HIPAA Notice of Privacy Practices

We are required to protect the privacy of health information about you and that can be identified with you, which we call “protected health information” (“PHI”).

• We must give you notice of our legal duties and privacy practices concerning PHI.
• We must protect PHI that we have created or received about your past, present or future health condition; health care we provide to you; or payment for your health care.
• We must notify you about how we protect PHI about you.
• We must explain how, when and why we use and/or disclose PHI about you. We may only use and/or disclose PHI as we have described in this notice.

We may use and disclose PHI about you to provide, coordinate or manage your health care and related services. This may include communicating with other health care providers regarding your treatment and coordinating and managing your health care with others. For example, we may disclose your PHI to a pharmacy to fulfill a prescription, to a laboratory to order a blood test or to a home health agency that is providing care in your home.

We may use and disclose your medical information to bill and collect payment for the treatment and services provided to you. Before you receive scheduled services, we may share information about these services with your health plan(s). For example, if certain procedures are recommended, we may need to disclose information to your health insurer to get prior approval for the procedure. We may also disclose protected health information to your insurance company to determine whether you are eligible for benefits or whether a particular service is covered under your health plan.

We may use and disclose PHI in performing business activities, which we call “health care operations.” These health care operations allow us to improve the quality of care we provide and reduce health care costs. Examples of the ways we may use or disclose PHI about you for health care operations include the following:

• Quality assessment and improvement activities.
• Employee review activities.
• Training programs, including those in which students, trainees or practitioners in health care learn under supervision.
• Accreditation, certification, licensing or credentialing activities.
• Reviewing and auditing, including compliance reviews, medical reviews, legal services and maintaining compliance programs.
• Business management and general administrative activities.

In certain situations, we may also disclose patient information to another provider or health plan for their health care operations.

We may use and/or disclose PHI about you for a number of circumstances in which you do not have to consent, give authorization or otherwise have an opportunity to agree or object, including:

• When the use and/or disclosure is required by federal, state or local law.
• When the use and/or disclosure is necessary for public health activities. For example, we may disclose PHI about you if you have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition.
• When the disclosure relates to victims of abuse, neglect or domestic violence.
• When the use and/or disclosure is for health oversight activities. For example, we may disclose PHI about you to a state or federal health oversight agency, which is authorized by law to oversee our operations.
• When the disclosure is for judicial or administrative proceedings. For example, we may disclose PHI about you in response to an order of a court or administrative tribunal.
• When the disclosure is for law enforcement purposes. For example, we may disclose PHI about you in order to comply with laws that require the reporting of certain types of wounds or other physical injuries.
• When the use and/or disclosure relates to decedents. For example, we may disclose PHI about you to a coroner or medical examiner for the purposes of identifying you should you die.
• When the use and/or disclosure relates to cadaveric organ, eye or tissue donation purposes.
• When the use and/or disclosure relates to medical research. Under certain circumstances, we may disclose PHI about you for medical research. When the use and/or disclosure is to avert a serious threat to health or safety. For example, we may disclose PHI about you to prevent or lessen a serious and eminent threat to the health or safety of a person or the public.
• When the use and/or disclosure relates to specialized government functions. For example, we may disclose PHI about you if it relates to military and veterans’ activities, national security and intelligence activities, protective services for the President and medical suitability or determinations of the Department of State.
• When the use and/or disclosure relates to correctional institutions or other law enforcement custodial situations. In certain circumstances, we may disclose PHI about you to a correctional institution having lawful custody of you.

Unless you object, we may use or disclose PHI about you in the following circumstances:

• We may share your name, your room number and your condition in our patient listing with clergy and with people who ask for you by name. We also may share your religious affiliation with clergy.
• We may share PHI with a family member, relative, friend or other person identified by you when the PHI is directly related to that person’s involvement in your care or payment for your care. We may share with a family member, personal representative or other person responsible for your care PHI necessary to notify such individuals of your location, general condition or death.
• We may share with a public or private agency (for example, the American Red Cross) PHI about you for disaster relief purposes. Even if you object, we may still share the PHI about you, if necessary for the emergency circumstances.

We may use and/or disclose PHI to contact you with a reminder about an appointment you have for treatment or medical care.

We may use and/or disclose PHI to manage or coordinate your health care. This may include telling you about treatments, services, products and/or other health care providers. We may also use and/or disclose PHI to give you gifts of a small value.

