Notice of Privacy Practices

Effective Date: April 14, 2003
Revision Date: June 1, 2009


If you have any questions about this notice, please contact our Privacy Officer at
(812) 265-0121.

This notice describes our organization's practices and that of:

  • Any health care professional authorized to enter information into your patient record.
  • All departments and units of the organization.
  • All employees, staff and other organizational personnel, including volunteer groups associated with the organization.
  • All these entities, sites and locations will follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for the express purpose of treatment, payment or organizational operation purposes described in this notice.

We understand that medical information about you and your health is personal and we are committed to protecting that information. We create a record of the care and services you receive at this organization to enable us to provide you with quality care and comply with certain legal requirements. This notice applies to all records of your care generated by this organization, whether made by hospital personnel, your personal doctor or other practitioners involved in your care.

This notice will inform you about ways in which we may use and disclose your medical information. This notice also describes your rights and certain obligations we have regarding the use and disclosure of your medical information.

We are required by law to:

  • Make sure that medical information that identifies you is kept private;
  • Give you this notice of our legal duties and privacy practices with respect to medical information about you; and follow the terms of the notice currently in effect.

The following categories describe different ways we use and disclose medical information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories. Other uses and disclosures will be made only with written authorization and may be revoked at anytime.

FOR TREATMENT: We may use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your protected health information. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to other physicians who may be treating you when we have the necessary permission from you to disclose your protected health information. For example, your protected health information may be provided to a physician to whom you have been referred to ensure the physician has the necessary information to diagnose or treat you. In addition, we may disclose your protected health information, from time-to-time, to other physician or health care providers (e.g., a specialist or laboratory) who, at the request of your physicians, have become involved in your care by providing assistance with your diagnosis or treatment.

FOR PAYMENT: Your protected health information may be used, as needed, to obtain payment for health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you, such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for admission. You may restrict disclosure of PHI to your health plans for purposes of payment or health care operations if you pay the entire cost of the health care service or item.

FOR HEALTH CARE OPERATIONS: We may use and disclose medical information about you for organizational operations. These uses and disclosures are necessary to run the organization and ensure our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may send you a patient satisfaction survey. We may also disclose information to doctors, nurses, technicians, health care students, and other organizational personnel for review and teaching, in which case we may remove information that identifies you from the records.

APPOINTMENT REMINDERS: We may use and disclose medical information when contacting you to remind you of an appointment for treatment or medical care.

TREATMENT REMINDERS: We may use and disclose medical information when telling you about or recommending possible treatment options or alternatives that may be of interest to you.

HEALTH-RELATED BENEFITS: We may use and disclose medical information when telling you about our health-related benefits, services, or medical education classes that may be of interest to you.

FUNDRAISING ACTIVITIES: We may use information about you to contact you in an effort to raise money for the hospital and its operations. We may disclose information about you to a foundation related to the organization so that the foundation may contact you about raising money for the organization. In these instances we would only release contact information, such as your name, address, phone number and the dates you received treatment or services at the hospital. If you do not want the hospital to contact you for fund-raising efforts, you may opt out by contacting the Foundation Director at (812) 265-0555.

FACILITY DIRECTORY: Unless you object, we may use and disclose in our facility directory your name, the location at which you are receiving care, your condition (in general terms), and your religious affiliation. All this information, except your religious affiliation, may be disclosed to people that ask for you by name. Members of the clergy may be told your religious affiliation.

INDIVIDUALS INVOLVED IN YOUR CARE or PAYMENT FOR YOUR CARE: Health professionals, using their professional judgment, may disclose to an individual identified by you (family member, other relative, close personal friend or any other person you identify), health information relevant to that person’s involvement in your care or payment related to your care.

RESEARCH: We may disclose information to researchers when their research has been approved by the Executive Committee of the Medical Staff, which reviews research proposals and establishes protocol(s) to ensure the privacy of your health information.

AS REQUIRED BY LAW: We will disclose medical information about you when required to do so by federal, state or local law.


Organ and 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. We will do this as necessary to facilitate organ or tissue donation and transplantation.

Military: If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.

Workers' Compensation: We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks (Health and Safety to you and/or others): We may use and disclose medical information about you to appropriate agencies when necessary to prevent a serious threat to your health and safety or the health and safety of the public or others. Reasons for disclosure generally include the following: To prevent or control disease, injury, or disability; to report births and deaths; to report child abuse or neglect; to report reactions to medications or problems with products; to notify people of recalls of products they may be using; to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make these disclosures when required or authorized by law.

Health Oversight Activities: We may disclose medical information to health oversight agencies for activities authorized by law. These oversight activities include for example: audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.

Lawsuits and Disputes: If you are involved in a lawsuit or dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by other parties involved in the dispute.

Law Enforcement: We may release medical information if asked to do so by law enforcement officials:

  • In response to a court order, subpoena, warrant, summons or similar process;
  • To identify or locate a suspect, fugitive, material witness, or missing person;
  • About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement to release information;
  • About a death we believe may be the result of criminal conduct;
  • About criminal conduct at the facility; and
  • In emergency circumstances to report a crime.

Coroners, Medical Examiners and Funeral Directors: We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine a cause of death. We may also release medical information about patients of the hospital to funeral directors, as necessary, to carry out their duties.

National Security and Intelligence Activities: We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Protective Services for the President and Others: We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state.

Inmates: If you are an inmate of a correctional facility or under the custody of law enforcement officials, we may release medical information about you to the correctional institution or law enforcement officials.

You have the following rights regarding medical information we maintain about you:

Right to Inspect and Copy: You have the right to inspect and copy medical 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 medical information that may be used to make decisions about you, you must submit your request in writing to Health Information Management Services. If you request a copy of the information, we may charge a fee for the cost of copying, mailing or other supplies associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If your request is denied, you may request that the denial be reviewed. Another licensed health care professional chosen by the organization 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 Amend: If you feel that medical information 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 the organization. To request an amendment, your request must be made in writing and submitted to Privacy Officer at (812) 265-0121. In addition, you must provide a reason that supports your request.

  • We may deny your request for amendment if it is not in writing or does not include a reason to support the request. 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 medical information kept by or for the hospital;
  • Is not part of the information which you would be permitted to inspect and copy; or
  • Is accurate and complete.

Right to an Accounting of Disclosures: You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures if they occurred after April 14, 2003.

Right to Request Restrictions: You may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. However, we are not required to agree to a requested restriction.

Alternative Communications: You have the right to request to receive confidential communications from us by alternative means or at an alternate location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled after specification of an alternative address or other method of contact. Please make this request in writing to our Privacy Officer.

Right to a Paper Copy of this Notice: You have the right to a paper copy of this privacy notice, upon request, even if you have agreed to accept this notice electronically.

CHANGES TO THIS NOTICE: We reserve the right to change this notice at any time. We reserve the right to make the revised or changed notice effective for medical information already on record about you as well as any information we receive in the future. We will post a copy of the current notice in the facility. The notice will contain on the first page the effective date. In addition, each time you register at or are admitted to the facility for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.

COMPLAINTS: If you believe your privacy rights have been violated, you may submit your complaint via:

  1. The Privacy Officer at (812) 265-0121
  2. The Compliance Integrity Line at (812) 265-0222
  3. The Mail:
    King’s Daughters’ Hospital
    P.O. Box 447
    Attn: Privacy Officer
    Madison, IN 47250
  4. Secretary of the Department of Health & Human Services via

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