Notice of Privacy Practices
Date: February 1, 2010
notice describes how health information about you may be used and
disclosed (shared) and how you can get access to (see and copy) your
health information. Please review this notice carefully.
Is a Notice of Privacy Practices?
Area Hospital creates and maintains records that contain information
about your health and the care and services you receive at the
Hospital. We need that information in order to provide you with quality
care and to comply with the law. Under federal law, we are required to
maintain the privacy of your health information. We are also required
to notify you about how we use your health information. This privacy
notice tells you about the ways we may use and share your health
information, as well as the legal obligations we have in regard to your
Our Duty to Protect Your
are required by law to:
sure that information that identifies you is kept confidential and is
protected by the hospital.
you with this privacy notice that describes the ways we use and share
your health information and your rights under the law about your health
the privacy notice that is currently in effect at the time your health
information is used or disclosed.
How We Use and Share
Your Health Information
law permits us to use and share your health information in certain
defined ways. For some of those ways, federal law authorizes us to use
and share your health information without your permission. In other
cases, we need your express authorization in order to use or share your
health information. The following is a description and example of the
ways in which we may use and disclose your health information.
where the law allows us to use and share your health information with
others without your consent.
We may provide health information about you to doctors, nurses,
technicians, medical students, and other people and places that provide
medical care to you. 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. We also may disclose health information about you to
people and places outside the hospital who may be involved in your
medical care after you leave the facility—such as nursing
homes, home-care agencies, and medical providers who may provide
We may disclose your health information so that the treatment and
services you receive or are going to receive can be approved and billed
to you or to health insurance companies or other payors. For example,
we may need to give your health plan information about care you
received so your health plan will pay for the care.
If you have health insurance but choose to pay for your treatment out
of pocket, you may tell us to not tell your insurer about that
treatment. If you ask, we will not share information about your
treatment with your health plan for the purposes of payment or health
care operations. This only applies if you pay the full cost of your
Care Operations: We may disclose
your health information for the business operations of Titusville Area
Hospital. 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 health information to review our treatment and
services and to evaluate the performances of our staff in caring for
Associates. We may share your
health information with “business associates” who
perform legal, accounting, billing, consulting, data management,
accreditation, and other similar services on our behalf. For example,
we may share your health information with a billing company we hire to
bill for the services we provide. We may also use and disclose your
health information to maintain our status with hospital-accreditation
organizations. Our business associates must agree in writing to protect
the confidentiality of your health information.
Reminders: We may use and
disclose health information to contact you as a reminder that you have
an appointment for treatment or medical care at the hospital.
Required By Law: We may use or
disclose your health information to the extent required by law,
provided that the use or disclosure complies with and is limited to the
relevant requirements of the law.
Activities: We may use
information about you to contact you in an effort to raise money for
the hospital and foundation operations.
If a researcher has obtained the required waiver and has demonstrated
that the information is necessary to the research and posses a minimal
risk of inappropriate use or disclosure, we may use and disclose health
information about you for research purposes. If a researcher has not
obtained the required waiver, we will not disclose the information
without your written authorization.
Avert a Serious Threat to Health or Safety:
We may use and disclose health information about you when necessary to
prevent a serious threat to your health and safety or the health and
safety of the public or another person.
of Abuse, Neglect, or Domestic Violence:
If we believe you have been a victim of abuse, neglect, or domestic
violence, we may disclose your health information to a government
authority. We will make this disclosure if it is necessary to prevent
serious harm to you or other potential victims, you are unable to agree
due to your incapacity, you agree to the disclosure, or when required
and Tissue Donation: For the
purpose of facilitating organ, eye, or tissue donation and
transplantation, we may use or disclose health information to
organizations that handle organ procurement, banking, or organ, eye, or
Compensation: We may release
health information about you for workers’ compensation or
similar programs that are established by the law to provide benefits
for work-related injuries or illness without regard to fault.
Health Activities: To the extent
authorized or required by law, we may disclose your health information
to a public-health authority to report a birth, death, disease, or
injury, as part of a public-health investigation, and to report child
or adult abuse, or domestic violence. To the extent authorized or
required by the Food and Drug Administration we may disclose your
health information to persons authorized to report adverse events,
track products, enable product recalls, repairs, or replacement, and/or
conduct post-marketing drug surveillance.
Oversight Activities: We may
disclose health 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.
Suits and Disputes: We may
disclose health information about you as required by a court or
administrative order or under certain circumstances in response to a
subpoena, discovery request, or other legal process.
Enforcement: We may release
health information to law enforcement officials as required by law.
Under limited circumstances we may release your health information to
report a crime or in response to a court order, grand-jury subpoena,
warrant, or administrative request.
Medical Examiners, and Funeral Directors:
Consistent with applicable law, we may release health information to a
coroner, medical examiner, or funeral director.
