NOTICE OF HEALTH INFORMATION PRACTICES

This notice describes how health information about you may be used and disclosed and how you can get access to this health information. Please read it carefully and ask any questions.

WHAT IS HEALTH INFORMATION:

Each time that a service is rendered or a procedure is done, even as simple as a routine blood pressure check, data and information are collected. This is health information or what is commonly referred to as information for or in the medical record of the patient record. Accurate, credible, and timely data and information are used by this facility as the basis for planning your care, as a means of having multiple healthcare providers know about your current health status, as a health legal document, as a record for billing purposes, as a source of data for research, planning, and marketing, as a source of required information for public health officials, and as a means to continue to improve the care that we provide. At this facility, we have always, and will continue to protect the privacy of your health information and the dignity of you as an individual. On July 6, 2001, the U.S. Federal Government passed compliance regulations that mandate all healthcare facilities to protect health information and inform consumers of the healthcare information practices of the facility.

THE CONSUMER’S HEALTH INFORMATION RIGHTS:

This facility maintains a medical record for you containing medical information concerning you. With this in mind, you have the right to:

Request a restriction on use and disclosure of health information, although the facility is not required to comply (45 CFR 164.5220).

Obtain a copy of this notice.

Inspect and receive a copy of your medical record (45 CFR 164.524).

Amend your medical record (45 CFR 164.528).

Obtain an accounting of disclosures of your medical record (45 CFR 164.528).

Request your medical record by alternative means or location.

Revoke your authorization to use or disclosure your health information except to the extent that action has already been taken.

THIS FACILITY’S RESPONSIBILITIES:

This facility’s mission of quality service and respect of the individual has always taken into account protecting health information privacy. Our responsibilities are to:

Maintain the privacy of your health information.

Provide you this notice of health information practices.

Notify you if we are unable to satisfy a request.

Accommodate all reasonable requests while maintaining quality care and respect for you.

Make you aware of all health information practice policy changes.

We will not use or disclose your health information without your approval except as stated in this notice.

When health information is disclosed as above, it will be disclosed at the minimum necessary level.

TO REQUEST FURTHER INFORMATION OR ASK QUESTIONS:

If you would like further information or have questions, this facility’s HIPAA Compliance Officer is Joel D. Brown, M.D. who can be reached at (412-351-3062).

If you believe that your privacy rights have been violated, you can file a complaint with the Compliance Officer or with the Secretary of Health and Human Services. There will be no penalty or retaliation for filing a complaint.

Examples of Permitted Types of Uses and Disclosures of Health Information:

This facility may use or be required to use your health information without your authorization or consent for normal business activities as follows:

For Care and Treatment: Health information obtained by a healthcare practitioner such as a physician, nurse, or therapist, will be entered into your medical record and used to determine a plan of care. For example, healthcare members will write and read what others have written such that your care can be coordinated and everyone is aware of how you are responding to your treatment plan. When you are discharged from this facility, your healthcare information may go with you such that future healthcare providers will have a record or your care. Your health insurer may disclose health information to the sponsor of the plan.

For Billing and Payment: In addition to demographic information, information on a bill sent to an insurer may include health information. This health information is restricted to that which is needed for the financial transactions.

For Healthcare Operations: In order to provide quality care, healthcare providers at this facility may use your health information, for example, to analyze the care, treatment, and outcomes of your medical case and of others. This health information will be used to continually improve the care of the services that we provide to you.

For Directory Purposes: We will use your name, facility location, general medical condition, and religious affiliation for directory purposes unless you instruct us not to. This health information is only for the use of clergy and to people who ask for you specifically by full name (although religious affiliation will not be given in the latter).

For Clergy: Unless you specify that you object, health information such as your name, room number, and general medical condition will be given to clergy for professional purposes only.

For Business Associates: In order to provide quality care, this facility requires business services such as pharmacy, medical equipment, medical laboratories, information technology, etc.. These services will have use of your health information as it pertains to their service delivery. Also, business associates must follow our standards for protecting your health information and sign a business agreement. In addition, the business associates must follow the HIPAA Security Rule as specified in the Health Information Technology for Economic and Clinical Health Act (HITECH)/Energy and Commerce Recovery and Reinvestment Act, SubtitleD, Section 4401.

For Notification: We may use or disclose health information, such as your general condition, to notify or assist in notifying a family member or person responsible for your care.

For Communication: We may use or disclose health information relevant to your care to family member’s or those that you deem responsible for your care on a ‘need to know’ basis.

For Research: We may disclose health information to researchers if they have appropriate consent forms and the research has been approved by our institutional review process. The researchers will be held to this facility’s health information privacy standards.

For Funeral Directors: We may disclose health information to funeral directors in accordance with state laws and for professional purposes only.

For Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or organizations involved in the procurement, banking, or transplantation or organs for the purpose of tissue donation and transplant.

For Marketing Purposes: We may contact you to provide information on appointment reminders or alternatives treatments In addition, a covered entity or business associate shall not directly or indirectly receive remuneration in exchange for any protected health information of an individual unless the covered entity obtained from the individual, in accordance with section 164.508 of title 45, code of Federal Regulations, a valid authorization that includes, in accordance with such section, a specification of whether the protected health information can be further exchanged for remuneration by the entity receiving protected health information of that individual. Exceptions under HITECH include, when the purpose of the exchange is for research, public health, treatment, health care operations, providing an individual with a copy of their protected health information, and for remuneration that is provided by a covered entity to a business associate for activities involving the exchange of protected health information that the business associate undertakes on behalf of and t the specific request of the covered entity pursuant to a business associate agreement. The price charged must reflect not more than the costs of preparation and transmittal of the data for such purpose.

For Fundraising: We may contact you for fundraising efforts that are aligned with the mission of this facility.

For the Food and Drug Administration: As requested or required by the FDA< we may disclose health information relative to an adverse health condition related to food, food supplements, product and product defects related to food, or posting marketing surveillance information to allow product recalls, repairs, or replacements.

For Workers Compensation Issues: In compliance with Worker’s Compensation laws, health information may be revealed to the extent necessary to comply with the law and your individual case.

For Public Health Requirements: As required by law, health information may be disclosed to public health or legal authorities for the jurisdiction of disease, injury, or disability prevention or control.

For Correctional Instructions: Should you be an inmate in a correctional institution, health information may be disclosed to the institution or its agents that which would be necessary for your health and safety and the health and safety of other individuals.

For Law Enforcement Agencies: Health information may be disclosed to law enforcement agencies for purposes required by law or subpoena.

For Judicial and General Administrative Proceedings: Patient health information may be released per minimum necessary requirements for proceedings.

For Healthcare Oversight: Patient health information may be used by health oversight agencies for activities such as audits, inspections, and licensure activities.

For Specialized Government Functions: In the event that appropriate military authorities require information, it may be released at the minimum necessary level.

For Victim of Abuse, Neglect, and Domestic Violence: Information may be released to social service agencies or protective services in order to protect an individual.

Other uses and disclosures are to be made with your written authorization and you may revoke such authorization at any time.

Effective Date: 3/16/09