THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
This notice of Privacy Practices is being provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). The terms of this Notice of Privacy Practices apply to Hocking Valley Community Hospital operating as a clinically integrated health care arrangement composed of Hocking Valley Community Hospital, the Physicians and Other Licensed Professionals Seeing and Treating Patients at the Hospital. The members of this clinically integrated health care arrangement work and practice at the Hocking Valley Community Hospital campus and Rehab Center. All of the entities and persons listed will share protected health information of our patients as necessary to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information in some cases. Your “protected health information” means any of your written and oral health information, including demographic data that can be used to identify you. This is health information that is created or received by your health care provider, and that relates to your past, present or future physical or mental health or condition.
I. Uses and Disclosures of Your Protected Health Information
The provider may use your protected health information for purposes of providing
treatment, obtaining payment for treatment, and conducting health care operations. Your protected health information may be used or disclosed only for these purposes unless the Provider has obtained your authorization or the use or disclosure is otherwise permitted by the HIPAA Privacy Regulations or State law. Disclosures of your protected health information for the purposes described in the Notice may be in writing, orally, or by facsimile.
A. Treatment. We will disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party for treatment purposes. For example, we may disclose your protected health information to a pharmacy to fulfill a prescription, to a laboratory to order a blood test, or to a home health agency that is providing care in your home. We may also disclose protected health information to other physicians who may be treating you or consulting with your physician with respect to your care. In some cases, we may also disclose protected health information to an outside treatment provider for purposes of the treatment activities of the other provider.
B. Payment. Your protected health information will be used, as needed, to obtain payment for the services that we provide. For instance, we may forward information regarding your medical procedures and treatment to your insurance company to arrange for payment for the services provided to you or we may use your information to prepare a bill to send to your or to the person responsible for your payment.
C. Operations. We may use and disclose your protected health information as necessary, and as permitted by law, for our health care operations, which include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance, we may use and disclose your protected health information for purposes of improving the clinical treatment and care of our patients. We may also disclose your protected health information to another health care facility, health care professional, or health plan for such things as quality assurance and case management, but only if that facility, professional, or plan also has or had a patient relationship with you.
D. Other Uses and Disclosures. As part of treatment, payment and health care operations, we may also use or disclose your protected health information for the following purposes:
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To remind you of an appointment.
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To inform you of potential treatment alternative or options.
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To inform you of health-related benefits or services that may be of interest to you.
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To contact you to raise funds for the provider or an institutional foundation
related to the provider. If you do not wish to be contacted regarding fundraising, please contact:
Privacy Officer Hocking Valley Community Hospital
PO Box 966
601 State Rt. 664 North
Logan, Ohio 43138
II. Uses and Disclosures Beyond Treatment, Payment, and Health Care Operations Permitted Without Authorization or Opportunity to Object
We are permitted or required by law to make certain other uses and disclosures of your protected health information without your consent or authorization.
A. When Legally Required. We will disclose your protected health information
when we are required to do so by any Federal, State, or local law.
B. When There Are Risks to Public Health. We may disclose your protected health information for the following public activities and purposes:
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To prevent, control, or report disease, injury or disability as permitted by law.
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To collect or report adverse events and product defects, track FDA regulated products, enable product recalls, repairs or replacements to the FDA.
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To report to an employer information about an individual who is a member of the workforce as legally permitted or required.
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To report vital events such as birth or death as permitted or required by law.
C. To Report Abuse, Neglect or Domestic Violence. We may release your protected health information as required by law if we suspect child abuse or neglect; we may also release your protected health information as required by law if we believe you to be a victim of abuse, neglect, or domestic violence.
D. To Conduct Health Oversight Activities. We may release your protected health information if required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings.
E. In Connection With Judicial and Administrative Proceedings. We may disclose your protected health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order in response to a subpoena in some circumstances.
F. For Law Enforcement Purposes. We may disclose your protected health information to a law enforcement official for law enforcement purposes as follows:
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As required by law for reporting of certain types of wounds or other physical injuries
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Pursuant to court order, court-ordered warrant, subpoena, summons or similar process.
G. To Coroners, Funeral Directors, and for Organ Donation. We may disclose your protected health information to a coroner or medical examiner for identification purposes; to determine cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. We may release your protected health information if necessary to arrange an organ or tissue donation from you or a transplant for you.
H. For Research Purposes. We may disclose your protected health information for research when the use or disclosure for research has been approved by an institutional review board or privacy board that has reviewed the research proposal and research protocols to address the privacy of your protected health information.