Government Functions: Health
information may be disclosed for military and veterans affairs,
national security and intelligence, or for correctional activities. For
example, if you are an inmate of a correctional institution or under
the custody of a law-enforcement officer, we may share your health
information with the correctional institution or the officer.
where you have an opportunity to agree or object to us using and
sharing your health information.
following is a description of ways in which we may use and disclose
your information without written consent or authorization. We will
attempt to obtain your permission prior to making a disclosure for
these purposes. You may ask us not to make these disclosures. Your
permission or objection may be oral. If we are unable, due to your
incapacity or unavailability, to obtain your permission, we may use or
disclose some or all of this information if based on our professional
judgment we believe it is in your best interest.
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, 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 do not 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
Involved in Your Care or Payment for Your Care:
We may release health information about you to a friend or family
member who is involved in your medical care. We may also tell your
family or friends your condition and that you are in the hospital. In
addition, we may disclose health information about you to an entity
assisting in a disaster relief effort so that your family can be
notified about your condition, status and location.
all other situations, we need your written authorization to use or
share your health information.
as described in Sections A and B above, your written authorization is
required before we may use or disclosure your health information with
anyone outside of Titusville Area Hospital. We have an authorization
form for you to use. You may revoke your authorization, in writing, at
any time. However, this revocation will not apply to the extent we have
taken action in reliance on that authorization. In addition, if the
authorization was obtained as a condition of obtaining insurance
coverage, the insurer will have a right to contest a claim under the
policy. Please note we cannot take back any information that we shared
with your permission.
we share health information with others outside of the Hospital, we
will take efforts to limit what we share to the information that is
reasonably necessary for the task.
Your Rights Regarding
Health Information About You
law gives you the following rights about your health information:
to Inspect and Copy: You have
the right to inspect and copy your health information maintained at the
hospital. You must submit your request in writing to our Privacy
Officer. If you request a copy of your health information, we may
charge fees as permitted by law for the costs of copying, mailing, or
other supplies associated with your request.
may deny your request to inspect and copy in certain very limited
circumstances. If you are denied access, you may request that the
denial be reviewed. Another licensed healthcare 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 whatever that professional decides.
to Amend: If you feel that
health information we have about you 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 our hospital. To
request an amendment, your request must be made in writing and
submitted to our Privacy Officer. In addition, you must provide a
reason that supports your request.
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; (2) is not part of the health 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 as is.
to an Accounting of Disclosures:
You have the right to request an accounting of certain disclosures by
the hospital. This will be a list of people and organizations that
received or accessed your health information. To request an accounting
you must submit a written request to our Privacy Officer. Your request
should indicate in what form you want the list (for example, on paper
or electronically). You must also tell us how far back in time you want
us to go, which may not be longer than six years. The right to an
accounting does not apply to all disclosures. For example, you do not
have a right to an accounting of disclosures to carry out treatment,
payment, or health care operations.
If we maintain your health information using an electronic medical
record system, and you ask for an accounting of disclosures, we must
include all disclosures, including those made to carry out treatment,
payment, and health care operations. Also, if your health information
is maintained by our business associates in electronic form, you also
have the right to ask our business associates for an accounting of
their disclosures. We will provide you with a list of all of our
business associates and how to contact them.
to Request Restrictions: You
have the right to request a restriction or limitation on the health
information we disclose about you for treatment, payment, or health
care operations. You also have the right to request a limit on the
health information we disclose about you to someone who is involved in
your care or the payment of your care, like a family member or friend.
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.
request a restriction, you must make your request in writing to our
Privacy Officer. 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. The written request may be given to
the registration clerk at the time of registration for data entry
before it is forwarded to our Privacy Officer.
may terminate an agreed-upon restriction without your consent. In that
situation the restriction will only apply to protected health
information created or received before you were informed of the
termination of the restriction.
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
our Privacy Officer. 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.
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. Even if you have agreed to
receive this notice electronically, you are still entitled to a paper
copy of this notice. You may view an electronic copy of this notice on
our website, www.titusvillehopital.org. To obtain a paper copy of this
notice, you may print one from our website or contact Patient Services
or our Privacy Officer.
Changes to this Notice
reserve the right to change this notice and to make the new notice
provisions effective for all health information that we maintain. We
will post a copy of the current notice in the hospital. The notice will
contain on the first page, in the top right-hand corner, 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 offer you a copy of the current notice in effect.
Questions and Complaints
you believe your privacy rights have been violated, you may file a
complaint with the hospital or with the Secretary of the Department of
Health and Human Services. To file a complaint with the hospital, your
complaints must be submitted in writing to our Privacy Officer at the
address listed below. You will not be retaliated against for filing a
you have questions about this privacy notice, please contract our
Privacy Officer at the address listed below.
Attn: Privacy Officer
406 West Oak Street
Titusville, PA 16354
814-827-1851 or 800-950-1851
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