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.
Wamego City Hospital provides health care services and products to those we serve in cooperation with physicians and other professionals and organizations involved in your care. Our privacy practices govern the following:
• Health care professionals;
• Workforce, students, and volunteers; and,
• Business Associates with whom we share your protected health information ("PHI").
We are required by law to:
• Maintain the privacy of your PHI;
• Provide you this notice of our legal duties and privacy practices with respect to PHI;
• Abide by our current Notice of Privacy Practices ("NPP"); and
• Follow the more stringent state law or federal law.
Wamego City Hospital reserves the right to change our NPP at any time. Changes apply to PHI we already maintain. When we make a significant change to our policies or privacy practices, we post the new NPP in clear and prominent locations and on our web site at www.wamegocityhospital.com. You may request a copy of the current NPP at any time. The NPP is provided no later than date of first service. You are required to acknowledge in writing that you received this NPP.
Permissible Uses and Disclosure of PHI:
• We are permitted to use and disclose PHI for treatment. For example, we may provide PHI to another
provider such as a specialist as part of a referral or another provider who has been asked to be involved
in your care.
• We are permitted to use and disclose PHI to obtain payment for treatment. For example, we may send
PHI as part of the billing information to your insurance company or payer.
• We are permitted to use and disclose PHI for use in health care operations. For example, we may use
PHI to improve quality of our care or operations or to evaluate our staff's performance while caring for you.
• Subject to certain limitations, we are permitted to use and disclose PHI without your prior authorization for
public health purposes; reporting on abuse, neglect, or domestic violence; health oversight activities;
funeral arrangements; organ donations; law enforcement activities; research purposes; workers'
compensation purposes; prevention of serious threats to health or safety; or when required by federal,
state, or local law.
• We are permitted to contact you for appointment reminders or to inform you about treatment options,
alternatives, health-related benefits, or services that may be of interest to you.
• Unless you object, we list your name, room number, location, general condition (good, fair, etc.), and
religious affiliation in the patient directory and your religious affiliation may be disclosed to a clergy member.
• We are permitted to disclose PHI to a friend, family member, or other individual who you identify as being
involved in your medical care or payment for care. In situations where you are incapacitated or unable to
make this decision, we will use our professional judgement in making such disclosures.
• We are permitted to disclose PHI to disaster relief authorities, so that your family may be notified of your
location and condition.
Except as previously described, we must obtain your written authorization before using or disclosing your PHI. You can later revoke any authorization by notifying us in writing of your decision.
Your Rights and Responsibilities regarding PHI:
• In most cases, you have the right to review or obtain a copy of your PHI by submitting a written request. If
you request a copy, either paper or electronic, we may charge a reasonable fee for this service. If your
request is denied, you may submit a written request for review of that decision.
• If you believe information in your record is incorrect or missing, you may request an amendment of the
record by submitting a written request. If your request is denied, you may appeal, in writing, the decision
not to amend a record. You may also ask that your written statement requesting an amendment be placed
in your medical record.
• You have the right to request an accounting of the disclosures of your PHI made to outside parties. This
does not include the permitted disclosures of treatment, payment, and health care operations. The
request must state the time period desired for the accounting of disclosure, but not more than 6
years prior to the current date. You may request the accounting be provided in paper or electronic
form. One accounting of disclosure in a 12-month period is free; additional requests are billed based
on the cost of production. We will inform you of the fee for this service before any charges occur.
• We will agree to your request to restrict PHI disclosed to a health plan for payment or healthcare operations
(i.e., non-treatment) purposes if the information is about a health care service or product for which you
paid us, out-of-pocket, in full.
• You may request that we communicate with you in a specific manner. Such special request must be
submitted in writing.
• You may request additional restrictions regarding the use and disclosure of your PHI. Although not legally
required to comply with your request, we carefully review all such request and provide notification of
• If you obtained this NPP electronically, you have the right to a paper copy.
• We may contact you for fundraising activities. You may opt out of fundraising communications by
completing an opt-out form available with this notice.
Electronic Health Information Exchange:
Wamego City Hospital participates in the electronic exchange of health information with other healthcare providers and health plans in the State of Kansas through an approved health information organization. Through our participation, your PHI may be accessed by other providers and health plans for the purposes of treatment, payment, or health care operations.
Under Kansas law, you have the right to decide whether providers and health plans can access your health information maintained at a health information exchange ("HIE"). You have two choices. You can permit authorized individuals to access your PHI maintained at the HIE for treatment, payment, or health care operations. If you choose this option, you do not have to do anything.
You can choose to restrict access to your PHI maintained at an HIE by submitting the required form to the Kansas Health Information Exchange at http://www.khie.org. Your restriction does not prevent access to your PHI maintained by an HIE for purposes of obtaining information about certain communicable diseases or suspected incidents of abuse by authorized individuals. Your decision to restrict access of your PHI maintained at an HIE does not prevent permissible uses and disclosures of your PHI, outside of an HIE, by Wamego City Hospital as outlined in this notice. Additional information regarding electronic health information exchange is available at http://www.khie.org.
Patient Grievance Process Notice
A grievance is a formal or informal written or verbal complaint that is made to Wamego City Hospital by a patient (or a patient representative) when an issue cannot be resolved promptly by the staff present. If a complainant requests their complaint to be handled as a formal complaint, then the complaint is considered a grievance. Wamego City Hospital has two responsibilities in handling grievances as described below.
First: Wamego City Hospital has a duty to inform patients of the following:
•1. To file a grievance please contact our Risk Manager at 785-458-7420 or our Administrator at
•2. Patients have the right to lodge a grievance with the state agency directly, regardless of whether he/she
has first used the hospitals grievance process.
•3. Complaints directed to the State go to the Kansas Department of Health and Environment 1000 SW
Jackson, Suite 200 Topeka, Kansas 66612-1365 Phone: 800-842-0078
Second: If a grievance has been made, Wamego City Hospital will provide the patient with an initial written notice. This initial written notice will be sent within approximately seven (7) days of the grievance.
Once an investigation of a grievance is complete a final written notice will be provided to the patient.
The final written notice will provide these elements:
•1. Wamego City Hospital's decision
•2. Wamego City Hospital contact person
•3. Steps taken to investigate the grievance
•4. Investigation results
•5. Completion date of investigation
Grievance Resolution: The grievance may be considered resolved when either the patient is satisfied with the actions taken on their behalf or when Wamego City Hospital has demonstrated that it has done everything feasible to resolve the issue.
To File a Written Grievance Please fill out the following information:
Contact Phone Number:
Please write your comments here:
Questions and Concerns:
• Written requests or appeals should be submitted to the Privacy Officer listed below.
• If you wish to file a complaint because you believe that your privacy rights may have been violated, please
contact the Privacy Officer.
• You also may send a written complaint to the U.S. Department of Health and Human Services Office of
• Retaliation or retribution for making complaints or raising concerns are prohibited.
Privacy Officer, Wamego City Hospital
711 Genn Dr.
Wamego, KS 66547
U.S. Dept. of Health & Human Services
Offices of Civil Rights
200 Independence Ave., S.W.
Washington, DC 20201
Effective Date: September 2, 2012