This notice Describes How Information About YouMay be Used and Disclosed and How You Can GetAccess to This Information. Please Review It Carefully.
Hospice of Southern Kentucky is committed to treating and using protected health information about you responsibly. This Privacy Notice describes our privacy practices that relate to your protected health information. Your “protected health information” means any written or oral health information about you, including demographic data that can be used to identify you.This notice describes your rights to access and control your protected health information. This health information is created or received by your health care provider, and relates to your past, present or future physical or mental health condition.
Your Health Record and Protected Health Information
Each time you receive medical care from Hospice or another health care provider, a record of the visit or care provided is created. The record usually includes information such as your name, age, address, a history of your illness, injury or symptoms, any test results, x-rays or laboratory work, the treatment provided to you and treatment plans devised for your care and any notes on follow-up care to be performed. How your healthcare information may be used and what controls you may exercise over the use of your health care information is described in this Privacy Notice.
Uses and Disclosures of Protected Health Information
Hospice may use your protected health information for purposes of providing treatment, obtaining payment for treatment and conducting health care operations.In certain situations, we may also disclose patient information to another provider or health plan for their health care operations.
•Basis for planning your care and treatment
•To communicate among other health care professionals who contribute to your care
•Will serve as a legal document describing the care you receive
•A tool in educating health professionals
•A source of data information for our planning and marketing
•A means by which you or a third party payer can verify that services were actually provided
•Activities related to improving health care or reducing health care costs
•Medical review and auditing
•To Coroners, Funeral Directors and for Organ Donation
•For Specified Government Functions
•For Worker’s Compensation
Although your health record is the physical property of Hospice of Southern Kentucky, the information belongs to you.
You have the right to:
•Obtain a paper copy of this notice of information practices upon request.
•Inspect and copy your protected health information as provided for in 45 CFR 164.524.
•Amend your health record as provided for in45 CFR 164.524.
•Right to Request a restriction on uses and disclosures as provided for in 45 CFR 164.524.
•Request to receive confidential communications from us by alternative means or at an alternative location.
•To obtain an accounting of disclosures of your health information as provided in 45 CFR 164.524.
•Revoke your authorization to use or disclose health information except to the extent that action has already been taken.
Hospice of Southern Kentucky is required to:
•Keep your health information private and only disclose it when required to do so by law
•Explain our legal duties and privacy practices in connection with your health records
•Abide by the terms of this notice
•Notify you if we are unable to agree to a requested restriction
•Accommodate reasonable requests you may have for an alternative means of delivery or destination when sending your health information
We reserve the right to change the terms of this notice and to make the new notice provisions effective for all future protected health information that we maintain. If we change our information practices, we will provide a copy of the revised Notice by sending a copy of the revised Notice via regular mail or through in-person contact. We will not disclose your health information without your authorization, except as described in this notice.We will also discontinue to use or disclose your health information after we receive a written revocation of the authorization according to the procedures included in the authorization
HSK does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. These activities include, but are not limited to, hiring and firing of staff, selection of volunteers and vendors, and provision of services. We are committed to providing an inclusive and welcoming environment for all members of our staff, clients, volunteers, subcontractors, vendors, and clients.
Our goal is to treat you fairly. That’s why we follow Federal civil rights laws in our health programs and activities. We do not view or treat people differently because of their race, color, national origin, age, disability, or sex.
If you need assistance with any of the information we provide, please let us know. We offer services that may help you. These services include aids for people with disabilities to communicate effectively with us, such as language assistance through interpreters and are available at no charge to you. If you need these services, please call contact us at 270-782-3402.
If you believe that we have failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, please let us know. You have the right to file a grievance also known as a complaint. If you need to file a complaint please contact us: Address: 5872 Scottsville Rd Bowling Green KY 42104; Telephone number: 270-782-3402; [Dial 7-1-1 or TTY number 1-800-648-6056]; Fax 270-782-3496; Email: email@example.com. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, we are available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 or 1-800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
Nondiscrimination Notice Document
Attention: You have the right to get this information and help in your language for free. Interested in these services call for help (TTY: 711 or 1-800-648-6056).
Español (Spanish) :
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-270-782-3402, (TTY: 711 or 1-800-648-6056).
注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-270-782-3402（TTY：711 or 1-800-648-6056).
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-270-782-3402 (TTY: 711 or 1-800-648-6056).
Tiếng Việt (Vietnamese):
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-270-782-3402 (TTY: 711 or 1-800-648-6056).
ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 1-270-782-3402 رقم هاتف الصم والبكم:117 - 1-800-648-6056
OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 1-270-782-3402 (TTY- Telefon za osobe sa oštećenim govorom ili sluhom: 711 or 1-800-648-6056).
注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-270-782-3402（TTY:711 or 1-800-648-6056）まで、お電話にてご連絡ください。
Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-270-782-3402 (ATS : 711 or 1-800-648-6056).
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-270-782-3402 (TTY: 711 or 1-800-648-6056)번으로 전화해 주십시오.
Deitsch (Pennsylvania Dutch):
Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 1-270-782-3402 (TTY: 711 or 1-800-648-6056).
ध्यान दिनुहोस्: तपार्इंले नेपाली बोल्नुहुन्छ भने तपार्इंको निम्ति भाषा सहायता सेवाहरू निःशुल्क रूपमा उपलब्ध छ । फोन गर्नुहोस् 1-270-782-3402 (टिटिवाइ: 711 or 1-800-648-6056) ।
*Cushite/ Oroomiffa (Oromo):
XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-270-782-3402 (TTY: 711 or 1-800-648-6056).
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-270-782-3402 (телетайп: 711 or 1-800-648-6056).
Tagalog (Tagalog – Filipino):
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-270-782-3402 (TTY: 711 or 1-800-648-6056).
Ikirundi (Bantu – Kirundi):
ICITONDERWA: Nimba uvuga Ikirundi, uzohabwa serivisi zo gufasha mu ndimi, ku buntu. Woterefona 1-270-782-3402 (TTY: 711 or 1-800-648-6056).