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Notice of Privacy Practices
Effective April 14, 2003
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.
If you have any questions about this notice, please contact our
Patient Representative at 724-258-1076.
Who Follows This Notice of Privacy Practices
Monongahela Valley Hospital (MVH) is part of a larger corporation,
Mon Vale Health Resources (MVHR). All of the MVHR entities (the
hospital, outpatient services, medical equipment supplies, rehabilitation
services, etc.) follow this Notice of Privacy Practices. This also
includes all of the members of our Medical Staff (including your
physician), departments, units, employees, and staff in our health
care facilities, all health care professionals permitted by us to
provide services to you, students, trainees, volunteers and others
involved in providing your care. As permitted by law, these places
and people may share your health information with each other for
the treatment, payment or health care operations that are described
in this Notice.
Our Pledge Regarding Medical Information
We understand that your medical information is personal. We are
committed to protecting your medical information. We create a record
of the care and services you receive at the hospital. We need this
record to provide you with quality care and to comply with certain
legal requirements. This notice applies to all of the records of
your care generated by the hospital, whether made by hospital personnel
or your personal doctor. Your personal doctor may have different
policies or notices regarding the doctor's use and disclosure of
your medical information created in the doctor's office or clinic.
This notice explains the ways in which we may use and disclose your
medical information. We also describe your rights and certain obligations
we have regarding the use and disclosure of medical information.
The law requires us to:
- Make sure that your medical information
is kept private;
- Give you this notice of our legal duties and
privacy practices with respect to your medical information; and
- Follow the terms of the notice currently in
effect.
How we may use and Disclose Your Medical Information
The following categories describe different ways that we use and
disclose medical information. For each category we will explain
what we mean and try to give some examples. Not every use or disclosure
in a category will be listed; however, all of the ways we are permitted
to use and disclose information will fall in one of the categories.
Treatment
We may use your medical information to provide you with medical
treatment or services. We may disclose your medical information
to doctors, nurses, technicians, medical students, or other hospital
personnel who are involved in taking care of you at the hospital.
For example, a doctor treating you for a broken leg may need to
know if you have diabetes because diabetes may slow the healing
process. In addition, the doctor may need to tell the dietitian
if you have diabetes so that we can arrange for appropriate meals.
Different departments of the hospital also may share your medical
information in order to coordinate the different things you need,
such as prescriptions, lab work and x-rays. We also may disclose
your medical information to people outside the hospital who may
be involved in your medical care after you leave the hospital, such
as family members, or others you select to provide services that
are part of your care. (i.e. visiting nurses, medical equipment
suppliers)
Payment
We may use and disclose your medical information so that the treatment
and services you receive at the hospital may be billed to and payment
may be collected from you, an insurance company or a third party.
For example, we may need to give your health plan information about
surgery you received at the hospital so your health plan will pay
us for the surgery. We may also tell your health plan about a treatment
you are going to receive to obtain prior approval or to determine
whether your plan will cover the treatment.
Health Care Operations
We may use and disclose your medical information for hospital operations.
These uses and disclosures are necessary to run the hospital and
make sure that all of our patients receive quality care. For example,
we may use medical information to review our treatment and services
and to evaluate the performance of our staff in caring for you.
We may also combine medical information about many hospital patients
to decide what additional services the hospital should offer, what
services are not needed, and whether certain new treatments are
effective. We may also disclose information to doctors, nurses,
technicians, medical students, and other hospital personnel for
review and learning purposes. We may also combine the medical information
we have with medical information from other hospitals to compare
how we are doing and see where we can make improvements in the care
and services we offer. We may remove information that identifies
you from this set of medical information so others may use it to
study health care and health care delivery without learning who
the specific patients are.
Appointment Reminders
We may use and disclose medical information to contact you as a
reminder that you have an appointment for treatment or medical care
at the hospital.
Treatment Alternatives
We may use and disclose medical information to tell you about or
recommend possible treatment options or alternatives that may be
of interest to you.
Health-Related Benefits and Services
We may use and disclose medical information to tell you about health-related
benefits or services that may be of interest to you.
Hospital Directory
We may include certain limited information about you in the hospital
directory while you are a patient at the hospital. This information
may include your name, location in the hospital, your general condition
(e.g., fair, stable, serious, etc.) and your religious affiliation.
The directory information, except for your religious affiliation,
may also be released to people who ask for you by name. Your religious
affiliation may be given to a member of the clergy, such as a priest
or rabbi, even if they don’t ask for you by name. This is so
your family, friends and clergy can visit you in the hospital and
generally know how you are doing. You also have the right to tell
us not to include your information in the directory.
