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 your
We are required by law to:
- Maintain 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 INFORMATION
- 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
- Uses or disclosures for purposes relating to
treatment, payment, and health care operations:
– 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
- To create material(s) that originally
had any identifying information concerning you deleted from the final material(s);
- When required by law;
- For public health purposes;
- To disclose
information about victims of abuse, neglect, or domestic violence;
- For judicial or
- For law enforcement purposes;
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;
- To avert a serious threat to health or
- 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.
– 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 situations.
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
marketing or 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 coverage.
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 below.
- 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 granted.
- 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
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 Notice.
- 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 Notice.
- 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.
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