Notice of Privacy Practices

Castle Rock Medical Center has developed this Notice of Privacy Practices to comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996. HIPAA was enacted by Congress to establish standards for the protecting the confidentiality and security of your health information. 

A Notice of Privacy Practices is a document that identifies the general ways your protected health information can be used to carry out treatment, payment, and health care operations. Protected health information means your personal health information found in your medical and billing records. this information is created or received by a health care provider, reinsurance company, or employer and relates to your past, present, or future physical or mental health conditions.


If you have questions about this notice or want more information, please contact Castle Rock Hospital District’s Privacy Officer, Bailie Dockter, Executive Director.  The effective date of this notice is April 14, 2003.

To appropriately treat you and receive payment for the services we provide, we need to obtain information from you including your full name and address, insurance company, family medical history, current medical history, and current medical condition. We will use and disclose this information and other information we collect in the ways described below. To help you understand how we will use and disclose your information we have put the different uses and disclosures into categories and give examples of each. All of the ways we use or disclose your information will fir into one of the categories listed below, but we cannot list all of the uses and disclosures in each category.

We may use and disclose your health information for the following.

We may use and disclose your information to provide you with medical treatment and services. Your information may be disclosed to individuals providing care to you and different departments in the hospital. These individuals and departments need your information to provide care, and to coordinate and provide services (such as prescriptions, lab tests, meal and x-rays). We may also disclose your information to individuals outside the hospital or to other health care providers that may be involved in your care after you leave (nursing homes, home health agencies, and family or friends.)

Health Care Operations
We may use and disclose your information for health care operation purposes of our health care facility or to another health care facility that has or has a relationship with you. Health care operations includes review of the care you receive for quality assessment, educational., business planning, and compliance plan purposes.

We will use and disclose your information to receive payment for the services and treatment provided to you. We use your information to create a bill and disclose your information when we send the bill  to your insurance company, you, pr a third party. The individual or enmity paying the bill may request more information to determine whether the bill is covered by your insurance, and may tell your health plan about a treatment you are going to receive to get approval for payment or to determine whether your health plan will cover the treatment. We may also disclose information about you for payment activities of another health care facility.

We may use and disclose your health information and you authorize us to use and disclose your health information for:

Appointment Reminders. We may provide appointment reminders to you. You may request in writing that we send reminders to a confidential or alternative address.

Treatment Alternatives. We may provide you with information about treatment alternatives and other health related benefits and services.

Fundraising. We may contact you to raise funds for our health care facility.

We may also disclose your health information to outside entities without your authorization in the following circumstances;

Required by Law.  We disclose information as required by law. For example, we are required to report gunshot wounds to the police.

Public Health Purpose. We disclose information to health agencies as required by law for preventing or controlling disease. Examples are reporting of sexually transmitted disease, communicable and infectious diseases.

To prevent a Serious Threat to Health or Safety. We may disclose information about you to law enforcement or an identified victim to prevent a serious threat to your health or safety or the health or safety of another individual or the public.

Research.  Your information may be used by or disclosed to research approved by a privacy board or an institutional review board.

Health Oversight Activities. Your health information may be disclosed to governmental agencies and boards for investigations, audits,licensing,and compliance purpose.

Judicial and Administrative Proceedings.  We may be required to disclose your health information to a court or for an administrative hearing.

Law Enforcement Activities. We may be required to disclose your information as required by law, pursuant to a court order, warrant, subpoena, or summons.


Deceased Individual. We may disclose your information for the identification of the body or to determine cause of death.

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

Inmates. To a correctional institution or law enforcement official having lawful custody of you. This release must be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety of the health and safety of others; or (3) for the safety or security of the correctional institution.


Organ and Tissue Donation.  If you are an organ donor, we may release your medical information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ bank, as necessary to facilitate organ or tissue donation.

Worker’s Compensation. We may release medical information about you for worker’s compensation or similar programs.

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

We will give you the opportunity to object to the following uses and disclosure of your information.

Notification.  We may tell your friends, relatives and other caretakers information that is relevant to their involvement in your care.

Disaster Relief. We may disclose information about you to public or private agencies for disaster relief purposes.

To use or disclose your information for any other uses or disclosures, we will request an authorization from you or your representative.  If we do obtain an authorization from you or your representative, your or your representative may revoke it at any time.

Your Rights

You have the right to request a restriction on how much information about you is used and disclosed. If you want to request a restriction of a use or disclosure of your information, contact the CRMC Privacy Officer. We are not required to agree to any restrictions on the use or disclosure of your information.

You have the right to request communications with you be made at an alternative address or phone number. To request this service, contact CRMC Privacy Office.

You have the right to inspect and copy your medical record. To inspect and copy your medical record, a request must be made to Castle Rock Medical Center.

If you believe information we have about you is incorrect or incomplete you may request we amend your medical record. To request an amendment, contact the CRMC Privacy Officer.

You have the right to receive a list of individuals and entities to which health information was disclosed. We do not have to provide you with an accounting if your health information was releases for treatment, payment, and healthcare operations or release because of an authorization. You may receive one (1) free accounting during a twelve (12) moth period. If you request more than one (1) accounting you will be charged a fee of $25.00 for a one year accounting and $10.00 for each additional year up to six (6) years. An accounting is not provided for disclosures prior to April 14, 2003.

You have the right to request a paper copy of this notice.

Our Duties

We are required by law to maintain the privacy of our protected health information and to provide individuals with Notice of our legal duties and privacy practice regarding health information.

We are required to follow the terms of the current notice. 

We may change the terns of this Notice and the revised Notice will apply to all health information in our possession. If we revise this Notice, a copy of the revised Notice will be posted in the front lobby and a copy may be requested from the CRMC Privacy Officer.


If you believe your privacy rights have been violated, you may contact Bailie Dockter (Privacy Officer) at 307-872-4510 or the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.