Extraordinary People Extraordinary Care
Our Mission is your Health

Privacy Statement

Notice of Privacy Practices

Revised 02/22/2021

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.



This notice describes the information privacy practices followed by our employees, staff, and other personnel as required by 45 CFR 164.520


This notice applies to your health information and may include information created and received by Rangely District Hospital or Rangely Family Medicine; it may be in the form of written or electronic records. It may consist of information about your health history, health status, symptoms, examinations, test results, diagnoses, treatments, procedures, prescriptions, related billing activity, and similar types of health-related information.

We are required by law to give you this notice. This notice is also available on our website
vvww.rangelyhospital.com.  This notice is designed to inform you about how we may use and disclose health information about you and describes your rights and our obligations regarding the use and disclosure of that information.


We may use and disclose health information for the following purposes:


We may use health information about you to provide you with medical treatment or services. We may disclose health information about you to doctors, nurses, technicians, staff, or other personnel involved in taking care of you and your health.

For example, your doctor treating you for a heart condition may need to know if you have other health problems that could complicate your treatment. The doctor may use your medical history to decide what treatment is best for you. The doctor may also tell another doctor about your condition to help determine the most appropriate care for you.

Department personnel in our organization may share information about you and disclose information to people who do not work for Rangely Hospital District or Rangely Family Medicine; to coordinate your care. Such as phoning in prescriptions to your pharmacy, scheduling lab work, and ordering x-rays. Family members and other health care providers may be part of your medical care outside this office and may require information about you that we have. We will request your permission before sharing health information with your family or friends unless you cannot consent to such disclosures due to your health condition.

For Payment.

We may use and disclose your medical information about the treatment and services you receive at Rangely District Hospital, and/or Rangely Family Medicine can be billed and collected from you, an insurance company, or a third party.

For example, we may need to give your health plan information about a service you received here so your health plan will pay us or reimburse you for the service. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will pay for the service.


We may use and disclose health information about you to run Rangely District Hospital and Rangely Family Medicine and make sure that you and our other patients receive quality care. We may use your health information to evaluate the performance of our staff in caring for you. We may also use health information about our patients to help us decide what additional services we should offer, how we can become more efficient, or whether specific new treatments or procedures are adequate.

We may also disclose your health information to health plans that provide you insurance coverage and other health care providers that care for you. Our disclosures of your health information to plans and other providers may help these plans and providers provide or improve care, reduce cost, coordinate and manage health care and services, train staff, and comply with the law.

For Special Situations.

We may use or disclose health information about you for the following purposes, subject to all applicable legal requirements and limitations:


We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.


Covered entities may disclose protected health information to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) in response to a law enforcement official’s request for information about a victim or suspected victim of a crime; (4) to alert law enforcement of a person’s death, if the covered entity suspects that criminal activity caused the death; (5) when a covered entity believes that protected health information is evidence of a crime that occurred on its premises; and (6) by a covered health care provider in a medical emergency not occurring on its premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.


We may use and disclose your medical information for research purposes. Most research projects, however, are subject to a unique approval process. Most research projects require your permission if a researcher will be involved in your care or will have access to your name, address, or other information that identifies you. However, the law allows some research to be done using your medical information without requiring your authorization.


If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate such donation and transplantation.


We may release Health information to a coroner or medical examiner, for example, to identify a deceased person or determine the cause of death.


Suppose you are or were a member of the armed forces or part of the national security or intelligence communities. In that case, we may be required by military command or other government authorities to release health information about you. We may also release information about foreign military personnel to the appropriate foreign military authority. 45 CFR 164.512


We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.


We may disclose health information about you for public health reasons to prevent or control disease, injury, or disability.


We may disclose health information to a health oversight agency for audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the health care system, government programs, and compliance with civil rights laws.


Covered entities may disclose protected health information in a judicial or administrative proceeding if the information is requested through an order from a court or administrative tribunal. Such information may also be disclosed in response to a subpoena or other lawful process if certain assurances regarding notice to the individual or a protective order are provided.


We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.


We may disclose health information about you to your family members or friends if we obtain written authorization. We may also disclose health information to your family or friends if we can infer from the circumstances that you would not object based on our professional judgment. For example, we may assume you agree to our disclosure of your personal health information to your spouse when you bring your spouse with you into the exam room or the hospital during treatment or while treatment is discussed. In situations where you cannot give consent (due to your incapacity or medical emergency), we may use our professional judgment and determine that a disclosure to your family member or friend is in your best interest. In that situation, we will disclose only health information relevant to the person’s involvement in your care and provide updates on your progress and prognosis. We may also use our professional judgment and experience to make reasonable inferences that it is in your best interest to allow another person to act on your behalf to pick up filled prescriptions, medical supplies, or X ray.


We will not use or disclose your health information for any purpose other than those identified in the previous sections without your specific written Authorization. Disclosures requiring your permission include; Disclosures to your partner, spouse, and children. We also will not use or disclose your health information for the following purposes without your specific, written Authorization:

  • For our marketing purposes.
  • Any disclosure of your psychotherapy notes, substance abuse, mental health, or any other specially protected information.
  • If you give us the authorization to use or disclose health information about you, you may revoke that Authorization, in writing, at any time. If you withdraw your consent, we will no longer use or disclose information about you for the reasons covered by your written authorization. Still, we cannot take back any uses or disclosures already made with your permission.
  • In some instances, we may need specific, written authorization from you to disclose certain types of specially-protected information such as psychotherapy notes, HN, substance abuse, mental health, and genetic testing information for purposes such as treatment, payment, and health care operations.
  • We may disclose your Protected Health Information to disaster relief organizations that seek your Protected Health Information to coordinate your care or notify family and friends of your location or condition in a disaster. We will provide you with an opportunity to agree or object to such a disclosure whenever we can do so.

You have the following rights regarding health information we maintain about you:

  • Right to receive a copy of this privacy notice on paper, electronically, or both.
  • Right to Inspect and Copy your Health information
  • Right to Amend or Correct your paper or electronic medical record.
  • Right to request confidential communication.
  • The right to request restrictions or ask us to limit the information we share.
  • The right to obtain a list of those with whom we’ve shared your information.
  • The right to choose someone to act for you.
  • The right to file a complaint if you believe your privacy rights have been violated.

We reserve the right to change this notice and make the revised or changed notice effective for medical information we already have about you and any information we receive in the future.

We will post the current notice at our location(s) with its effective date on the top center title page. You are entitled to a copy of the notice currently in effect. This notice is prominently posted in our facilities and the public spaces of our admission areas.

This Notice of Privacy Practices applies to the following organizations:

  • Rangely Hospital District dba:
  • Rangely Community Medical Health and Wellness Center
  • Rangely District Hospital
  • Rangely Family Medicine
  • Rangely Pharmacy
  • Eagle Crest Assisted Living

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services at:

U.S. Dept. of Health & Human Services Office of Civil Rights
200 Independence Ave. S.W.,
Washington DC 20201,
Phone: 877-696-6775
Website: https://www.hhs.gov/hipaa/filing-a-complaint/index.html

To file a HIPAA complaint with Rangely Hospital District contact:

Lois Pittman, Privacy Official,
225 Eagle Crest Drive,
Rangely, CO 81648
Phone: 970-675-5011
Email: lpittman@rdhosp.org.

You will not be penalized for filing a complaint.