Sumner County Hospital District #1

This notice Describes how Medical information about you may be used and disclosed and how you can obtain access to this information. Please review it carefully. You have the right to a paper copy of this Notice; you may request a copy at any time.

Hospital provides health care to patients in partnership with physicians and other professionals and organizations. The information in this Notice of Privacy Practices will be followed by all the following entities, sites, and locations of hospital:

  • All individuals employed by hospital

  • All hospital inpatient and outpatient departments

  • Volunteers working at any hospital facility

  • Medical, nursing and other students present at any hospital facility

  • Any health care professional that treats you at any hospital facility

  • Rural Health Clinics

  • Healthcare Professionals

  • General Surgery Physician


How Hospital may use and disclose  Health information about you.

Hospital may use and disclose your health information for the following purposes without your express consent or authorization.

Treatment: We may use you health information to provide you with medical treatment. We may disclose information to doctors, nurses, technicians, medical students, or other personnel involved in your care. We also may disclose information to persons outside hospital involved in your treatment, such as other health care providers, family members, and friends.

We may use and disclose health information to discuss with you treatment options or health-related benefits or services or to provide you with promotional gifts of nominal value. We may use and disclose your to remind you of upcoming appointments. Unless you direct us otherwise, we may leave messages on your telephone answering machine identifying hospital and asking for you to return our call. We will not disclose any health information to any person other than you except to leave a message for you to return the call.


We may use and disclose your health information as necessary to collect payment for services we provide to you. We also may provide information to other health care providers to assist them in obtaining payment for services they provide to you.

Health Care Operations

We may use and disclose you health information for our internal operations. These uses and disclosures are necessary for our day-to-day operations and to make sure patients receive quality care. We may disclose health information about you to another health care provider or health plan with which you also have had a relationship for purposes of the provider’s or plan’s internal operations.

Business Associates

Hospital provides some services through contracts or arrangements with business associates. We require our business associates to appropriately safeguard your information. Creation of de-identified health information. We may use your health information to created de-identified health information. This means that all data items that would help identify you are removed or modified.

Uses and disclosures required by law

We will use and/or disclose you information when required by law to do so.

Disclosures for public health activities.

We may disclose your health information to a government agency authorized (a) to collect data for the purpose of preventing or control disease, injury, or disability: or (b) to receive reports of child abuse or neglect. We also may disclose such information to a person who may have been exposed to communicable disease if permitted by law.

Disclosures about victims of abuse, neglect, or domestic violence. Hospital may disclose your health information to a government authority if we reasonably believe you are a victim of abuse, neglect, or domestic violence. Disclosures of judicial and administrative proceedings. Your protected health information may be disclosed in response to a court order or in response to a subpoena, discovery request, or other lawful process if certain legal requirements are satisfied.

Disclosures for law enforcement purposes.

We may disclose your health information to a law enforcement official as required by law or in compliance with a court order, court-ordered warrant, a subpoena, or summons issued by a judicial officer; a grand jury subpoena; or an administrative request related to a legitimate law enforcement inquiry.

Disclosures regarding victims of a crime

In response to a law enforcement official’s request, we may disclose information about you with your approval. We may also disclose information in an emergency situation or if you are incapacitated if it appears you were the victim of a crime.

Disclosures to avert a serious threat to health or safety.

We may disclose information to prevent or lessen a serious threat to the health and safety of a person or the public or as necessary for law enforcement authorities to identify or apprehend an individual.

Disclosures for specialized government functions.

We may disclose your protected health information as required to comply with governmental requirements for national security reasons or for protection of certain government personnel or foreign dignitaries.

Disclosure for fundraising

We may disclose demographic information and dates of service to an affiliated foundation or a business associate that may contact you to raise funds for Hospital. You have a right to opt out of receiving such fundraising communications.

Other uses and Disclosures

We will obtain your express written authorization before using or disclosing your information for any other purpose not described in this notice. For example, authorizations are required for use and disclosure of psychotherapy notes, certain types of marketing arrangements, and certain instances involving the sale of your information. You may revoke such authorizations, in writing; at any time to the extent hospital has not relied on it.

Your Rights Regarding your Health Information

Right to inspect and copy

You have the right to inspect and copy health information maintained by hospital. To do so, you must complete a specific form providing information needed to process you request. If you request copies, we may charge a reasonable fee. We may deny you access in certain limited circumstance if we deny

Access, you may request review of that decision by a third party, and we will comply with the outcome of the review.

Right to Request Amendment

If you believe your records contain inaccurate or incomplete information, you may ask us to amend the information.  To request an amendment, you must complete a specific form providing information we need to process your request, including the reason that supports your request.

Right to an Accounting of Disclosures and Access Report

You have the right to request a list of disclosures of your health information we have made, with certain exceptions defined by law, to request an accounting or an access report, you must complete a specific written form providing information we need to process your request.

Right to Request Restrictions

You have the right to request a restriction on our uses and disclosures of your health information for treatment, payment, or health care operations. You must complete a specific written form providing information we need to process your request. Hospital’s Privacy Officer is the only person who has the authority to approve such a request. Hospital is not required to honor your request for restrictions, except if (a) the disclosure is for purposes of carrying out payment or health care operations and is not otherwise required by law and (2) the protected health information that pertains solely to a health care item or services for which you or any person (other than a health plan on your behalf) has paid the Hospital in full.

Right to Request Alternative Methods of Communication.

You have the right to request that we communicate with you in a certain way or at a certain location. You must complete a specific form providing information needed to process your request. Hospital’s

Privacy Officer is the only person who has the authority to act on such a request. We will not ask you the reason for your request, and we will accommodate all reasonable requests.

Rights Relating to Electronic Health Information Exchange

Hospital participates in electronic health information exchange, or HIE. New technology allows a provider or a health plan to make a single request through a health information organization, HIO, to obtain electronic records for a specific patient from other HIE participants for purposes of treatment, payment, or health care operations.

You have two options with respect to HIE. First, you can permit authorized individuals to access your electronic health information through an HIO. If you choose this option, you do not have to do anything, second, you can restrict access to all of your electronic health information (except access by properly authorized individuals as needed to report specific information as required by law). If you wish to restrict access, you must complete and submit a specific form available at You cannot restrict access to certain information only; your choice is to permit or restrict access to all of your information.

If you have questions regarding HIE or HIOs, please visit  for additional information. Your decision to restrict access through at HIO does not impact other disclosures of your health information. Providers and health plans may share your information directly through other means (e.g., facsimile or secure e-mail) without your specific written authorization.

Electronic Health Information Exchange

If you receive health care services in a state other than Kansas, different rules may apply regarding restrictions on access to your electronic health information. Please communicate directly with your out-of-state health care provider about what action, if any, you need to take to restrict access.


If you believe your rights with respect to health information have been violated, you may file a complaint with hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with hospital, please contact Brooke Bollman @ 620-845-6492. All complaints must be submitted in writing. You will not be penalized for filing a complaint.