Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY
BE USED AND DISCLOSED AND HOW YOU CAN HAVE ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Understanding Your Health Record/Information
Whenever you visit a hospital, physician, or healthcare provider,
you are establishing a healthcare record with that provider. Your
healthcare record contains notes about your visit, including such
things as your symptoms, examination and test results, diagnoses,
treatment, and a plan for future care or treatment. Your health
care or medical record serves many purposes.
- It may be used to plan your care and treatment.
- It may be used to obtain payment from a third-party, such as
an insurance company or Medicare and Medicaid.
- It is a means of communication among the many health professionals
who contribute to your care.
- It is a legal document describing the care you received.
- It is a means by which you or a third-party payer can verify
that services billed were actually provided.
- It may be used as a tool in educating health professionals or
a source of data for medical research.
- It may be a source of information for public health officials.
- It may be a source of data for facility planning and marketing.
- It may be a tool with which we can assess and continually work
to improve the care we render and the outcomes we achieve.
Understanding what is in your record and how your health information
is used helps you to ensure its accuracy. It also helps you to understand
who may access your health information and under what conditions,
and it helps you to make more informed decisions when authorizing
disclosure to others.
Your Health Information Rights
The physical record of your health is the property of the healthcare
practitioner or facility that compiled it. However, the underlying
information belongs to you. You have the right to:
- Request restrictions on certain uses and disclosures of your
information, however we do not have to comply with your request.
- Receive a paper copy of the notice of information practices.
- Inspect and obtain a copy of your health record, except in limited
circumstances (you will be charged a reasonable fee for copying)
- Request amendment to your healthcare record.
- Obtain an annual accounting of certain disclosures of your health
information (you will be charged for additional accountings)
- Request communications of your health information by alternative
means or at alternative locations.
- Revoke your authorization to use or disclose health information
except to the extent that action has already been taken.
We do not have to honor your request for restrictions on activities
that are otherwise allowable under law.
WE WILL ACCOMMODATE REASONABLE REQUESTS TO DIRECT COMMUNICATION
TO AN ALTERNATE LOCATION OR TO MAKE COMMUNICATION BY ALTERNATE MEANS.
WE WILL ACCOMMODATE REASONABLE REQUESTS TO RESTRICT DISCLOSURE TO
OTHER PARTIES (NON-HEALTHCARE PROFESSIONALS) DIRECTLY INVOLVED IN
ANY REQUEST FOR RESTRICTIONS ON USE OR DISCLOSURE MUST BE MADE
IN WRITING. WE WILL NOTIFY YOU WITHIN 30 DAYS OF OUR DECISION. WE
MAY REQUEST AN ADDITIONAL 30 DAYS TO CONSIDER YOUR REQUEST.
We are required to:
- Maintain the privacy of your health information
- Provide you with a Notice of Privacy Practices that describe
our legal duties and privacy practices with respect to information
we collect and maintain about you.
- Accommodate reasonable requests you may have to communicate
health information by alternative means or at alternative locations.
We reserve the right to change our practices at any time and to
make any new provisions effective for all the protected health information
we maintain. Prior to making any significant changes in our privacy
practices, we will change our Notice of Privacy Practices and post
the Notice in the waiting room.
We will not use or disclose your health information without your
authorization, except as described in this notice.
Examples of Disclosures for Treatment, Payment, and Health Operations
We will use you health information for treatment.
For example: Information obtained by your doctor, our nurses, and
any other employees of this facility is recorded in your record
and is used to determine the course of treatment that should work
best for you.
Your doctor also documents in your record his or her expectations
of recommended treatment. Individuals involved in your treatment
record the actions that they take and their observations. In that
way, the physician will have a more complete picture of your health.
We will also provide any subsequent physician or healthcare provider
with copies of your healthcare information that should assist him
or her in continuing your course of treatment.
We will use your health information for payment.
For example: We bill you or a third-party payer for payment of
healthcare services rendered. The information on or accompanying
the bill may include information that identifies you, as well as
your diagnosis, procedures, and supplies used. This information
is necessary in order for us to obtain payment.
If necessary this may include releasing information to a collection
We will use your health information for regular health operations.
For example: Members of the medical staff, the risk or quality
improvement manager, or members of the quality improvement team
may use information in your health record to assess the care and
outcomes in your case and others like it. This information will
then be used in an effort to continually improve the quality and
effectiveness of the healthcare and service we provide.
There are some services provided in our organization through contracts
with Business Associates, such as billing services. When these services
are contracted, we may disclose your health information to our business
associate so that they can perform the job weve asked them
to do, such as billing you or your third-party payer for services
rendered. To protect your health information, however, we require
the business associate to appropriately safeguard your information,
and we will only disclose the minimum
necessary information to our Business Associates. The Business Associate
is obligated to protect your information in the same manner as we
We may use or disclose information to notify or assist in notifying
a family member, personal representative, or another person responsible
for your care, your location, and general condition.
Communication with family
Health professionals, using their best judgment, may disclose to
a family member, other relative, close personal friend or any other
person you identify, health information relevant to that persons
involvement in your care or payment related to your care.
We may disclose information to researchers without your authorization
when such disclosure has been approved by an institutional review
board. Under certain circumstances, we may use health information
to identify potential participants for research or educational programs.
Other Uses and Disclosures Allowable or Required under law.
We may disclose health information to funeral directors consistent
with applicable law to carry out their duties.
Organ procurement organizations
Consistent with applicable law, we may disclose health information
to organ procurement organizations or other entities engaged in
the procurement, banking, or transplantation or organs for the purpose
of tissue donation and transplant.
We may contact you to provide you with information about treatment
alternatives or other health-related benefits and services that
may be of interest to you. We may use health information to identify
participants for research or educational programs.
Food and Drug Administration (FDA)
We may disclose to the FDA health information relative to adverse
events with respect to food, supplements, products and product defects,
or post marketing surveillance information to enable product recalls,
repairs, or replacement.
We may disclose health information to the extent authorized by
and to the extent necessary to comply with laws relating to workers
compensation or other similar programs established by law.
We may use and disclose health information to contact you with
reminders of scheduled appointments.
As required by law, we may disclose your health information to
public health or legal authorities charged with preventing or controlling
disease, injury, or disability.
If you are an inmate of a correctional institution, we may disclose
to the institution or agents thereof information necessary for your
health and the health and safety of other individuals.
We may disclose health information for law enforcement purposes
or in response to a valid court order of subpoena.
Federal law makes provision for your health information to be released
to an appropriate health oversight agency, public health authority
or attorney, provided that a work force member or business associate
believes in good faith that we have engaged in unlawful conduct
or have otherwise violated professional or clinical standards and
are potentially endangering one or more patients, workers or the
OTHER USES AND DISCLOSURES WILL BE MADE ONLY UPON YOUR WRITTEN
AUTHORIZATION. You have the right to revoke such authorization,
in writing, except where we have previously taken action in reliance
on your prior authorization or if the authorization was a condition
to obtaining insurance coverage and other law provides the insurer
with the right to contest a claim under the policy.
For More Information or to Report a Problem
If you have questions and would like additional information, you
may contact the Privacy officer at 330-494-2097.
If you believe your privacy rights have been violated, you can
file a complaint with the Privacy Officer or with the secretary
of Health and Human Services. There will be no retaliation for filing
a complaint. The Privacy Officer can provide you with the appropriate
address upon request.
Our Legal Duty
We are required by law to protect the privacy of your information,
provide this notice about our information practices, and follow
the information practices that are described in this notice.
Effective Date: 4/14/03
You may also download a PDF copy of this notice for printing.