NOTICE OF PRIVACY PRACTICES
Effective date: September 22, 2013
You can download
and print a copy of these policies by clicking here.
For additional information, contact: Cheryl A Girardier,
MBA, PMP; 814-868-8326
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
When this notice refers to “we” or “us” it is referring to Millcreek
Community Hospital, Lake Erie College of Osteopathic Medicine, and Millcreek Manor (d/b/a Millcreek
Geriatric Education and Care Center).
This Notice describes how we will use and disclose your
health information. The policies outlined in this Notice apply to all of your health information
generated by this Organization, whether recorded in your medical record, invoices, payment forms,
videotapes, or other ways. Similarly, these policies apply to the health information gathered from
other Organizations by any health care professional, employee, or volunteer who participates in
We are required by law to:
the privacy of protected health information
- Give you this notice of our legal duties
and privacy practices regarding health information about you
- Follow the terms of our
notice that is currently in effect
USE AND DISCLOSURE OF YOUR HEALTH
- In some circumstances we are permitted or required to use or disclose
your health information without obtaining your prior authorization and without offering you the
opportunity to object. These circumstances include:
- Uses or disclosures
for purposes relating to treatment, payment, and health care operations:
- TREATMENT. – We may use or disclose your health information for the purpose of
providing, or allowing others to provide treatment to you. An example would be if your primary care
physician discloses your health information to another doctor for the purposes of a consultation.
Also, we may contact you with appointment reminders or information about treatment alternatives or
other health-related benefits and services that may be of interest to you.
- PAYMENT. – We may use and/or disclose your health information for the purpose of allowing
us, as well as other entities, to secure payment for the health care services provided to you. For
example, we may provide information about your treatment to your insurance company.
- HEALTH CARE OPERATIONS. – We may use and/or disclose your information for the purposes of
our day-to-day operations and functions. We may also disclose your information to another covered
entity to allow it to perform its day-to-day functions, but only to the extent that we both have a
relationship with you. For example, we may compile your health information, along with that of
other patients, in order to allow a team of our health care professionals to review that
information and make suggestions concerning how to improve the patient safety and quality of care
provided at this facility. Also, we may contact you as a part of our efforts to raise funds for the
Organization. All fundraising communications will include information about how you may opt out of
future fundraising communications.
- To create
material(s) that originally had any identifying information concerning you deleted from the final
- When required by law;
- For public health
- To disclose information about victims of abuse, neglect, or domestic
- For judicial or administrative proceedings;
- For law
- To assist coroners, medical examiners, or funeral directors
with their official duties;
- To facilitate organ, eye, or tissue donation;
- For certain research projects that have been evaluated and approved through a research
approval process that takes into account patients’ need for privacy. For health oversight
activities, such as audits, or civil administrative or criminal investigations;
avert a serious threat to health or safety;
- For specialized governmental functions,
such as military, national security, criminal corrections, or public benefit purposes;
- For workers’ compensation purposes, as permitted by law: or
- Upon request
from the Secretary of the United States Department of Health and Human Services.
- We may also use or disclose your health information in the following circumstances.
However, except in emergency situations, we will inform you of our intended action prior to making
any such uses and disclosures and will, at that time, offer you the opportunity to object.
- DIRECTORIES. – We may maintain a directory of patients that includes your
name and location within the facility, your religious designation, and information about your
condition in general terms that will not communicate specific medical information about you. We
will only disclose your religious designation to members of the clergy.
- NOTIFICATIONS. – We may disclose to your relatives or close personal friends any health
information that is directly related to that person’s involvement in the provision of, or
payment of, your care. We may also use and disclose your health information for the purpose of
locating and notifying your relatives or close personal friends of your location and general
condition or death, and to Organizations that are involved in those tasks during disaster relief
Except as described above, disclosures of your health
information will be made only with your written authorization or that of your guardian, if you have
one. Most uses and disclosures of psychotherapy notes, uses and disclosures for
research purposes and disclosures that constitute a sale of PHI require authorization. You may
revoke your authorization at any time, in writing, unless we have taken action in reliance upon
your prior authorization, or if you signed the authorization as a condition of obtaining insurance
YOUR RIGHTS Under HIPAA Regarding Your Protected Health Information
- TO REQUEST RESTRICTIONS. – You have the right to request restrictions on the use and
disclosure of your health information for treatment, payment, or health care operations purposes or
notification purposes. We are not required by law to agree to your requested restrictions except
when a disclosure is to be restricted to a health plan for services paid exclusively by you, the
patient, or guarantor. If we do agree to a restriction, we will abide by that restriction unless
you are in need of emergency treatment and the restricted information is needed to provide that
emergency treatment. To request a restriction, submit a written request to the Contact listed
- TO LIMIT COMMUNICATIONS. – You have the right to receive confidential
communications about your own health information by alternative means or at alternative locations.
