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Notice of Privacy Practices

This notice tells you how medical information about you can be used and shared, and how you can get access to this information. Please read it carefully. If you have any questions, please contact our Privacy Officer at 17651 B Hwy, Boonville, MO 65233 at (660)-882-7461.

Who will follow this notice:
Cooper County Memorial Hospital & Clinics provides health care to our patients, residents, and clients working with physicians, other professionals and organizations. The list below tells you who will follow the outlined practices for keeping your health information private.

  • Any health care worker who treats you at our hospital.
  • All areas of our organization.
  • All employees, staff, volunteers or students associated with our organization.
  • Any business associate with whom we share health information.

Our pledge to you.
We understand that health information about you is private. We promise to protect this information. We make a record of the care and service you receive so we can provide good care and to comply with legal rules. This notice applies to all of your health records that we maintain, whether they were made by our staff or by the doctor. The doctor may have other rules or a notice about use and release of your health record kept in his/her office.

 By law we must:

  • keep your health information private.
  • give you this notice of our legal duties and our practice of keeping your health information private.
  • follow terms of the notice in effect at the current time.

Changes to this Notice.
We may change our policies at any time. Changes will apply to health information we have on file, as well as new information we record after the notice is changed. Before we make a major change in our policies, we will change our notice and post the new notice in various areas within our organization.  You can get a copy of the current notice any time. The date it went into effect is listed just below the title. You will be given a copy of the current notice at the time of your next visit, after the change is made. You will also be asked to sign your name to show that you received this notice.

How we are allowed to use and share your health information.
We may use and share your health information for:

  • treatment (such as sending your health information to another doctor or another health care facility when you are referred to them)
  • obtaining payment for treatment (such as sending billing information to your insurance company or Medicare);
  • supporting our health care efforts (such as when we compare patient information to improve treatment methods.)

Subject to certain rules, we may use or share your health information without your prior permission for other reasons:

  • for public health issues
  • to report abuse or neglect (as required by law)
  • to report dog bites (as required by law)
  • during health care audits or inspections
  • as part of research studies
  • to arrange funerals and organ donation
  • for workers’ compensation claims
  • In an emergency, when required by law, we also may share health care information.
  • In certain cases we must respond to valid subpoenas or valid court orders.
  • This hospital and its staff may be involved as a study site to conduct research. You may benefit from our efforts to advance science and medicine through research. None of your private health information will be given to third parties without your written consent.
  • We also may contact you to remind you about a scheduled visit or to tell you about or suggest treatment options, alternatives, health-related benefits or services that may be of interest to you.
  • If you are admitted as a patient, we will add your name to our patient list, unless you ask us not to. The patient list includes your hospital room number and your religious faith. We will release your room number to anyone who asks about you by your name. Your religious faith may be shared only with a clergy member, even if they do not ask for you by name.
  • We may share health care information about you with your legal representative or anyone you tell us to. Your health information may also be shared with disaster relief authorities so they can contact your family to tell them where you are and how you are doing.

Other uses of health information:

  • In any other situation not covered by this notice, we will ask for your written permission before we use or share your health information. If you choose to permit us to use or share this information, you can later withdraw that permission by telling us in writing about your decision.

Your rights about your health information.

  • You may make a written request to look at or get a copy of your information we use for your care.  If you request copies, we may charge a fee for the cost of copying, mailing or other related supplies. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision.
  • If you think that information in your record is wrong or if important items are missing, you have the right to request that we correct the records. You may submit a written request providing your reason for requesting the change. We could deny your request to change a record if it was not created by us, or if we decide that the record is correct. You may submit a written appeal if we decide not to change a record.
  • You have the right to receive a list showing where we have shared health information about you, other than for treatment, payment, health care operations, or where you gave written permission. The request must state the time period you want us to include.

    It must be less than a 6-year period and begin after April 14, 2003. Within a 12-month period, the first list you request is free. If you make more requests, you will be charged our cost to produce the list. We will tell you about the cost before you are charged.

    • You may request, in writing, that we not use or share your health information for treatment, payment or healthcare operations; or with persons involved in your care except when specifically authorized by you, when required by law, or in an emergency. We will review your request but we are not required by law to accept it. We will inform you of our decision on your request. All written requests or appeals should be submitted to our Privacy Officer.


    • If you are concerned that your privacy rights may have been violated; or if you disagree with a decision we made about access to your records, you may contact our Privacy Officer at 17651 B Hwy, P.O. Box 88, Boonville, MO  65233 or by phone at 660-882-7461.
    • You may send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights. Our Privacy Officer can give you the address.
    • We will not punish you or take action against you if you file a complaint.


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