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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.
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WHO FOLLOWS THIS NOTICE OF PRIVACY PRACTICES:
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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.
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OUR PLEDGE REGARDING MEDICAL INFORMATION:
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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.
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HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION.
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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.
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SPECIAL SITUATIONS
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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.
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YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION.
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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:
1. Was not created by us, unless the person or entity
that created the information is no longer available to make
the amendment;
2. Is not part of the medical information kept by or for
the hospital;
3. Is not part of the information which you would be permitted
to inspect and copy; or
4. 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
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OTHER USES OF MEDICAL INFORMATION.
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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.
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COMPLAINTS
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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.
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CHANGES TO THIS NOTICE
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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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