HIPAA Notice









At the Noble County Health Department, we are committed to treating and using protected health information about you responsibly. This

Notice of Privacy Practices describes the personal information we collect, and how and when we use or disclose that information. It also

describes your rights as they relate to your protected health information (PHI). This notice is effective April 14, 2003, and applies to all

protected health information as defined by federal regulations.

Understanding Your Health Record Information:

Each time you visit the Noble County Health Department, a record of your visit is made. Typically, this record contains your symptoms,

examination & test results, diagnoses, treatment, and a plan for future care or treatment. This information, referred to as your PHI serves as


  •  Basis for planning your care & treatment,
  •  Means of communication among the many health professionals who contribute to your care,
  •  Legal document describing the care your received,
  •  Means by which you or a third-party can verify that services billed were actually provided,
  •  A tool in educating health professionals,
  •  A source of data for medical research,
  •  A source of information for public health officials charged with improving the health of this state & nation,
  •  A tool with which we can assess and continually work to improve the care we render & outcomes we achieve.

Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what,

when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

Your Health Information Rights:

Although your record is the physical property of the Noble County Health Department, the information belongs to you. You have the right to:

  •  Inspect & copy your health record as provided for in 45CFR 164.524,
  •  Amend your health record as provided in 45 CFR 164.528,
  •  Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528,
  •  Request communications of your health information by alternative means or at alternative locations,
  •  Request a restriction on certain uses & disclosures of your information as provided by 45 CFR 164.522, and
  •  Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Our Responsibilities:

The Noble County Health Department is required to:

  •  Maintain the privacy of your health information,
  •  Provide you with this notice as to our legal duties & privacy practices with respect to information we collect and maintain about you,
  •  Abide by the terms of this notice,
  •  Notify you if we are unable to agree to a requested restriction, and
  •  Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain.

Should our information practices change, we will provide you with a revised notice.

We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue using

or disclosing your health information after we have received a written revocation of the authorization according to the procedures included in

the authorization.

For more information or to Report a Problem:

If you have any questions and would like additional information, you may contact one of the practice’s Privacy Officers, Madeline Watson, RN, or

Shari Rayner, RN at (740) 732-4958.

If you believe your privacy rights have been violated, you can file a complaint with the practice’s Privacy Officer or with the Office for Civil

Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either source. The address for

the OCR is listed below:

Office for Civil Rights

U.S. Department of Health and Human Services

200 Independence Avenue, S.W.

Room 509F, HHH Building

Washington, D.C. 20201

Examples of Disclosures for Treatment, Payment and Health Operations:

We will use your health information for treatment.

  • For example: Information obtained by a nurse, physician, or other member of your health care team will be recorded in your record
    and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her
    expectations of the members of the health care team. Members of your health care team will then record the actions they took and
    their observations. In that way, the physician will know how you are responding to treatment. We will also provide your physician or a
    subsequent health care provider with copies of various reports that should assist him or her in treating you.

We will use your health information for regular payment.

  • For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information
    that identifies you as well as your diagnosis, procedures, and supplies used.

We will use your health information for regular health operations.

  • For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team
    may use information in your health record to assess the care & outcomes in your case and others like it. This information will then be
    used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.

Business Associates: There are some services provided in our organization through contracts with business associates. Examples include

physician services in the emergency department and radiology, certain laboratory tests. When these services are contracted, we may disclose

your health information to our business associate so they can perform the job we’ve asked them to do and bill you or your third-party payer for

services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Directory: Unless you notify us that you object, we will use your name, location in the facility, general condition, for directory purposes. This

information may be provided to people who ask for you by name.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person

responsible for your care. We will disclose the minimum information necessary to assist with your care.

Communication with family: Health professionals, using their best judgment, may disclose to a 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 an institutional review board that has

reviewed the research proposal and established protocols to ensure the privacy of your health information.

Funeral Directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.

Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related

benefits and services that may be of interest to you.

Fund Raising: We may contact you as part of a fund-raising effort.

Food & Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food,

supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with the laws

relating to worker’s compensation or other similar programs established by law.

Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or

controlling disease, injury, or disability.

Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or

attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have

otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.

We will require you to sign a statement acknowledging that you have received a copy of the Noble County Health Department’s Notice of Privacy



Noble County Health Department

44069 Marietta Road

Caldwell, OH 43724