Individuals Involved in Your Care or Payment for Your Care
We may release your medical information to a friend or family member
who is involved in your ongoing medical care. We may also give information
to someone who helps pay for your care. We may also tell your family
or friends your condition and that you are in the hospital. In addition,
we may disclose your medical information to an entity assisting
in a disaster relief effort so that your family can be notified
about your condition, status and location. You also have the right
to tell us of any person(s) whom you do not want your protected
health information shared with.
Research
We may use and disclose your medical information for research purposes.
For example, a research project may involve comparing the health
and recovery of all patients who received one medication to those
who received another, for the same condition. All research projects,
however, are subject to a special approval process. This process
evaluates a proposed research project and its use of medical information,
trying to balance the research needs with patients' need for privacy
of their medical information. Before we use or disclose medical
information for research, the project will have been approved through
this research approval process, but we may, however, disclose medical
information about you to people preparing to conduct a research
project, for example, to help them look for patients with specific
medical needs, so long as the medical information they review does
not leave the hospital. We will usually ask for your specific permission
if the researcher will have access to your name, address or other
information that identifies who you are, or will be involved in
your care at the hospital.
Required By Law
We will disclose your medical information when required to do so
by federal, state or local law.
To Avert a Serious Threat to Health or Safety
We may use and disclose your medical information when necessary
to prevent a serious threat to your health and safety or the health
and safety of the public or another person. Any disclosure, however,
would only be to someone able to help prevent the threat.
Special Situations
Organ and Tissue Donation
If you are an organ donor, we may release medical information to
organizations that handle organ procurement or organ, eye or tissue
transplantation or to an organ donation bank, as necessary to facilitate
organ or tissue donation and transplantation.
Military and Veterans
If you are a member of the armed forces, we may release your medical
information as required by military command authorities. We may
also release medical information about foreign military personnel
to the appropriate foreign military authority.
Workers' Compensation
We may release your medical information for workers' compensation
or similar programs. These programs provide benefits for work-related
injuries or illness.
Inmates
If you are an inmate of a correctional institution or under the
custody of a law enforcement official, we may release your medical
information to the correctional institution or law enforcement official.
This release would be necessary (1) for the institution to provide
you with health care; (2) to protect your health and safety or the
health and safety of others; or (3) for the safety and security
of the correctional institution.
Public Health Risks
We may disclose your medical information for public health activities.
These activities generally include the following:
- Prevent or control disease, injury or
disability;
- Report births and deaths;
- Report child abuse or neglect;
- Report certain reactions to medications or
problems with products;
- Notify people of recalls of products they
may be using;
- Notify a person who may have been exposed
to a disease or may be at risk for contracting or spreading a
disease or condition;
- Notify the appropriate government authority
if we believe a patient has been the victim of abuse, neglect
or domestic violence. We will only make this disclosure if you
agree or when required or authorized by law.
Health Oversight Activities
We may disclose medical information to a health oversight agency
for activities authorized by law. These oversight activities include,
for example, audits, investigations, inspections, and licensure.
These activities are necessary for the government to monitor the
health care system, government programs, and compliance with civil
rights laws.
Lawsuits and Disputes
If you are involved in a lawsuit or a dispute, we may disclose your
medical information in response to a court or administrative order
or rule. We may also disclose your medical information in response
to a subpoena, discovery request, or other lawful process by someone
else involved in the dispute.
Law Enforcement
We may release medical information if asked to do so by a law enforcement
official:
- In response to a court order, subpoena,
warrant, summons or similar process;
- To identify or locate a suspect, fugitive,
material witness, or missing person;
- About the victim of a crime if, under
certain limited circumstances, we are unable to obtain the person's
agreement;
- About a death we believe may be the
result of criminal conduct;
- About criminal conduct at the hospital;
and
- In emergency circumstances to report
a crime; the location of the crime or victims; or the identity,
description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral
Directors
We may release medical information to a coroner or medical examiner.
This may be necessary, for example, to identify a deceased person
or determine the cause of death. We may also release medical information
about patients of the hospital to funeral directors as necessary
to carry out their duties.
National Security and Intelligence Activities
We may release your medical information to authorized federal officials
for intelligence, counterintelligence, and other national security
activities authorized by law.
Your Rights Regarding Your Health Information
Right to Inspect and Copy
You have the right to inspect and copy your medical information.
Usually, this includes medical and billing records, but does not
include psychotherapy notes. To inspect and copy your medical information,
you must submit a request in writing to the Director, Medical Records
Department, Monongahela Valley Hospital, Country Club Road, Monongahela,
PA 15063. If you request a copy of the information, we may charge
a fee for the costs of copying, mailing or other supplies associated
with your request. We may deny your request to inspect and copy
in certain very limited circumstances. If you are denied access
to medical information, you may request that the denial be reviewed.
