NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW CAPE GIRARDEAU COUNTY PUBLIC HEALTH CENTER
MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION AND HOW YOU CAN
ACCESS THIS INFORMATION PLEASE REVIEW CAREFULLY

The Cape Girardeau County Public Health Centers' (CCHD) mission is to protect and promote the health of the population of Cape Girardeau County. To accomplish this mission, Missouri has enacted a number of state laws and/or rules that require reporting of individually identifiable protected health information (PHI) to the Missouri Department of Health and Social Services (DHSS). DHSS continuously assess the health of the population by evaluating this and other health information. These laws also detail what data are confidential, under what circumstances the data may be disclosed, and penalties for inappropriate disclosures. CCHD staff and their associates are mandated to comply with these laws. The law further requires that CCHD maintain the privacy of protected health information and to provide individuals with notice of its legal duties and privacy practices.

CCHD may disclose public health related individually identifiable health information to health care providers to carry out treatment, payment, or health care operations. This information will only be shared with health care providers that have signed an agreement with CCHD. It will not be used for any other purpose except in an aggregate form, without specific written consent of the individual or their parent or guardian if a minor. The confidentiality of the information will be maintained as required by applicable state and federal laws. An example of these types of disclosures would be sharing the results of your infant's heel blood test with the health care provider you visit for medical care. The results would only be disclosed to appropriate health care providers and not the general public or merchants that have a product they wish to sell.

YOUR RIGHTS
Under 45 CFR 160-164, individuals have rights regarding their protected health information, and CCHD must act on these requests within 60 days:

• Request restrictions on certain uses and disclosures, however CCHD is not required to agree to a requested restriction. If disclosure is required by state or federal laws, the consent of the individual is not required and disclosure will be made accordingly.
  
• Inspect and receive a copy of their health care information and amend or update it if it is inaccurate.
  
• Receive an accounting of disclosures - to receive a list of disclosures we have made of your health information for purposes, other than treatment, payment, healthcare operations and certain other activities, for a period of time up to six years, but not including dates before April 14, 2003. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for providing the list.
  
• Receive confidential communications of protected health information - You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. You must make your request in writing and it must specify the alternative means or location.
  

USES AND DISCLOSURES OF HEALTH INFOMATION
Examples of uses and disclosures for treatment:

• If the nurse practitioner or physician at CCHD refers you for a test and needs to call the provider for results, the nurse practitioner or physician may give your name and the reason for ordering the test to the other doctor's office.
  
• A nurse or nurse practitioner at CCHD may call you to advise you of treatment alternatives.
  
• We may use or disclose health information to notify or assist in the notification of a family member or personal representative of your location, your general condition, or death, if you are present, then we will provide you with a opportunity to object to such uses or disclosures before they are made. In the event of your incapacity or emergency circumstances, we may disclose information that is directly relevant to the peron's involvement in your healthcare, if we determine that it is in your best interest to do so. As required by law: We may disclose your health information when we are required to do so by federal, state or local law.

Examples of uses and disclosures to obtain payment:

• The CCHD may submit a claim form that contains your name, address, social security number, diagnosis, and procedures performed in our office to your insurance company.

Examples of uses and disclosures to operate the Cape Girardeau County Public Health Center:

• The CCHD nurses, nurse practitioners or physicians may audit (read and comment on) your chart, to track and improve our performance in assuring that we perform screening tests and immunizations on time.
  
• The CCHD staff may mail you reminders of upcoming appointments
  
• The CCHD staff may leave messages on your telephone and ask you to return our call.

The CCHD may use or disclose protected health information about you for other purposes, and without your consent, if the law requires us to disclose information to government authorities. Examples of such uses or disclosures include suspected abuse and infectious diseases.

• Judicial and administrative proceedings: We may disclose medical information about you in response to a court or administrative order. We may disclose medical information in response to a subpoena, discovery request, or other lawful process.
  
• Law enforcement purposes: We may disclose health information to law enforcement officials when certain conditions are met.
  
• Worker's compensation: We may release medical information about you for worker's compensation or similar programs.
  
• National Security and similar government functions: We may disclose to the military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. If you are an inmate o f a correctional institution or under custody of a law enforcement official, we may disclose information about you to the institution or official under certain circumstances.
  
• Organ or Tissue donation: If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank as necessary to facilitate organ or tissue donation and transplantation.

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.

CCHD reserves the right to change its privacy practices described in this notice and to provide individuals with notice revisions. CCHD will post all updates and or revisions on the agency website. Individuals may obtain updates by visiting the CCHD website at www.cgcohealthdept.com/index.html.

You may complain to CCHD or the U.S. Department of Health and Human Services if you believe your privacy rights have been violated. File a complaint with the practice by writing to Cape Girardeau County Public Health Center, P.O. Box 1839, Cape Girardeau, MO 63702. NO one will retaliate against you for filing a complaint. For more information about this notice, contact the CCHD at 573-335-7846.

Effective: 04/2003

Cape Giradeau Public Health Center is An Equal Opportunity/Affirmative Action Employer.
Services provided on a non-discriminatory basis