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HIPPA Notice of Privacy Practices

HIPAA Notice of Privacy Practices

West Kentucky Surgical, Inc

300 South 8th Street, Suite 401E, Murray KY 42071

P:  270-753-2444


This Notice of Privacy describes how we at West Kentucky Surgical, Inc, may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations (TPO) and for other purposed that are permitted or require by law.  It also describes your rights to access and control your PHI.  “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related healthcare services. 

Uses and Disclosers of Protected Health Information

Your protected health information may be used and disclosed by your physician, our office staff, and others outside of our office that are involved in you care and treatment for the purpose of providing healthcare services to you, to pay your healthcare bill, to support the operation of the physician’s practice, and any other use required by law.


We will use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services.  This includes the coordination or management of your healthcare with a third party.  For example, we would disclose your PHI, as necessary, to a home health agency that provides care to you.  For example, your PHI may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose and/or treat you.

Payment and Financial Responsibility

Your PHI will be used, as needed, to obtain payment for your healthcare services.  For example, obtaining approval for a hospital stay or a surgical procedure may require that your relevant PHI be disclosed to the insurance company to obtain approval or precertification.  You also agree, in order for us to service your account and/or to collect financial amounts that you may owe that we may contact you by telephone at any telephone number associated with your account including cellular phone numbers. Methods of contact may include using pre-recorded/artificial voice messages and/or use of an auto dialing device.  We may also contact you by sending text messages or emails using an email address that you provided.  This may also include outside vendors affiliated with our office including a collection agency.  If unpaid outstanding balances are sent to a collection agency for recovery, you agree to also assume financial responsibility for any additional fees that are charged by the collection agency.

Healthcare Operation

We may use or disclose, as needed, your PHI in order to support the business activities of our practice.  These activities include but are not limited to quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities.  For example, we may disclose your PHI to medical school students that see patients in our office.  In addition, we may call you by name in the waiting room when the physician is ready to see you.  We may use or disclose your PHI, as necessary, to contact you to remind you or to reschedule an appointment time.

Other Permitted and Required Uses and Disclosure

We may use or disclose your PHI in the following situations without your authorization.  These situations include:  as required by law, public health issues as required by law, communicable diseases, health oversight, abuse or neglect, food and drug administration requirements, legal proceedings, law enforcement: coroners, funeral directors, organ donation, research: criminal activity, military activity and nation security, workers compensation, inmates: required uses and disclosers.  Under the law we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with requirements of section 164.500.  Other permitted and required uses and disclosure will be made only with your consent, authorization or opportunity to objection unless required by law.  You may revoke this authorization at any time in writing, except to the extent that your physician or the physician’s practice has taken action in reliance on the use or disclosure indicated in the authorization.

Your Rights - Following is a statement of your rights to your protected health information:

You have the right to inspect and copy your protected health information.  Under federal law however, you may not inspect or copy the following records: psychotherapy notes, information compiles in reasonable anticipation of or use in a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.  Your physician is not required to agree to a restriction that you may request.  You then have the right to use another healthcare professional.  If the physician believes it is in your best interest to permit use and disclosure of your PHI, then your PHI will not be restricted.

You have the right to request to receive confidential communications from us by alternative means or an alternative location.  You have the right to obtain a paper copy of this notice from West Kentucky Surgical, Inc upon request, even if you have agree to accept this notice alternatively i.e. electronically.


You may voice concerns to us or to the Secretary of Health and Human Services if you believe your privacy and security right have been violated.  You may file a complaint with us by notifying our privacy contact of your complaint.  There is no retaliation levied against you for filing a complaint.


We reserve the right to change the terms of this notice and will inform you of any changes.  You have the right to object or withdraw as provided with this notice

We are required by law to maintain the privacy of and provide individuals with this notice of our legal duties and privacy practices with respect to protected health information and financial policies.  If you have any objections to this form, please ask to speak with our HIPAA Compliance Officer in person or by phone at our main phone number.