appointment, and to provide information about health-related benefits and services, which may include sending information to your home. You can tell us if you do not want to get this

We can share your Protected Health Information with your authorization when:

• You sign a valid authorization; you may cancel this authorization in writing at any
• Uses or disclosures of protected health information (PHI) for marketing purposes requires authorization;
• The disclosure or sale of PHI requires authorization;
• Contact for telephonic or text appointment reminders requires

We can share your Protected Health Information without your authorization when:

• It is required by law e.g.; suspect child abuse or neglect.
• There might be abuse, neglect, domestic violence, or criminal
• There is a court
• We need to review your records to make sure we are following the law.
• We need to collect information about disease or injury, or to report births and deaths to other healthcare providers.
• We need to give the information to an agency that reports or looks at illness or injury that is unusual.
• We need to share your information with coroners and funeral directors in the case of your death, and with organ, tissue and blood donor
• We need to share your information with law enforcement, prisons, or the military, etc. if there is a threat to health and
• When releasing to public health agencies to help control and track reportable diseases, injury, or

You can refuse to share your Protected Health Information:

If you do not want others to have your Protected Health Information as designated in #2 you must state this in writing. This may limit the ability of other health care providers to treat you. If you are too sick, you may not be able to decide “no”. Where possible, you must be given the opportunity to say “no” in writing. We agree to restrict the disclosure of PHI to a health plan when you (the patient) paid for the service or item in question out of pocket in full.

You have other rights. You may:

• Ask that we limit the use of your Protected Health We do not have to agree to those limits. If we do agree, we will do so in writing and will follow your requests unless there is an emergency, or unless law enforcement, the courts, or the government ask for the information. We will not agree to your requests if they are against the law. You may verbally cancel this limit with us.
• Tell us how and where to contact you. We will do our best to follow your
• Ask to review your Protected Health Information. You must ask us in writing. We will answer you in 30 days or less. If we say that you cannot review your Protected Health Information, we will tell you why in writing. You may ask us to review your request again. You have the right to review your information for as long as it is
• Ask for copies of your Protected Health Information. You must tell us in writing what you want copied and sign a release. There will be no charge to you. Note: there may be a charge to lawyers and other third parties for copies of Protected Health information.
• Ask us in writing to correct or add to your Protected Health Information or if you think there is something wrong with your information or that something is We will answer you within 60 days of getting your letter. We may say “no” if we think that the Protected Health Information is:
  • accurate and complete
  • from another agency and not the Madison County Health Department
  • not in a designated record set
  • not subject to your review

We will tell you why you cannot change your Protected Health Information. We will also tell you how to have your request reviewed again. If we agree your Protected Health Information is wrong, we will change it. We will inform you and others who need to know about the changes.

• Ask us in writing for an accounting of your information that we have shared with We will tell you:
  • whom we shared it with
  • what we shared
  • when we shared it, and
  • why we shared it

We will let you know this information in writing (in printed or electronic form) within 60 days of getting your request. There is no cost for one request each year. We will give you information up to a five-year period that began after April 13, 2003.

You have a right to be notified when a breach of your unsecured PHI has occurred.

In the case of a breach of unsecured protected health information, we will notify you as required by law. In some circumstances, our business associate may provide the notification.

Madison County Health Department contact person:

If you have questions about this Privacy Notice or complaints about our privacy practices, please contact our Privacy Officer, Madison County Health Department, 216 Boggs Lane, Richmond, KY 40476

You may file a complaint:

If you think we have made a mistake with protecting your information you can report this by writing to us, or to the U.S. Department of Health Human Services at HHS Privacy Advocate John Fanning, HHH Bldg., Room 440-D, Washington, D.C. 20201. There will be no retaliation for filing a complaint.