We may use and/or disclose PHI about you, including disclosure to a foundation, to contact you to raise money for the hospital and its operations. In this circumstance, we only release your contact information and the dates you received treatment or services at the hospital. If you do not want to be contacted in this way, you must notify in writing our contact person listed on the last page of this notice.

You have the right to request that we restrict the use and disclosure of PHI about you. We are not required to agree to your requested restrictions. However, even if we agree to your request, in certain situations your restrictions may not be followed. These situations include emergency treatment, disclosures to the Secretary of the Department of Health and Human Services and uses and disclosures described in the previous section of this notice. You may request a restriction by contacting the Pleasant Valley Hospital privacy officer at 304.675.4340, ext. 1161

You have the right to request how and where we contact you about PHI. For example, you may request that we contact you at your work address or phone number or by email. Your request must be in writing. We must accommodate reasonable requests, but, when appropriate, our accommodation may depend on your providing us with information regarding how payment, if any, will be handled and your specification of an alternative address or other method of contact. You may request alternative communications by contacting the Pleasant Valley Hospital privacy officer at 304.675.4340, ext. 1161.

You have the right to request to see and receive a copy of PHI contained in clinical, billing and other records used to make decisions about you. Your request must be in writing. We may charge you related fees. Instead of providing you with a full copy of the PHI, we may give you a summary or explanation of the PHI about you, if you agree in advance to the form and cost of the summary or explanation. There are certain situations in which we are not required to comply with your request. Under these circumstances, we will respond to you in writing, stating why we will not grant your request and describing any rights you may have to request a review of our denial. You may request to see and receive a copy of your PHI by contacting the Pleasant Valley Hospital privacy officer at 304.675.4340, ext. 1161

You have the right to request that we make amendments to clinical, billing and other records used to make decisions about you. Your request must be in writing and must explain your reason(s) for the amendment. We may deny your request for the following reasons:

• The information was not created by us (unless you prove the creator of the information is no longer available to amend the record).
• The information is not part of the records used to make decisions about you.
• We believe the information is correct and complete.
• You would not have the right to see and copy the record as described in Item 3 above. We will tell you in writing the reasons for the denial and describe your rights to give us a written statement disagreeing with the denial. If we accept your request to amend the information, we will make reasonable efforts to inform others of the amendment, including persons you name who have received PHI about you and who need the amendment.

You may request an amendment of your PHI by contacting the Pleasant Valley Hospital privacy officer at 304.675.4340, ext. 1161.

If you ask our contact person in writing, you have the right to receive a written list of certain disclosures we have made of PHI about you. You may ask for disclosures made up to six years before your request (not including disclosures made prior to April 14, 2003). We are required to provide a listing of all disclosures, except disclosures that were made:

• For your medical treatment.
• For billing and collection of payment for your treatment.
• For our health care operations.
• By your request or authorization.
• As a byproduct of permitted uses and disclosures.
• To individuals involved in your care, for directory or notification purposes or for other purposes as described above.
• In relation to certain specialized government functions or correctional institutions and/or other law enforcement custodial situations, as allowed by law.
• As part of a limited set of information that does not contain information that would identify you.

The list will include the date of the disclosure, the name (and address, if available) of the person or organization receiving the information, a brief description of the information disclosed and the purpose of the disclosure. If, under permitted circumstances, PHI about you has been disclosed for certain types of research projects, the list may include different types of information.

If you request a list of disclosures more than once in 12 months, we may charge you a reasonable fee. You may request a listing of disclosures by contacting the Pleasant Valley Hospital privacy officer at 304.675.4340, ext. 1161.

You have the right to request a paper copy of this notice at any time by contacting the Pleasant Valley Hospital privacy officer at 304.675.4340, ext. 1161. We will provide a copy of this notice no later than the date you first receive service from us (except for emergency services, and then we will provide the notice to you as soon as possible).

If you think we have violated your privacy rights, or you want to complain to us about our privacy practices, you can contact the privacy officer listed below:

Pleasant Valley Hospital
2520 Valley Drive
Point Pleasant, WV 25550
Phone: 304.675.4340, ext. 1161
E-mail: pbrooker@pvalley.org

You may also send a written complaint to the United States Secretary of the Department of Health and Human Services. If you file a complaint, we will not take any action against you or change our treatment of you in any way.

Effective date of this notice: This Notice of Privacy Practices is effective on April 14, 2003.