THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Why You Are Receiving This Notice
At Philhaven, we are committed to treating and using protected health information about you in a responsible manner. We are required by federal and Pennsylvania law to keep your health information confidential.
As a sign of our respect for your dignity and autonomy, we have developed a Privacy Compliance Program that is directed at protecting the privacy and confidentiality of your health information. This Notice of Privacy Practices describes the health information we collect, how and when we use or disclose it, and your rights under our Privacy Compliance Program.
Understanding Your Health Record Information
Each time you visit Philhaven, we create a record of your visit. Typically, this record contains your symptoms, examination, test results, diagnoses, treatment and a plan for future care or treatment. Medical records are valuable tools that serve a number of purposes, such as:
• Planning your care and treatment
• Communicating with those who provide you with care or services
• Allowing your insurer to verify that services billed were actually provided
• Educating healthcare professionals
• Providing information for our planning and marketing activities
• Assessing our own performance so that we can continue to improve our care and services.
Although the physical record that we create is the property of Philhaven, the information in it is about you and belongs to you. We want to help you make informed decisions about who has access to your health information.
Our Legal Duty
We are required by law to restrict the uses and disclosures of your health information. We are also required to give you this Notice about our privacy practices, our legal duties and your rights concerning your health information. We will follow the privacy practices that are in this Notice while it is in effect.
USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
Highly Confidential Health Information
Much of your health information is "highly confidential" because it is specially protected under Pennsylvania law. "Highly confidential" information includes mental health treatment information; treatment information about drug or alcohol abuse or dependence; HIV-related information; and sexual assault counseling records. We are generally not permitted to disclose your highly confidential health information unless authorized to do so. You may learn more about when we are permitted to disclose your highly confidential health information without your permission by using the contact information that appears at the end of this Notice.
Treatment, Payment, and Health Care Operations Activities (TPO)
We may use or disclose your health information for TPO purposes, without the need to get your written authorization. For example, doctors, nurses, and counselors who are involved in your care and treatment will have access to your health information. In order for us to receive payment for the care provided to you, we will need to tell your insurance company about that care. We may also use your health information for our own purposes, such as monitoring, planning and developing our care and services, and educating our staff.
We may also disclose or release information from your medical records for the treatment activities of another healthcare provider or agency that is not affiliated with us, but only if it were needed to provide you with care or services.
Other Uses and Disclosures Not Requiring Your Authorization
We may use your health information to tell you about treatment options or alternatives or health-related benefits or services that we think may be of interest to you. We may use your health information to provide you with appointment reminders, such as voicemail messages, postcards or letters. We may disclose your health information to business associates, which are individuals or organizations that perform certain key functions or processes for us. Before we disclose your health information to our business associates, we require them to give us written assurances that they will safeguard and protect the privacy of your health information.
We may contact you with information about Philhaven-sponsored activities, including fundraising programs and events, but we will only use limited information about you for that purpose. You have no obligation to respond to these communications, and you may choose not to receive them in the future.
We will disclose your health information when required to do so by law, for health oversight activities conducted for or by governmental agencies; and for public health activities, such as to report suspected child abuse, communicable diseases, or certain types of injuries. We may use or disclose your health information for workers' compensation or similar programs as permitted and required by law. We may use your health information for our research purposes, but only if we are sure that your privacy will be protected.
If you are or were a member of the armed forces, we may release your health information to military command authorities as required by law. We may use or disclose your health information in order to prevent or lessen a serious threat to your health and safety or that of someone else. We may release your health information for law enforcement purposes, as permitted by law. We may disclose your health information to authorized federal officials for purposes of national security.
We may disclose your health information, as directed by court order. In most circumstances, we may disclose your health information to a coroner or medical examiner, or to a funeral director. If you are an inmate, we may release your health information to the correctional institution where you are being housed, if required by law.
When possible, we will give you the option of restricting or limiting our disclosure of your health information to a disaster relief agency in the event of a disaster.
Other uses and disclosures of your health information not covered by this Notice will only be made with your written permission. You can revoke that permission, in writing, but if you do, we are unable to take back any disclosures we have already made with your permission.
Your Rights Regarding Your Health Information
You have the right to look at or get copies of your health information, with limited exceptions. You must submit a request in writing to the Director of Customer Service (see contact information below). A fee may be charged to provide copies. We may deny your request to look at or get a copy of your health information. If we do, we will explain the reasons to you, and you may have the denial reviewed.
You have the right to request corrections to your health information. The request must be in writing, explaining the corrections to be made. We may deny your request under certain circumstances; and if so, we will explain the reasons to you.
With certain exceptions, you have the right to know the times (after April 14, 2003) when we have disclosed your health information without your authorization. We will provide you with a listing of those disclosures if you request it. If you request this listing more than once a year, a fee may be charged.
You have the right to request that we restrict or limit some of our uses or disclosures of your health information, although we are not required to agree to those restrictions.
You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we contact you only at work or by mail. Your request must be in writing, and you must tell us where or how to contact you. We may require you to explain how payments will be handled under the alternative means or location you request.
If you received this Notice on our website or by electronic mail (e-mail), you have the right to receive this Notice in written form. To obtain a paper copy of this Notice, use the contact information below.
FOR QUESTIONS REGARDING YOUR PRIVACY RIGHTS, USE THE CONTACT INFORMATION BELOW.
For More Information
If you have any questions or would like more information, you may contact:
Dir. of Medical Records/HIPAA Privacy Officer
283 S. Butler Road, P.O. Box 550
Mt. Gretna, PA 17064
Phone: 717-273-8871 ext. 2406
We will be happy to provide you with a more detailed version of this Notice. Simply ask the person who gave you this form for our full Notice of Privacy Practices.
If you believe your privacy rights have been violated, you can file a complaint with the Secretary of the U.S. Department of Health and Human Services or directly with Philhaven by using the above contact information.
Effective Date and Revisions
We reserve the right to change our privacy practices and the terms of our Notice at any time, as permitted by law. We reserve the right to make those changes effective for all health information that we maintain, even if we created or received it before we made the changes.
Our privacy practices, as described in this Notice, will remain in effect until changed. Whenever we make significant changes to our privacy practices, we will change this Notice and make the new Notice available upon request.