HIPAA NOTICE OF PRIVACY PRACTICES and Pricing  Effective: 5/01  THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. If you have any questions about this notice, please contact the Privacy Officer. OUR PLEDGE REGARDING MEDICAL INFORMATION:  We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of 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 will tell you about the ways in which we may use and disclose medical information about you. We also describe your right and certain obligations we have regarding the use and disclosure of medical information.  The Law requires us to: · Make sure that medical information that identifies you is kept private; · Give you this notice of our legal duties and privacy practices with respect to medical information about you; and · Follow the terms of the notice that is currently in effect. HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.  The following categories describe different ways that we use and disclose medical information. 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 within one of the categories. Ø      For Treatment. We may use medical information about you to provide you with family members, physician, clergy or others we use to provide services that are part of your care, medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you at the hospital. We also may disclose medical information about you to people outside the hospital who may be involved in your medical care after you leave the hospital, such as physicians, family members, clergy, or others we use to provide services that are part of your care. Ø      For Payment. We may use and disclose medical information about you so that the treatment and services you receive at the hospital may be billed to and payment may be collected from you, to an insurance company or a third party. Ø      For Health Care Operations. We may use and disclose medical information about you for hospital operations. These uses and disclosures are necessary to run the hospital and see that all of our patients receive quality care.  Ø      Appointment Reminders and Call Backs. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment at the hospital. We may also use information to contact you following a procedure so as to verify your recovery.  Ø      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.  Ø      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.  Ø      Hospital Directory.  We may include certain information about you in the hospital directory while you are a patient in the hospital. This information may include your name, location in the hospital, your general condition, and your religious affiliation. The directory information, except for 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, even if they don’t ask for you by name.  Ø      Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care.  Ø      As Required by Law. We will disclose medical information about you when required to do so by federal, state, or local law.  Ø      To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.  Ø      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 donor bank, as necessary to facilitate organ or tissue donation and transplantation.  Ø      Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities.  Ø      Workers’ Compensation. We may release medical information about you for workers’ compensation or similar programs.  Ø      Public Health Risks. We may disclose medical information about you for public health activities. These activities may include: the prevention or control of disease, report births and deaths, report child abuse or neglect, to notify people of recalls, and to report reactions to medications.  Ø      Health Oversight Activities. We may disclose medical information to health oversight agencies for activities authorized by law. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.  Ø      Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else in dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.  Ø      Law Enforcement. We may release medical information if asked to do so by a law enforcement official in response to a court order, to identify or locate a suspect, witness or missing person, about the victim of a crime, about a death believed to be a result of criminal conduct, about criminal conduct at the hospital, and in emergency circumstances to report a crime.  Ø      Coroners, Medical Examiners, and Funeral Directors. We may release medical information to a coroner or medical examiner. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties. Ø      Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official.  YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU. You have the following rights regarding medical information we maintain about you. Ø      Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to Health Information Services. If you request a copy of the information, we may charge a fee for the costs of coping, 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 denial. We will comply with the outcome of the review. Ø      Right to Amend. If you feel that medical information we have about you 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. You should contact the Director of Health Information Services (740-568-2049) to discuss this process. Ø      Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical information about you. You should contact the Director of Health Information Services (740-568-2049) to discuss this process. Ø      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 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. 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. You must make your request in writing to the Director of Health Information Services. Ø      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. You must make your request in writing to the Director of Health Information Services. Ø      Right to a Paper Copy of this Notice. You have a right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, ask the Patient Registration clerk. 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, in the top right-hand corner, 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 may offer you a copy of the current notice in effect. COMPLAINTS If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with the hospital contact the Privacy Officer at (740) 568-2225.  You will not be penalized for filing a complaint.  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 reason 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.