Click here for a pdf of our Privacy Practices: Privacy Practices.pdf.
Your rights under the Health Insurance Portability & Accountability Act of 1996 (HIPAA)
How Your Medical Information May Be Used and Disclosed and How You Can Get Access To This Information
If you have any questions about this notice, please contact the facility's Health Information Management Department.
PLEASE REVIEW CAREFULLY.
Who Will Follow This Notice:
This notice describes the facility's practices and that of:
- Any health care professional authorized to enter information into your facility chart.
- All departments and units of the facility
- Any member of a volunteer group allowed to help you while you are in the facility
- All employees, staff, agents and other facility personnel
- All entities, sites and locations within this facility's system will follow the terms of this notice. They also may share
medical information with each other for treatment, payment and health care operations purposes.
Our Pledge Regarding Medical Information:
We understand that medical information about you and your healthcare is personal. We are committed to protecting medical information
about you. A record is created of the care and services you receive at this facility. This record is needed to provide the necessary
care and to comply with legal requirements. This notice applies to all of the records of your care generated by the facility. Your
personal physician may have different policies or notices regarding the physician's use and disclosure of your medical information in
the physician's office or clinic.
This notice will tell about the ways in which the facility may use and disclose medical information about you. Also described are
your rights and certain obligations we have regarding the use and disclosure of medical information.
The law requires the facility to:
- Make sure that medical information that identifies you is kept private;
- Inform you of our legal duties and privacy practices with respect to medical information about you; and
- Follow the terms of the notice that is currently in effect.
HOW THE FACILITY MAY USE and DISCLOSE YOUR MEDICAL INFORMATION:
The following categories describe different ways the facility uses and discloses medical information. Each category will be
explained. Not every possible use or disclosure will be listed. However, all the different ways the facility is permitted to use and
disclose information will fall within one of these categories.
- Treatment.Your medical information may be used to provide you with medical treatment or services. This
medical information may be disclosed to physicians, nurses, technicians, or other agents of the facility who are involved in your
care at the facility. Your medical information may also be disclosed to healthcare students, interns and residents.
For example: A doctor treating you for a broken leg may need to know if you have diabetes because diabetes
may slow the healing process. The doctor may need to tell the dietitian about the diabetes so appropriate meals can be arranged.
Different departments of the facility may also share medical information about you in order to coordinate your different needs, such as
prescriptions, lab work and x-rays. The facility also may disclose medical information about you to people outside the facility who may
be involved in your medical care after you leave the facility, such as family members, home health agencies, or others used to provide
services that are part of your care.
- Payment.Your medical information may be used and disclosed so that the treatment and services received at the
facility may be billed and payment may be collected from you, the insurance company and/or a third party.
For example: The health plan or insurance company may need information about surgery you received at the
facility so they can provide payment for the surgery. Information may also be given to someone who helps pay for your care. Your health
plan or insurance company may also need information about a treatment you are going to receive to obtain prior approval or to determine
whether they will cover the treatment.
- Health Care Operations.Your medical information may be used and disclosed for purposes of furthering day-to-
day facility operations. These uses and disclosures are necessary to run the facility and to monitor the quality of care our patients
For example: Your medical information may be:
- Reviewed to evaluate the treatment and services performed by our staff in caring for you.
- Combined with that of other facility patients to decide what additional services the facility should offer, what services are
not needed, and whether certain new treatments are affective.
- Disclosed to doctors, nurses, technicians, and other agents of the facility for review and learning purposes.
- Disclosed to healthcare students, interns and residents.
- Combined with information from other facilities to compare how we are doing and see where we can improve the care and services
offered. Information that identifies you in this set of medical information may be removed so others may use it to study health care
and health care delivery without knowing who the specific patients are.
- Census Information:Limited information about you may be used in the census report while you are a patient at the facility. This information may include your name, location in the facility, admission date and room number.
- Clergy Members:While you are a patient in the facility, upon written consent, information about you may be
disclosed to your specific clergy. This information may include your name, location in the facility, admission date and room
- Appointment Reminders. Your medical information may
be used to contact you as a reminder of an appointment you
treatment or medical care at the facility.
- Treatment Alternatives. Your medical information may
be used to tell you about or recommend possible treatment
alternatives that may be of interest to you.
- Health-Related Benefits and Services. Your medical
information may be used to tell you about health-related benefits or services that may be of interest to you.
- Private Accreditation Organizations. Your medical
information may be used to fulfill this facility's
requirements to meet
the guidelines of private hospital accreditation organizations such as
JCAHO, NCQA, etc.
