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The Trover Clinic Foundation, Inc.

This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Trover Health System values the privacy of your health information. This Notice of Privacy Practices describes examples of how we may use and give out ("disclose") your personal health information. This is not a complete list

Trover Health System includes Regional Medical Center, Trover Clinic, and Medical Center Ambulance Service. Regional Medical Center includes RMC Home Health, Green River Hospice, Muhlenberg Medical Center, Western Kentucky Medical Management Services, Inc., Mahr Cancer Center, and Sports Medicine & Rehabilitation. Each group within Trover Health System may share personal health information with other parts of Trover Health System as necessary to carry out treatment, payment, or healthcare operations.

Our duties

We are required by law to protect the privacy of your health information. We are also required to give you this notice to tell you how we may disclose your personal health information. We are required to abide by the terms of this Notice. We may change the terms of our notice at any time. Any new notice will be effective for all personal health information that we maintain at that time. Our current Notice of Privacy Practices can be found on the Internet at www.troverhealth.org, or by calling (270-825-5201) and asking that a copy be sent to you in the mail.

Personal health information that we may collect

The personal health information that we collect may include your name, address, birth date, social security number, medical and mental health history, payment sources, the names of your care givers (doctors, etc.), and how to contact your family and others involved in your care.

When we may use or give out your personal health information without your authorization

Treatment, Payment and Health Care Operations. The following are examples of how we may disclose your personal health information to deliver treatment, obtain payment, and operate our programs and business:

• We may share information with other health care providers who are involved in your care such as physicians, outside consultants and other facilities to which you may be transferred.
• We may share information with our business associates who perform services for us (e.g. billing, audit services). If we do share information with them, we will have a written contract that will obligate the business associate to protect the privacy of your personal health information.
• We may disclose your information to obtain payment. This may include sharing information with your health insurance as it makes payment decisions. They may verify your coverage and review services for medical necessity. We may also disclose your information to another health care provider to help them obtain payment.
• We may disclose your information to operate our programs and business. For example, we may use your information for our quality and safety programs. We may also use it to train medical students.
• We may contact you about your appointment.
• We may call you by name in the waiting room.
• We may contact you for a donation.
• We may contact you about treatment options, other health-related benefits, and other products and services that we offer.
• We may share your information with manufacturer representatives. For example, a technical advisor on new devices may be present during surgery to answer questions from the operating team.
• We may collect data for analysis. In many cases, we will take out information that might identify you personally. In other cases, we will use only limited information as permitted by the privacy laws for research, public health purposes, or health care operations.

Required By Law. We may use or disclose your personal health information as required by law. The use or disclosure will be made in strict compliance with the law.

Public Health. We may give out your personal health information for public health purposes. For example:

• We report limited information to a public health authority in order to prevent or control disease, injury, or disability. For example, we contact the Health Department when we identify certain diseases, such as tuberculosis.
• We may give your personal health information to the Food and Drug Administration (FDA) about a product or activity that relates to your health.

Contagious Diseases. When permitted by law, we may disclose your information to a person who may have been exposed to a communicable disease.

Health Oversight. We may disclose your information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the healthcare system, government benefit programs, or other government regulatory programs. For example, we may disclose information to the state agency that issues our hospital license.

Abuse or Neglect. We may disclose your personal health information to a governmental agency authorized to receive such information if we believe that you have been a victim of abuse, neglect, or domestic violence. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Legal Proceedings. We may disclose your personal health information for judicial and administrative proceedings, such as responding to a subpoena or court order.

Law Enforcement. We may disclose your personal health information for law enforcement purposes, such as providing limited information to locate a missing person, to report certain types of wounds, and to report crimes that occur on our property.

Coroners, Funeral Directors, and Organ Donation. We disclose your information to a coroner or medical examiner in order for them to perform their legal duties such as making identification and determining cause of death. We disclose your information to funeral directors to permit them to carry out their duties. We also are required to disclose your information for organ donation. You or your family must approve organ donations.

Research. We may disclose your personal health information for research studies that meet all privacy law requirements, such as research related to the prevention of disease or disability.

Criminal Activity. We may disclose your information if we believe it is necessary to prevent or lessen a serious threat to health or safety. We may also disclose personal health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

Military Activity and National Security. If you are a member of the United States military, we may disclose your information as required by military command authorities. We may disclose your personal health information for federal officials to conduct national security and intelligence activities, to protect the President or other specified people, or to conduct special investigations. We disclose information for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.

