NOTICE OF PRIVACY PRACTICES
Effective Date: April 14, 2003
Revision Date: December 12, 2005 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. This notice is provided to you pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). It is designed to tell you how we may, under federal law, use or disclose your Health Information.
1. We may use or disclose your Health Information for purposes of treatment, payment or healthcare operations without a consent. The following is one example of each:
* The health care professionals, including doctors, nurses and technicians in our facility, may access your information for purposes of providing you care.
* Our billing department may access your information and send relevant parts to your insurance company to allow us to be paid for the services we render to you.
* We may access and/or send your information to our attorneys or accountants in the event we need the information in order to address one of our own business functions.
2. We may use or disclose your Health Information under the following circumstances without obtaining your prior consent or authorization:
* For treatment, payment or healthcare operations (see above).
* To provide it to you.
* To include you on our Room Roster. Unless you tell us that you object, we will list your name and where you are located in our facility. This information may be provided to other people who ask for you by name or to members of the clergy.
* To notify and/or communicate with your family. Unless you tell us you object, we may use or disclose your Health Information in order to notify your family or assist in notifying your family, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in any communications with your family and others.
II. As Required by Law: In general, we will attempt to ensure that you have been made aware of the use or disclosure of your Health Information prior to providing it to another person.
1. For Public Health Purposes: We may use or disclose your Health Information to provide information to state or federal public health authorities, as required by law, to: prevent or control disease, injury or disability; report child abuse or neglect; report domestic violence; report to the Food and Drug Administration problems with products and reactions to medications; and, report disease or infection exposure.
2. For Health Oversight Activities: We may use or disclose your Health Information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.
3. In Response to Subpoenas or Judicial and Administrative Proceedings: We may use or disclose your Health Information in the course of any administrative or judicial proceeding.
4. To Law Enforcement Personnel: We may use or disclose your Health Information to a law enforcement official to identify or locate a suspect, fugitive, material witness or missing person, to comply with a court order or subpoena and for other law enforcement purposes.
5. To Coroners or Funeral Directors: We may use or disclose your Health Information for purposes of communicating with coroners, medical examiners, and funeral directors.
6. For Purposes of Organ Donation: We may use or disclose your Health Information for purposes of communicating to organizations involved in procuring, banking or transplanting organs and tissues when you have made this choice known.
7. In Order to Conduct Research: We may use or disclose your Health Information in order to conduct research that has been approved by our Institutional Review Board.
8. For Public Safety: We may use or disclose your Health Information in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
9. To Aid Specialized Government Functions: If necessary, we may use or disclose your Health Information for military or national security purposes.
10. For Workers’ Compensation: We may use or disclose your Health Information as necessary to comply with Workers’ Compensation laws.
11. To Correctional Institutions or Law Enforcement Officials, if you are an inmate.
III. For all other circumstances, we may only use or disclose your Health Information after you have signed an authorization. If you authorize us to use or disclose your Health Information for another purpose, you may revoke your authorization in writing at any time.
IV. We may also use or disclose your Health Information for the following purposes:
* Appointment Reminders: We may use your Health Information in order to contact you to provide appointment reminders or to give information about other treatments or health-related benefits and services that may be of interest to you.
* Fund Raising: We may contact you to participate in our fund-raising activities.
* Change of Ownership: In the event that our facility is sold or merged with another organization, your records will become the property of the new owner.
* Providing information to a plan sponsor: We may disclose your Health Information to your plan sponsor.
V. Your Rights:
1. You have the right to request restrictions on the uses and disclosures of your Health Information. We are not required to comply with your request.
2. You have the right to receive your Health Information through confidential means, through reasonable alternative means, or at an alternative location.
3. You have the right to inspect and obtain a copy of your Health Information. We may charge you a reasonable cost-based fee to cover copying, postage and/or preparation of a summary.
4. You have the right to request that we amend your Health Information that is incorrect or incomplete. We are not required to change your Health Information. We will allow you to have included in your record a document you provide to us that may disagree with or clarify your Health Record.
5. You have a right to receive an accounting of disclosures of your Health Information made by us, except that we do not have to account for disclosures made for treatment, payment, health care operations, information provided to you, directory listings, notification and communication with family, certain government functions, appointment reminders, and fund raising as described in Section I in this Notice of Privacy Practices.
6. You have the right to a paper copy of this Notice of Privacy Practices. If you would like to have a more detailed explanation of these rights or our Privacy Practices, please contact Pine Run Health Center’s Privacy Officer at (215) 340-5200.
VI. Our Duties:
1. We are required by law to maintain the privacy of your Health Information and to provide you with a copy of this Notice.
2. We are also required to abide by this notice.
3. We reserve the right to amend this Notice at any time in the future and to make the new Notice provisions applicable to all your Health Information, even if it was created prior to the change in the Notice. If such an amendment is made, we will immediately display the revised Notice in our lobby and provide you with a copy of the amended Notice upon request.
VII. Complaints to the Government:
If you believe your rights have been violated, you may make a complaint to the Secretary of the Department of Health and Human Services at the following regional office:
Paul Cushing, Regional Manager, Office of Civil Rights
150 S. Independence Mall West
Suite 372, Public Ledger Building
Philadelphia, PA 19106-9111
Main Line: 215-861-4441
Hot Line: 800-368-1019
We promise not to retaliate against you for any complaint you make to the government about our privacy practices.