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Your Rights Regarding Your Health Information
Right to Inspect & Copy
You have the right to inspect and copy health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.

To inspect and copy your health information, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the person identified in the beginning of this notice. You will be asked to complete a written authorization form. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies and services associated with your request. We may require that you pay such fee prior to receiving the requested copies.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. Another licensed health care professional chosen by HCHD will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

Right to Request Amendment
If you believe that our records contain information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for HCHD.

To request an amendment, you must complete a specific form providing information we need to process your request, including the reason that supports your request. To obtain this form or to obtain more information concerning this process, please contact the privacy officer at 620-842-5132.

We may deny your request for an amendment if you fail to complete the required form in its entirety. In addition, we may deny your request if you ask us to amend information that:
  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment
  • Is not part of the health information kept by or for HCHD
  • Is not part of the information that you would be permitted to inspect or copy
  • Is accurate and complete

If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your records.

Right to An Accounting of Disclosures
You have the right to request an accounting of disclosures. This is a list of the disclosures we made of health information about you, with certain exceptions specifically defined by law.

To request this list or accounting of disclosures, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the privacy officer at 620-842-5132.

Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions
You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about to you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not disclose information about a surgery you had.

We are not required to agree to your request except if the (a) disclosure is for the purposes of carrying out payment or health care operations and is not otherwise required by law, and (2) the protected health information pertains solely to a health care item or services for which you or any person (other than a health plan on your behalf) has paid Harper County Health Department/Harper County Home Health Agency in full. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the privacy officer at 620-842-5132.

Right to Request Alternative Methods of Communication
You have the right to request that we communicate with you about matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

To request an alternative method of communications, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the privacy officer at 620-842-5132. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To obtain a paper copy of this notice, contact the privacy officer at 620-842-5132.

Rights Relating to Electronic Health Information Exchange
When the Harper County Health Department/Harper County Home Health Agency begins participation in an electronic health exchange (HIE), the technology will allow the exchange electronic records for specific patients from other HIE participants for purposes of treatment, payment, or health care operations.  You have two options with respect to HIE.  First, you can permit authorized individuals to access your electronic health information through an HIO (health informaiton organization).  If you choose this option you do not have to do anything.

Second, you can restrict access to all of your electronic health information (except access by properly authorized individuals as needed to report specific information as required by law).  If you wish to restrict access, you must compelte and submit a specific form available at http://www.khie.org.  You cannot restrict access to certain information only, your choice is to permit or restrict access to all of you r information. 

Complaints
If you believe your right with respect to health information about you has been violated by HCHD, you may file a complaint with HCHD. You may also file a complaint with the State Health Department or with the Secretary of the Department of Health and Human Services. To file a complaint with HCHD, contact the privacy officer at 620-842-5132. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Harper County, KS
201 N. Jennings Ave.
Anthony, KS  67003
Ph: 1-877-537-2110