- Individuals Involved in Your Care. With your permission,
your medical information may be released to a family
or other individuals involved in your care. They may also be told about
your condition unless you have requested
additional restrictions. In
addition, your medical information may be disclosed to an entity
assisting in a disaster relief effort so
your family can be notified
about your condition, status, and location.
- Research. Under certain circumstances, your medical
information may be used and disclosed for research purposes.
For example: A research project may involve comparing the health and recovery of all patients who received
one medication to those who received another, for the same conditions. All research projects, however, are subject to a special
approval process. This process evaluates a proposed research project and its use of medical information, balancing the research needs
with the patients' need for privacy of their medical information. Your medical information may be disclosed to people preparing to
conduct a research project; for example, helping them look for patients with specific medical needs, so long as the medical information
they review does not leave the facility. We will almost always ask for your specific permission if the researcher will have access to
your name, address or other information that reveals who you are, or will be involved in your care at the facility.
- As Required by Law. Your medical information will be
disclosed when required to do so by federal, state, or
authorities, laws, rules and/or regulations.
Lawsuits and Disputes. If you are involved in a
lawsuit or a dispute, your medical information will be
response to a court or administration order, subpoena, discovery
request, or other lawful process by someone else involved
in the dispute when we are legally required to respond.
Law Enforcement. Your medical information will be released if requested by a law enforcement official:
- In response to a court order, subpoena, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;
- About a death we believe may be the result of criminal conduct;
- In emergency circumstances to report a crime; the location of the
crime or victims; or the identify, description or
location of the
person who committed the crime.
National Security and Intelligence Activities. Your medical information will be released to authorized federal
officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others. Your medical information may be disclosed to authorized federal
officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special
To Alert a Serious Threat to Health or Safety. Your medical information may be used and disclosed when necessary to
prevent a serious threat to your health and safety and that of the public or another person. Any disclosure, however, would only be to
someone able to help prevent the threat.
Health Oversight Activities. Your medical information may be disclosed to a health oversight agency for activities
authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These
activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights
- Organ and Tissue Donation. If you are an organ or
tissue donor, your medical information may be released to
that handle organ procurement or organ, eye and tissue transplantation
or to an organ donation bank, as necessary to
facilitate organ or
tissue donation and transplantation.
- Medical Devices. Your social security number and
other required information will be released in accordance
laws and regulations to the manufacturer of any medical device(s) you
have implanted or explanted during this
hospitalization and to the Food
and Drug Administration, if applicable. This information may be used to
locate you should there be a
need with regard to such medical device(s).
- Military and Veterans. If you are a member of the
armed forces, your medical information may be released as
military command authorities. If you are a member of the foreign
military personnel, your medical information may be
released to the
appropriate foreign military authority.
- Workers' Compensation. If you seek treatment for a
work-related illness or injury, we must provide full
accordance with state-specific laws regarding workers' compensation
claims. Once state-specific requirements are met and
written request is received, only the records pertaining to the
work-related illness or injury may be disclosed.
- Public Health Risk. Your medical information may be
used and disclosed for public health activities. These
generally include the following:
- To prevent or control disease, injury or disability;
- To report births and deaths;
- To report child abuse or neglect
- To report reactions to medications or problems with products;
- To notify people of recalls of products they may be using;
- To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease
- To notify the appropriate government authority if we believe a
patient has been the victim of abuse, neglect or domestic
will only make this disclosure if you agree or when required or
authorized by law.
- Coroners, Medical Examiners, and Funeral Directors.
Your medical information may be released to a coroner or
examiner. This may be necessary, for example, to identify a deceased
person or determine the cause of death. We may also
information about patients of the facility to funeral directors as
necessary to carry out their duties.
- Inmates. If you are an inmate of a correctional
institution or under the custody of a law enforcement
official, we may
release medical information about you to the correctional institution
or law enforcement official. This release would
be necessary for the
- For the institution to provide you with health care;
- To protect the health and safety of you and others;
- For the safety and security of the correctional institution.
CERTAIN STRICTER REQUIREMENTS THAT WE FOLLOW
Several state laws may apply to your PHI that set a stricter standard than the protections offered under the Federal health privacy
regulations. Stricter state law in Pennsylvania will for example, limit us from disclosing medical records containing HIV related
information; medical records containing psychiatric and psychological treatment. State law dictates to whom and under what
circumstances disclosure is appropriate. Generally, release of this information is contingent upon your specific consent, or pursuant
to court order.
