Privacy Notices

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.

Effective April 14, 2003

If you have any question about this notice, or to obtain a copy of this notice, please contact our Privacy Officer at Suite 2, 494 Northampton Street, Edwardsville, PA 18704, Telephone (570) 288-8100.

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 the care and services you receive from us. We need this record to provide you with care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by us.

This notice will tell you about the ways we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law 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 INFORMATION ABOUT YOU

The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures 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 within one of the categories.

For Treatment: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, hospitals, nursing homes, visiting nurse associations, physical therapy, rehabilitation facilities, diagnostic testing and laboratory facilities.

For Payment: We may use and disclose medical information about you so the treatment and services you receive from us 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 services you received from us so you health plan will pay us or reimburse you for the treatment. 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.

For health Care Operations. We may use and disclose medical information about you for health care operations. These uses and disclosures are necessary for us to operate and manage our medical practice and to help provide you with quality care. Healthcare operations include quality assessment and improvement activities, employee review activities, and licensing activities.

Business Associates. We may disclose medical information to “business associates” who provide contracted services such as accounting, legal representation, claims process, consulting, and transcription services. If we do disclose medical information to a business associate, we will do so subject to a contract that provides that the information will be kept confidential.

Appointment Reminders. We may use and disclose information to contact you as a reminder of an appointment or medical care. Unless you object, we may leave a message on an answering machine to contact you or provide you with appointment reminders. No details regarding your diagnosis or treatment will be left on an answering machine.

Individuals Involved in Your Care or Payment for Your Care. Unless you object, 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 involved in payment for your care.

As Required by Law. We will disclose medical information about you when required to do so by the federal, state, or local law.

Research. In most cases, we will ask for your written authorization before using your information or sharing it with others in order to conduct research. Under some circumstances, we may use and disclose your health information without your authorization if we obtain approval through a special approval process to ensure that any disclosures for research pose a minimal risk to your privacy. Under no circumstances would we allow researches to use your name or identity publicly.

OTHER USE AND DISCLUSURES THAT MAY BE MADE WITHOUT YOUR AUTHORIZATION

Public Health Records. We may disclose information about you 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 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.

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 facilitates organ or tissue donation and transplantation.

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. We may also release information to components of the Department of Veterans Affairs to determine whether you are eligible for certain benefits.

Workers’ Compensation. We may release medical information about you for Workers’ Compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Law Enforcement. We may release medical information if asked to do so by a law enforcement official:

In response to a court order, subpoena, warrants, 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 results of criminal conduct;
About criminal conduct at our office;
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

To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when we determine it is 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.

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 to funeral directors as necessary for them to carry out their duties.

National Security and Intelligence Activities. We may also release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

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. 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.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding medical information we maintain about you:

Right to Inspect and Copy. You have the right to inspect and to receive a copy of medical information that may be used to make decisions about your care. Usually, this includes medical and billing records. You must submit your request in writing to The Privacy Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies we use to fulfill your request. We will ordinarily respond to your request within 30 days.

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. To request an amendment, your request must be made in writing and submitted to the Privacy Officer. In addition, you must provide a reason that supports your request. We may deny your request for the amendment if you ask us to amend information that:

Was not created by us, unless the person or entity that created the information is no longer available and make the amendment;
Is not part of the medical information kept by us;
Is not part of the information which would be permitted to inspect and copy; or
Is accurate and complete.

Right to Accounting of Disclosure. You have the right to request an “accounting of disclosures”. This is a list of the disclosures we made of medical information about you. The list does not include uses and disclosures that have been made for treatment, payment, or health care operations; disclosures that were made to you or with your authorization or consent; or disclosures that are incidental to other permissible disclosures (such as someone overhearing a conversation between you and your doctor). To request this list or accounting of disclosures, you must submit your request in writing to The Privacy Officer. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the cost of proving the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Rights 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. We are not required to agree to your request to restrict disclosures 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. If we 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 Privacy Officer at Medical Center. 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 (30: 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. To request confidential communications, you must make your request in writing to the Privacy Officer. 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.

CHANGES TO THIS NOTICE

We reserve the right to change this notice. We reserve the right to make the revised or changed notices 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 office. The notice will contain on the first page, in the top right-hand corner, the effective date.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with us or with the Department of Health and Human Services, Office of Civil Rights. Complaints may be submitted to the Privacy Officer. You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

Other uses or 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 we are required to keep records of the care that we provide to you.