Another licensed health care professional chosen by the hospital
will review your request and the denial. The person conducting the
review will not be the person who denied your request. We will comply
with the outcome of the review.
Right to Amend
If you feel that your medical information is incorrect or incomplete,
you may ask us to amend the information. You have the right to request
an amendment for as long as the information is kept by or for the
hospital. To request an amendment, your request must be made in
writing and submitted to the Director, Medical Records Department,
Monongahela Valley Hospital, Country Club Road, Monongahela, PA
15063. In addition, you must provide a reason that supports your
request. We may deny your request for an amendment if it is not
in writing or does not include a reason to support the request.
In addition, we may deny your request if you ask us to amend information
that:
- Was not created by us, unless the person or
entity that created the information is no longer available to
make the amendment;
- Is not part of the medical information kept
by or for the hospital;
- Is not part of the information which you
would be permitted to inspect and copy; or
- Is accurate and complete.
Right to an Accounting of Disclosures
You have the right to request an "accounting of disclosures."
This is a list of disclosures we made of your medical information.
Disclosures made for treatment, payment or health care operations
and disclosures authorized by you or your legal representative are
not included in the accounting of disclosures. To request this list
or accounting of disclosures, you must submit a request in writing
to the Privacy Officer, Monongahela Valley Hospital, Country Club
Road, Monongahela, PA 15063. Your request must state a time period,
which may not be longer than six years and cannot include dates
before April 14, 2003. Your request should indicate in what form
you want the list (for example, on paper, electronically). The first
list you request in a 12-month period will be free. For additional
lists, we will charge you for the costs of providing the list. We
will notify you of the cost involved and you can choose to withdraw
or modify your request at that time before any costs are incurred.
Right to Request Restrictions
You have the right to request a restriction or limitation on the
medical information we use or disclose about you for treatment,
payment or health care operations. You also have the right to request
a limit on the medical information we disclose about you to someone
who is involved in your care or the payment for your care, like
a family member or friend. For example, you could ask that we not
use or disclose information about a surgery you had. We are not
required to agree to your request. If we do agree, we will comply
with your request unless the information is needed to provide you
emergency treatment. To request restrictions, you must make your
request in writing to the Director, Medical Records, Monongahela
Valley Hospital, Country Club Road, Monongahela, PA 15063. In your
request, you must tell us (1) what information you want to limit;
(2) whether you want to limit our use, disclosure or both; and (3)
to whom you want the limits to apply, for example, disclosures to
your spouse.
Right to Request Confidential Communications
You have the right to request that we communicate with you about
medical matters in a certain way or at a certain location. For example,
you can ask that we only contact you at work or by mail. To request
confidential communications, you must make your request in writing
to the Director, Medical Records, Monongahela Valley Hospital, Country
Club Road, Monongahela, PA 15063. We will not ask you the reason
for your request. We will accommodate all reasonable requests. Your
request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice. You may ask us
to give you a copy of this notice at any time by contacting our
Patient Representative at (724) 258-1076. Even if you have agreed
to receive this notice electronically, you are still entitled to
a paper copy of this notice. You may also obtain a copy of this
notice at our website, www.monvalleyhospital.com
Other Uses of Medical Information
Other uses and disclosures of medical information not covered by
this notice or the laws that apply to us will be made only with
your written permission. If you provide us permission to use or
disclose medical information about you, you may revoke that permission,
in writing, at any time. If you revoke your permission, we will
no longer use or disclose medical information about you for the
reasons covered by your written authorization. You understand that
we are unable to take back any disclosures we have already made
with your permission, and that we are required to retain our records
of the care that we provided to you.
Complaints
If you believe we have violated your privacy rights, you may file
a complaint directly with the hospital or by contacting the Secretary
of the Department of Health and Human Services. You can file a complaint
with the hospital by contacting the Patient Representative at (724)
258-1076 or by calling the MVH Compliance Line at (724) 258-1115
or by writing us at Monongahela Valley Hospital, ATTN: Patient Representative,
Country Club Road, Monongahela, PA 15063. You will not be penalized
for filing a complaint.
Changes to This Notice
We reserve the right to change this notice. We reserve the right
to make the revised or changed notice effective for medical information
we already have about you as well as any information we receive
in the future. We will post a copy of the current notice in the
hospital. The notice will contain, on the first page, the effective
date. In addition, each time you register at or are admitted to
the hospital for treatment or health care services as an inpatient
or outpatient, we will make available to you a copy of the current
notice in effect.
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© 2009 Mon-Vale Health Resources, Inc. | MVH
Notice of Privacy Practices | All rights reserved.
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