Notice of Privacy Practices

Effective April 14, 2003

Revision Dates: May 2011; September 18, 2013; January 21, 2018

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 Director of Patient and Community Engagement at 724-258-1076.

Who Follows This Notice of Privacy Practices

Mon Vale Health Resources (MVHR) facilities, entities, sites and locations (Monongahela Valley Hospital, Mon-Vale Primary Care, Mon-Vale Specialty Practices) follow this Notice of Privacy Practices. This Notice of Privacy Practices is also followed by the members of our medical staff (including your physician), departments, units, employees, staff in all MVHR 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 the privacy and security of your medical information. We create a record of the care and services you receive at MVHR facilities. 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 at any of the MVHR facilities, whether made by MVHR 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:

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, interns, or other personnel who are involved in taking care of you during your visit with us. 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 MVHR facilities 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 others outside of MVHR facilities who may be involved in your medical care after you leave, such as family members, or others you select to provide services that are part of your care. (i.e. visiting nurses, medical equipment suppliers, ambulance services, etc.)

Payment
We may use and disclose your medical information so that the treatment and services you receive at our facilities 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 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. We may also disclose your medical information to other entities to bill and collect payment for the treatment and services you receive from them.

Health Care Operations
We may use and disclose your medical information for health care operations. These uses and disclosures are necessary to run our facilities 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 MVHR 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 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.

Business Associates
We may share your medical information with our "business associates" to carry out treatment, payment, or health care operations. We will obtain written agreements with our business associates that they will appropriately safeguard your information.

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 one of our facilities.

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.

Fundraising
We may contact you as part of our fundraising efforts. We may use contact information, such as your name, address, phone number, department of service, treating physician, outcomes and the dates you received treatment or services to contact you. We may use and share this information with a Business Associate. If you receive a communication from us for fundraising purposes, you will be told how you can opt out of any further fundraising communications and we will make all reasonable efforts to comply with your request.

Marketing
We will not use or disclose medical information for the purpose of marketing non-MVHR products or services without your authorization. We will not sell or distribute your medical information to third parties.

Patient Directory
We maintain limited information about you in a "directory" while you are a patient. This information may include your name, location in the facility, 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 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, unless you tell us in advance not to do so. 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 our facility. 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 facility. 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.

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:

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:

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.

Protective Services for the President and Others
We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

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, 1163 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 one of our facilities. To request an amendment, your request must be made in writing and submitted to the Director, Medical Records Department, Monongahela Valley Hospital, 1163 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:

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, 1163 Country Club Road, Monongahela, PA 15063. Your request must state a time period, which may not be longer than six years from the date of the request. 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. You also have the right to request a restriction to disclose your medical information to a health plan if the purpose of the disclosure is: (i) to carry out payment or health care operations; (ii) the disclosure is not required by law; and (iii) the medical information pertains to a health care item or service that you or someone other than the health plan has paid MVHR in advance for the services to be provided. To request restrictions, you must make your request in writing to the Director, Medical Records, Monongahela Valley Hospital, 1163 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, 1163 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 Notice in the Event of a Breach
You have the right to be notified in the event that we (or one of our Business Associates) discover a breach of unsecured protected health information involving your medical information.

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 Director of Patient and Community Engagement 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 us or by contacting the Secretary of the Department of Health and Human Services. You can file a complaint by contacting the Director of Patient and Community Engagement at (724) 258-1076 or by calling the MVH Compliance Line at (724) 258-1115 or by writing us at Monongahela Valley Hospital, ATTN: Director of Patient and Community Engagement, 1163 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 our facilities and it is also available on our website at www.monvalleyhospital.com. The notice will contain, on the first page, the effective date. In addition, each time you register at any of our facilities 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.

Addendum to the Notice of Privacy Practices Health Information Exchange (HIE)

Monongahela Valley Hospital is a participating member of the Vale-U-Health Regional Health Information Organization (VUH RHIO) Health Information Exchange (HIE). The HIE serves as a central database for participating providers in the region to exchange patient health information in an effort to consolidate a patient's health record into a more complete and holistic view and provide physicians with a more accurate, historical view of each patient that they see. By having this consolidated, patient-centric view available, VUH RHIO hopes to help facilitate better patient care, avoid duplication of services, reduce medical errors, and allow for easier collaboration between physicians involved in a patient's care.

By participating in the HIE, your provider may share aspects of your medical record including, but not limited to: general laboratory results, pathology results, medical imaging results, diagnosis lists, immunizations, allergies, medication history, progress notes, consultation notes, discharge summaries and instructions, medical history information, and operative reports.

Information about you can only be shared with the HIE if you have signed a VUH RHIO Consent Form agreeing to "Opt-in" or join the HIE network. Once you have signed the VUH RHIO Consent Form, health information transmitted to the HIE from that date forward (considered the start date) will be accessible via the HIE. Participating healthcare providers involved with your treatment and care will have access to your health information shared on the HIE. All participating healthcare providers with the HIE have agreed upon a set of standards around the use and disclosure of health information available across the HIE. These standards are intended to comply with all applicable state and federal laws.

If you have "Opted-In" to the HIE and wish to leave at any time, you may do so by signing the VUH RHIO Opt-Out Form available here or at any participating healthcare provider location. By "Opting Out", your health information will no longer be accessible on the HIE; however, any health information obtained by a participating healthcare provider prior to the "Opt-Out" date will still remain at the participating healthcare provider facility. Even after you have "Opted Out", you may rejoin the HIE at any time by signing a new VUH RHIO Consent Form.