I. For Specified Government Functions. We may release your protected health information if you are a member of the military as required by armed forces services. We may also release your protected health information if necessary for national security or intelligence activities.
J. For Worker’s Compensation. We may release your protected health information to comply with worker’s compensation laws or similar programs.
K. State Laws that are more stringent. Ohio law requires that we obtain a consent from you in many instances before disclosing the performance or results of an HIV test or diagnoses of AIDS or an AIDS-related condition; before disclosing information about drug or alcohol treatment you have received in a drug or alcohol treatment program; before disclosing information about mental health services you may have received; and before disclosing certain information to the State Long-Term Care Ombudsman. For full information on when such consents may be necessary, you can contact the Privacy Officer.
III. Uses and Disclosures Permitted Without Authorization But With Opportunity to Object
A. Family and Friends Involved with Your Care. We may disclose your protected health information to your family member or a close personal friend if it is directly relevant to the person’s involvement in your care or payment related to your care. We can also disclose your information in connection with trying to locate or notify family members or others involved in your care concerning your location, condition or death. If you are unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in your best interest, we may share limited protected health information with such individuals without your approval.
B. Our Facility Directory. We maintain a facility directory listing the name, room number, general condition and, if you wish, your religious affiliation. Unless you choose to have your information excluded from this directory, the information, excluding your religious affiliation, will be disclosed to anyone who requests it by asking for you by name. This information, including your religious affiliation, may also be provided to members of the clergy. You have the right during registration to have your information excluded from this directory.
IV. Uses and Disclosures Which You Authorize
Other than stated above, we will not disclose your protected health information other than with your written authorization. You may revoke your authorization in writing at any time except to the extent that we have taken action in reliance upon the authorization.
V. Your Rights
You have the following rights regarding your health information:
A. The right to inspect and copy your protected health information. You have the right to copy and or inspect much of the protected health information that we retain on your behalf. All requests for access must be made in writing and signed by you or your representative. We will charge you a search fee of $5.00 and $1.00 per page up to 10 pages; subsequent pages are $0.25 each, if you request a copy of the information. We will also charge for postage if you request a mailed copy. You may obtain an access request form our Privacy Officer.
B. The right to have your physician amend your protected health information. You may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In
certain cases, we may deny your request for an amendment. If we deny your request for an amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Requests for amendment must be in writing and must be directed to our Privacy Officer. In this written request, you must also provide a reason to support the requested amendments.
C. The right to receive an accounting. You have the right to receive an accounting of certain disclosures made by us of your protected health information after April 14, 2003. Requests must be made in writing and signed by you or your representative. Accounting request forms are available from our Privacy Officer. The first accounting in any 12-month period is free; you will be charged a fee of $5.00 for each subsequent accounting you request within the same 12-month period.
D. The right to request a restriction on uses and disclosures of your protected health information. You may ask us not to use or disclose certain parts of your protected health information for the purposes of treatment, payment or health care operations. You may also request that we not disclose your health information to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
We are not required to agree with your restriction request. We will notify you if we deny your request to a restriction. We retain the right to terminate an agreed to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You may request a restriction by contacting our Privacy Officer.
E. The right to obtain a paper copy of this notice. Upon request, we will provide a separate paper copy of this notice even if you have already received a copy of the notice.
F. The right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to request that we communicate with you in certain ways. We will accommodate reasonable requests. We may condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not require you to provide an explanation for your request. Requests must be made in writing to our Privacy Officer.
VI. Complaints
You have the right to express complaints to the provider and to the Secretary of Health and Human Services if you believe that your privacy rights have been violated. To register a complaint with us, contact our Privacy Officer verbally or in writing, using the Privacy Contact information below.
VII. Acknowledgment
You will be asked to sign an acknowledgment form that you received this Notice of Privacy Practices.
VIII. Our Duties
We are required by law to maintain the privacy of our patients’ protected health information and to provide patients with notice of our legal duties and privacy practices with respect to your protected health information. We must abide by the terms of this Notice as long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make the new Notice effective for all protected health information maintained by us.
IX. Privacy Contact
The provider’s contact for all issues regarding patient privacy and your rights under the Federal privacy standards is the Privacy Officer. For more information regarding matters covered by this Notice, please contact:
Privacy Officer
Hocking Valley Community Hospital
PO Box 966
601 State Rt. 664 North
Logan, OH 43138
The Privacy Officer can be contacted by telephone at 740-380-8315
X. Effective Date
This Notice is effective April 14, 2003.