INDIANA REGIONAL MEDICAL CENTER
835 Hospital Road
Indiana, PA 15701
This notice describes
how protected health information about you may be used and disclosed and how
you can get access to this information.
Please review it carefully.
SUMMARY
In the course of
receiving services from Indiana Regional Medical Center you will provide us
with personal information about your health, with the understanding that this
information will be kept confidential.
We may also obtain information about your health from examinations,
tests, or from others who have provided you with care.
We
may use and disclose your protected health information to carry out treatment,
payment or healthcare operations and for other purposes that are permitted or
required by law. “Protected health
information” is information that would allow someone to identify you and learn
something about your health.
When
this notice refers to "we" or "us," it is referring to Indiana
Regional Medical Center, the members of its Medical Staff (including your
physician(s)), and other health care providers affiliated with the Medical
Center. This notice applies only to
protected health information created or obtained in connection with medical
care provided to you in the Medical Center.
It does not apply to care provided to you in your physician’s office or
in the office of any other health care provider. If you have not previously visited your physician’s office, upon
your next visit you should receive that physician’s Notice of Privacy Practices
as it relates to his or her own office practice.
Maintain the privacy
of your health information
Provide this notice of
our privacy practices and legal duties regarding the release of your health
information.
Abide by the terms of
this notice until we officially adopt a new notice.
Neither state nor
federal law requires you to provide your written authorization before we may
internally use your protected health information, except for certain limited
situations, such as marketing and research.
In those situations, we will ask you to provide your written
authorization. We will obtain your written authorization before disclosing your
protected health information outside of the Hospital, unless such disclosures
are otherwise required by law.
For illustrative
purposes, the following list identifies the purposes for which we may use your protected
health information without your authorization.
This list also provides examples of the purposes for which we may need
or wish to disclose your protected health information outside of the Hospital
(with written authorization to be obtained from you in appropriate situations):
For Treatment:
We may use your health
information to provide you with medical care and services. This means that our employees, staff,
students, volunteers and others whose work is under our direct control, may
read your health information to learn about your medical condition and use it
to make decisions about your care. For
example, a hospital nurse may read your medical chart in order to care for you
properly. We may also disclose your
information to others who need it in order to provide you with medical
treatment or services. For example, we
may send your doctor the results of laboratory tests we perform.
We will ask for
your authorization to send information to other hospitals and physicians or
caregivers not on staff at Indiana Regional Medical Center, except in medical
emergencies.
For Payment:
We may use your health
information and disclose it to others as necessary to obtain payment for the
services we provide to you. For
example, an employee in our business office may use your health information to
prepare a bill. We will not use or disclose more information than is necessary
for payment.
Health Care Operations: We may use health information for activities that are necessary to
operate this organization. For example,
we may read your health information to review the performance of our staff.
We have agreed, to the
extent permitted by law, to share your protected health information among
ourselves for purposes of treatment, payment or health care operations. This enables us to better address your
health care needs.
Legal
Requirements to Disclose Information: We may disclose your information when we are
required by law to do so. We may also
disclose your health information when we are required by law to do so by a
court order or other judicial or administrative process.
Public
Health Activities: We may disclose health information about you
for public health purposes. This
includes reporting certain diseases, births, deaths, and reactions to certain
medications. It may also include
notifying people who have been exposed to a disease.
To Report Abuse: We may disclose your health
information when the information relates to a victim of abuse, neglect or
domestic violence. We will make this
report only in accordance with laws that require or allow such reporting, or
with your permission.
Law Enforcement: Health information may be disclosed for law enforcement purposes. We must also disclose your health information to a federal agency investigating our compliance with federal privacy regulations.
Specialized Purposes: We may disclose health information of members of the armed forces as authorized by military command authorities. We may disclose health information for a number of other specialized purposes. For example, to coroners, medical examiners, funeral directors; organ procurement organizations; ambulance/transport services or for national security.
For Correctional Institutions: We may disclose health information about an inmate to a correctional institution or to law enforcement officials.
Workers’ Compensation: We may disclose your health information to your employer for purposes of workers’ compensation and work site safety laws (OSHA, for instance).
To Avert a Serious Threat: We may disclose your health information if we decide that the disclosure is necessary to prevent serious harm to the public or to an individual.
Family and Friends: We may disclose your health information to a member of your family or to someone else who is involved in your medical care or payment for care. We may notify family or friends if you are in the hospital and tell them your general condition. We will not disclose your information to family or friends if you object.