This means that you may, for example, designate that we contact you only via e-mail, or at work
rather than home. To request communications via alternative means or at alternative locations, you
must submit a written request to the Contact listed below. All reasonable requests will be
- TO ACCESS AND COPY HEALTH INFORMATION. -- You have the right to inspect and
copy any health information about you other than psychotherapy notes, information compiled in
anticipation of or for use in civil, criminal or administrative proceedings, or certain information
that is governed by the Clinical Laboratory Improvement Act. To arrange for access to your records,
or to receive a copy of your records, you should submit a written request to the Contact listed on
the last page of this Notice. If you request copies, you will be charged our regular fee for
copying and mailing the requested information.
Despite your general right to
access you Protected Health Information, access may be denied in some limited circumstances. For
example, access may be denied if you are an inmate at a correctional institution or if you are a
participant in a research program that is still in progress. Access may be denied if the federal
Privacy Act applies. Access to information that was obtained from someone other than a health care
provider under a promise of confidentiality can be denied if allowing you access would reasonably
be likely to reveal the source of the information. The decision to deny access under these
circumstances is final and not subject to review. In addition, access may be denied if (i) access
to the information in question is reasonably likely to endanger the life and physical safety of
your or anyone else, (ii) the information make reference to another person and your access would
reasonably be likely to cause harm to that person, or (iii) you are the personal representative of
another individual and a licensed health care professional determines that your access to the
information would cause substantial harm to the patient or another individual. If access is denied
for these reasons, you have the right to have the decision reviewed by a health care professional
who did not participate in the original decision. If access is ultimately denied, the reasons for
that denial will be provided to you in writing.
- TO REQUEST AMENDMENT. -- You may
request that your health information be amended. Your request may be denied if the information in
question: was not created by us (unless you show that the original source of the information is no
longer available to seek amendment from), is not part of our records, is not the type of
information that would be available to you for inspection or copying (for example, psychotherapy
notes), or is accurate and complete. If your request to amend your health information is denied,
you may submit a written statement disagreeing with the denial, which we will keep on file and
distribute with all future disclosures of the information to which it relates. Requests to amend
health information must be submitted in writing to the Contact listed on the final page of this
- TO AN ACCOUNTING OF DISCLOSURES. -- You have a right to an accounting of any
disclosures of your health information made during the six-year period preceding the date of your
request. However, the following disclosures will not be accounted for: (i) disclosures made for the
purpose of carrying out treatment, payment or health care operations, (ii) disclosures made to you,
(iii) disclosures of information maintained in our patient directory, or disclosures made to
persons involved in your care, or for the purpose of notifying your family or friends about your
whereabouts, (iv) disclosures for national security or intelligence purposes, (v) disclosures to
correctional institutions or law enforcement officials who had you in custody at the time of the
disclosure, (vi) disclosures that occurred prior to April 14, 2003, (vii) disclosures made pursuant
to an authorization signed by you, (viii) disclosures that are part of a limited data set, (ix)
disclosures that are incidental to another permissible use or disclosure, or (x) disclosures made
to a health oversight agency or law enforcement official, but only if the agency or official asks
us not to account to you for such disclosures and only for the limited period of time covered by
that request. The accounting will include the date of each disclosure, the name of the entity or
person who received the information disclosed and the purpose of the disclosure. To request an
accounting of disclosures, submit a written request to the Contact listed on the final page of this
- TO BE NOTIFIED OF UNAUTHORIZED ACCESS -- Per the federal Modifications to the
HIPAA Privacy, Security, Enforcement, and Breach Notification final rule published January 25, 2013
unless a specific exception as identified in 45 CFR 160 or 164 exists, you have a right to be
notified of any unauthorized access, use or disclosure of your medical or business information
which compromises the privacy or security of such information.
- If you do not wish to
be contacted for fundraising efforts, you may submit a written request to the Contact listed on the
last page of this Notice.
- TO A PAPER COPY OF THIS NOTICE. -- You have the right to
obtain a paper copy of this Notice upon request. You have a right to receive any amendments or
updates to this Notice.
- We are required by law to
maintain the privacy of your health information and to provide you with this Notice of our legal
duties and privacy practices.
- We are required to abide by the terms of this Notice. We
reserve the right to change the terms of this Notice and to make those changes applicable to all
health information that we maintain. Any changes to this Notice will be posted on our website and
at our facility, and will be available from us upon request.
- We are required to
maintain policies and practices designed to protect the privacy of your health information, which
policies contain sanctions for any violation of these policies.
- We are required to
name a Privacy Officer, whose name is listed at the top of this notice.
- We are
required to make your health information available to you upon demand, as is reflected above and to
the Secretary of the United States Department of Health and Human Services.
You can complain to us and to the Secretary of the federal Department of
Health and Human Services if you believe your privacy rights have been violated. To lodge a
complaint with us, please file a written complaint with the Contact set forth below. This Contact
will also provide you with further information about our privacy policies upon request. No action
will be taken against you for filing a complaint. You may also file a complaint directly with the
Office of Inspector General of the U.S. Department of Health and Human Services.
Cheryl A Girardier, MBA, PMP
Director of Information Technology, Privacy
& Security Officer
Millcreek Community Hospital
5515 Peach St
(814) 868-8326 Revisions: 9/2013
Updated September 20, 2013