Workers' Compensation. We may disclose your personal health information under workers' compensation laws and other similar programs.

Inmates. If you are in custody, we may disclose your personal health information to the correctional facility or the law enforcement official that maintains your custody.

Your authorization is required for other uses and disclosures

You must give us your written authorization before we disclose your personal health information for other uses. You may revoke an authorization at any time by contacting our Privacy Officer. A revocation will not apply to any action we have taken in reliance on the authorization.

You have the opportunity to agree or object

You have the opportunity to agree or object to the use or disclosure of all or part of your personal health information as described below.

Hospital Directory. Unless you object, we will disclose your name, room number and condition (in general terms) in the hospital directory. This information will be disclosed to people who ask for you by name. We may disclose your religious affiliation to the clergy if you provide this information.

Others Involved in Your Healthcare. Unless you object, we may disclose your information to a relative, a close friend, or any other person you identify. We may also give out your information when it appears, under the circumstances, to be in your best interest to do so.

Disaster Relief. We may disclose limited information to an authorized entity to assist in disaster relief efforts if we cannot contact you.

Your rights

Access to your information. You may see and receive a copy of your personal health information. In some cases, we may deny your request. When required by law, we will give you an opportunity to have our denial reviewed.
Under federal law you may not inspect or copy certain records such as psychotherapy notes. Please contact our Privacy Officer if you have questions about access to your medical record.

Limits on what we use and disclose. You may ask us to limit how we use and disclose your health information to provide treatment, to obtain payment, to operate our programs and business, and to communicate with your family, friends, and others you have identified. Your request must state the specific restriction requested and to whom you want the restriction to apply. We are not required to agree to that request.

If Trover Health System does agree to the requested restriction, we may not use or disclose your personal health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with the Medical Records Manager or the Privacy Officer.

Confidential communications. We will accommodate reasonable requests. However, we may require you to tell us how you will handle payment and give details about where and how to contact you. We will not ask you why you make this request. Please make this request in writing to our Privacy Officer, Registration Manager, or Satellite Clinic Manager.

Amend your personal health information. You may ask that we amend your personal health information. We may deny your request. If we deny your request, you can appeal the denial in writing. We will respond to your appeal in writing. Please contact Medical Records or our Privacy Officer.

List of disclosures. You have the right to receive a list of those who received your personal health information from us during the six years before your request. We do not have to include what we disclosed:

• Before April 14, 2003
• To carry out treatment, payment and health care operations.
• For our hospital directory and to persons involved in your care.
• For national security or intelligence purposes.
• To prisons or their officers.
• To you or someone you have asked to speak for you.
• To those who get this information with your approval.

Reporting a problem

If you believe we violated your privacy rights, you may complain by:

• Contacting the patient representative at (270) 825-5391 or (270) 825-7313.
• Contacting Jerry Kelley, our Privacy Officer, at (270) 825-5629 or by mail at Regional Medical Center, 900 Hospital Drive Madisonville, Kentucky 42431.
• Contacting the Secretary of Health and Human Services.

We will not retaliate against anyone who makes a complaint.

Additional information

We may collect information that is not described above. We may use and disclose your information in any manner that is consistent with the concepts described in this Notice or permitted by the privacy laws.

For additional information about our privacy policies, please contact our Privacy Officer.

This notice was published and becomes effective on April 14, 2003.

Patient care and safety concerns

Individuals are encouraged to contact Regional Medical Center (270-825-5391) regarding patient care or safety concerns that have not been addressed.

If the concern continues, you may contact:

Joint Commission on Accreditation of Healthcare Organizations

One Renaissance Boulevard
Oakbrook Terrace, IL 60181

Patient complaint and grievance reporting

Please contact our patient representative at 270-825-5391 to report complaints or grievances regarding your or a loved ones care.

You may also report grievances to the Cabinet for Health Services Office of Inspector General at 270-889-6052.

Notice of Non-Discrimination

As a recipient of Federal funds, Trover Health System does not exclude, deny benefits to or otherwise discriminate against any person on the grounds of race, color, or national origin, or on the basis of disability or age in admission to, participation in, or receipt of the services and benefits of any of its programs and activities or in the employment therein, whether carried out by the hospital directly or through a contractor or any other entity with whom this facility arranges to carry out its programs and activities.

This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Regulations of the U.S. Department of Health and Human Services issued pursuant to the Acts, Title 45 Code of Federal Regulations Part 80, 84, and 91, and the Kentucky Civil Rights Act of 1966 and amendments thereto.