Facility Directory: Unless you ask us not to, the Medical Center may list you in its directory. This includes your name, general condition and location in the hospital.
Clergy: Unless you ask us not to, we may give the clergy of your specified church or the Indiana Regional Medical Center clergy your name and facility location.
Facility Research: We may disclose your health information in connection with medical research projects. Federal rules govern any disclosure of your health information for research purposes without your authorization.
De-identified Information: We may use your health information to create material that has had all identifying information concerning you deleted from it.
Limited Data Sets: We may use your health information to create materials that have most of the identifying information about you deleted from them, to allow other entities to conduct research, public health, or health care operation activities.
Appointment Reminders: We may use your health information to call you with an appointment reminder.
Fund Raising: We may use your information to contact you to ask for donations.
Treatment Alternatives: We may use your health information to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.
State Law: The following categories of information receive special protection under state law, and will be used and disclosed only as allowed by state law:
a. HIV-related information;
b. Records of mental health treatment;
c. Substance abuse records.
If you are under 18 years of age, and not emancipated, your parent or guardian will control access to, and disclosure of, your health information, subject to the provisions of this Notice, with the following exceptions:
a. Communicable Diseases. If you are being diagnosed or treated for a sexually transmitted disease or any other disease or condition that we are required by law to report to the government or health authorities, you (the minor) will control access to, and disclosure of, your health information that is related to that diagnosis or treatment.
b. Mental Health. If you are over 14 years of age, and you are able to understand the nature of your mental health records and the purpose of releasing them, you will control access to, and disclosure of, the health information related to your mental health treatment.
Your Rights:
Authorization. We
will not use or disclose your health information for any purpose that is not listed
in this notice without
your written authorization. If you
authorize us to use or disclose your health information, you have the right to
revoke the authorization at any time.
Request Restrictions. You
have the right to ask us to restrict how we
use or disclose your health information.
We will consider your request.
But we are not required to agree.
If we do agree, we will comply with the request unless the information
is needed to provide you with emergency treatment. We cannot agree
to restrict disclosures that are required by law.
Confidential Communication. You have the right to ask us to communicate with you at a special
address or by
special means.
Inspect And Receive a Copy of
Health Information. You have a right to inspect the health
information about you that we have in our records, and to receive a copy of
it. We may deny you access to certain
information. Due to the volume and complexity of records and requests, advanced
notice will ensure that we can completely fulfill your needs. Some requests can be satisfied in a few
minutes and others can take several days.
Regulations state we must respond to your request within 30 days. We may charge a fee for copies of your
records. These fees are regulated by
the State. Please call the Medical
Record Department with your requests or if you have questions (724-357-7038).
Amend Health Information. You
have the right to ask us to amend health
information about you which you believe is not correct, or not complete. You must make this request in writing, and
give us the reason you believe the information is not correct or complete. We will respond to your request in writing within
30 days. We may deny your request if we
did not create the information, if it is not part of the records we use to make
decisions about you, if the information is something you would not be permitted
to inspect or copy, or if it is complete and accurate.
Accounting of Disclosures. You
have a right to receive an accounting of
certain disclosures of your information to others. We may charge you for this
request. You must tell us the time
period you want the list to cover. You
may not request a time period longer than six years. We cannot include disclosures made before April 14, 2003.
Paper Copy of the Notice. You
have the right to obtain a paper copy of this Notice upon request.
Complaints. You
have a right to complain about our privacy practices, if you think your privacy
has been violated. You may file your
complaint with the person listed under “Whom to Contact” at the end of this
notice. You
may also file a complaint directly with the Secretary of the U. S. Department
of Health and Human Services, at the Office for Civil Rights, U.S. Department
of Health and Human Services, 200 Independence Avenue, S.W., Room 509F HHH
Bldg., Washington, D.C. 20201. All
complaints must be
in writing. We will not take any
retaliation against you if you file a complaint.
Our Right to Change this Notice:
We
reserve the right to change our privacy practices, as described in this notice, at any time.
We reserve the right to apply these changes to any health information
that we already have, as well as to health information we receive in the
future. Any changes to this Notice will
be posted on our website [if applicable] and at our facility, and will be
available from us upon request.
Whom to
Contact:
To File a
Complaint:
Julia Willis, Patient Representative, 724/357-7280
To Obtain more information regarding this notice, our privacy policies or to exercise your rights listed above contact: Sarah Foust, MPM, RHIA, Director, Medical Records Department, Privacy Official, 724/357-7197.
Effective Date: April 14, 2003