- Other Uses of Medical Information. Other uses and
disclosures of medical information not covered by this
notice or the
laws that apply to this facility will be made only with your written
permission. If you provide the facility permission
to use or disclose
your medical information, you may revoke that permission, in writing,
at any time. If you revoke your permission, we
will no longer use or
disclose your medical information for the reasons covered in your
written authorization. You understand that we
are unable to take back
any disclosures already made with your permission, and that we are
required to retain our records of the care
that the facility provided
ADDITIONAL INFORMATION CONCERNING THIS NOTICE:
- Changes To This Notice. We reserve the right to
change this notice and make the revised or changed notice
medical information we already have about you as well as any
information we receive in the future. The facility will post
copy of the notice with the effective date. In addition, each time you
register at, or are admitted to, the facility for
treatment or health
care services as an inpatient or outpatient, we will offer you a copy
of the current notice in effect.
- Complaints. You will not be penalized for filing a
complaint.If you believe your privacy rights have been
may file a complaint with the facility or with the Secretary of the
Department of Health and Human Services. To file a
complaint with the
facility, contact the Chief Nursing Officer (CNO). All complaints must
be submitted in writing.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
You have the following rights regarding medical information the facility maintains about you:
** NOTE: All Requests Must Be Submitted in Writing to the Facility Medical Records Department. **
- Right to Inspect and Copy. You have the right to
inspect and copy medical information that may be used to make
about your care. Except where individual state laws are more stringent,
this facility has a minimum of 30 days to act on your
To inspect and copy medical information that may be used to make
decisions about you, you must submit a written request. If
a copy of the information, we may charge a fee for the cost of copying,
mailing or other supplies associated with your
We may deny your request to inspect and copy in some limited
circumstances. If you are denied access to medical information, you may
request that the denial be reviewed. Another licensed health care
professional, other than the person who denied your request, will be
chosen by the facility to review your request and the denial. The
facility will comply with the outcome of the review.
Your request for access may be denied if:
- A licensed health care professional has determined, in the exercise
of professional judgment, that the access requested is
likely to endanger the life or physical safety of the individual or
- The protected health information makes reference to another person
(unless such other person is a health care provider) and
health care professional has determined, in the exercise of
professional judgment, that the access requested is reasonably
to cause substantial harm to such other person.
- The request for access is made by the individual's personal
representative, and a licensed health care professional has
in the exercise of professional judgment, that the provision of access
to such personal representative is reasonably likely
substantial harm to the individual or another person.
- Right to Amend. If you feel that medical information
we have about you is incorrect or incomplete, you may ask
us to amend
the information. You have the right to request an amendment to
information kept by or for the facility. Except where
laws are more stringent, this facility has a minimum of 60 days to act
on your request.
To request an amendment, your must submit a written request. You must also provide a reason that supports your request.
Your request for an amendment may be denied if:
- Your request is not in writing or does not include a reason to support the request;
- The medical information was not created by us, unless the person or
entity that created the information is no longer
available to make the
- The medical information is not part of the medical information kept by or for the facility;
- The medical information is not part of the information you would be permitted to inspect and copy; or
- The medical information is accurate and complete.
- Right to an Accounting of Disclosures. You have the
right to request an "accounting of disclosures." This is a
list of the
disclosures we made of your medical information for purposes other than
treatment, payment and health care operations.
Except where individual
state laws are more stringent, this facility has a minimum of 60 days
to act on your request.
To request this list or accounting of disclosures:
- You must submit your request in writing.
- Your request must state a time period, which may not be longer than six years and may not include dates before
April 14, 2003.
- Your request should indicate in what form you want the list (for example, on paper, electronically).
The first list you request within a 12-month period will be free. For
additional lists, we may charge you for the costs of
list. We will notify you of the cost involved and you may choose to
withdraw or modify your request at that time before
any costs are
- Right to Request Restrictions. You have the right to
request a restriction or limitation on the medical
information we use
or disclose about you for treatment, payment or health care operations.
You also have the right to request a limit
on the medical information
we disclose about you to someone who is involved in your care or the
payment for your care, like a family
For example: You could ask that we not use or disclose information about a surgery you had.
We are not required to agree to your request. If we do agree, we will comply with your request unless the
information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing. In your request, you must tell us:
- What information you want to limit;
- Whether you want to limit our use, disclosure or both;
- To whom you want the limits to apply, for example, disclosures to your spouse.
- Right to Request Confidential Communication. You have the right to request that we communicate with you about
medical matters in a certain way or at a certain location.
For example: You can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. We
will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. You have the right to a copy of this notice. You may ask us to give you a
copy at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this