Bloomsburg Hospital

HIPAA Privacy Statement

Notice of privacy practices 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.

If you have any questions about this notice, please contact our Privacy Officer at (570) 387-2128 x2178.

This notice describes our Hospital's practices and that of:

• The medical staff and any healthcare professionals authorized to enter information into your Hospital record.
  
• All departments and units of the Hospital.
  
• All employees, staff, trainees, students, volunteers, and contractors.
  
• All covered health plans, healthcare clearinghouses and/or healthcare providers who conduct financial and administrative transactions electronically, business associates, or public agencies that do business with Bloomsburg Hospital. All these entities, sites and locations follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment, or Hospital operations purposes described in this notice.

When this notice refers to Hospital, it is referring to the Bloomsburg Hospital and members of its medical staff (including your physician(s)).

This Notice applies only to protected health information created or obtained in connection with medical care provided to you in the Hospital. It does not apply to care provided to you in your physician's office or in the office of any other healthcare provider. If you have not previously visited your physician's office, upon your next visit you should receive that physician's Notice of Privacy Practices as it relates to his or her own office practice.

Notice of Privacy Practices

We understand that medical information about you and your health is personal. We are committed to protecting medical information or protected health information (PHI) about you. We create a record of the care and services you receive at the Hospital. We need this record to provide your care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the Hospital, whether made by Hospital personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your medical information created in the doctor's office or clinic.

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 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,
• Follow the terms of the notice that is currently in effect.

How We May Use and Disclose Medical 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 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, coordinate or manage your medical treatment and related services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other Hospital personnel who are involved in taking care of you at the Hospital. 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. In addition, the doctor may need to tell the dietitian if you have diabetes so we can arrange for appropriate meals. Different departments of the Hospital also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose medical information about you to people outside the Hospital who may be involved in your medical care after you leave the Hospital, such as family members, clergy or others we use to provide services that are part of your care.
  
• For Payment: Generally, we may use and give your medical information to others to bill and collect payment for the treatment and services provided to you by us or by another provider. Before you receive scheduled services, we may share information about these services with your health plan(s). Sharing information allows us to ask for coverage under your plan or policy and for approval of payment before we provide the services. We may also share portions of medical information about you with the following:
  • Billing departments;
  • Collection departments or agencies, or attorneys assisting us with collections;
  • Insurance companies, health plans and their agents which provide you coverage;
  • Hospital departments that review the care you received to check that it and the costs associated with it were appropriate for your illness or injury; and
  • Consumer reporting agencies (e.g., credit bureaus).
• EXAMPLE: Let's say you have a broken leg. We may need to give your health plan(s) information about your condition, supplies used (such as plaster for your cast or crutches), and services you received (such as x-rays or surgery). The information is given to our billing department and your health plan so we can be paid or you can be reimbursed. We may also send the same information to our Hospital department which reviews our care of your illness or injury.
• We may use and disclose medical information about you so the treatment and services you receive at the Hospital 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 surgery you received at the Hospital so your health plan will pay us or reimburse you for the surgery. 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 PHI in performing business activities, which we call “healthcare operations“. These ”healthcare operations” allow us to improve the quality of care we provide and reduce healthcare costs. We may also disclose medical information for the “healthcare operations” of any “organized healthcare arrangement” in which we participate. An example of an “organized healthcare arrangement” is the care provided by a Hospital and the physicians who see patients at the Hospital. In addition, we may disclose PHI about you for the “healthcare operations” of other providers involved in your care to improve the quality, efficiency and costs of their care, or to evaluate and improve the performance of their providers.
• Examples of the way we may use or disclose PHI about you for “healthcare operations” include the following:
  • Reviewing and improving the quality, efficiency and cost of care that we provide to you and our other patients. For example, we may use PHI about you to develop ways to assist our healthcare providers and staff in deciding what medical treatment should be provided to others.
  • Improving healthcare and lowering costs for groups of people who have similar health problems and to help manage and coordinate the care for these groups of people. We may use PHI to identify groups of people with similar health problems to give them information, for instance, about treatment alternatives, classes, or new procedures.
  • Reviewing and evaluating the skills, qualifications, and performance of healthcare providers taking care of you.
  • Providing training programs for students, trainees, healthcare providers, or non-healthcare professionals (for example, billing clerks or assistants, etc.) to help them practice or improve their skills.
  • Cooperating with outside organizations that assess the quality of the care we and others provide. These organizations might include government agencies or accrediting bodies such as the Joint Commission on Accreditation of Healthcare Organizations.
  • Cooperating with outside organizations that evaluate, certify, or license healthcare providers, staff, or facilities in a particular field or specialty. For example, we may use or disclose PHI so that one of our nurses may become certified as having expertise in a specific field of nursing, such as pediatric nursing.
  • Assisting various people who review our activities. For example, doctors reviewing the services provided to you, and by accountants, lawyers, and others who assist us in complying with applicable laws may see PHI.
  • Planning for our organization's future operations, and fundraising for the benefit of our organization.
  • Conducting business management and general administrative activities related to our organization and the services it provides.
  • Resolving grievances within our organization.
  • Reviewing activities and using or disclosing PHI in the event that we sell our business, property or give control of our business or property to someone else.
  • Complying with this Notice and with applicable laws.
• We may use and disclose PHI under other circumstances without your authorization or an opportunity to agree or object
• 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. Those circumstances include:
  • When the use and/or disclosure is required by law. For example, when a disclosure is required by federal, state or local law or other judicial or administrative proceeding.
  • 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 and 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 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 imminent 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 and in other law enforcement custodial situations. For example, 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 medical information about you in the following circumstances:
  • Appointment Reminders: We may use and disclose medical information to contact you as a reminder of an appointment for treatment or medical care at the Hospital.
  • Treatment Alternatives: We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
  • Health-Related Benefits and Services: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
  • Fundraising Activities: We may use medical information about you to contact you in an effort to raise money for the Hospital and its operations. We may disclose medical information to a foundation related to the Hospital so the foundation may contact you in raising money for the Hospital. We only would release contact information, such as your name, address, phone number and the dates you received treatment or services at the Hospital. If you do not want the Hospital to contact you for fundraising efforts, you must submit a written request to our Privacy Officer.
  • Hospital 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 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 don't 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 doing.
  • Individuals Involved in Your Care or Payment for Your Care: 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 who helps pay for your care. We may also tell your family or friends your condition and that you are in the Hospital.
  • Public or Private Agencies Involved in Disaster Relief: In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so your family can be notified about your condition, status, and location. Even if you object, we may still share medical information about you, if necessary for the emergency circumstances.

Special Situations

• State Confidentiality Laws: Certain state laws provide greater protection for medical records of a sensitive nature, including HIV related records, records of alcohol or substance abuse treatment, mental health records, and records of sexual abuse/assault counseling. We will use and disclose your health information only in accordance with the more restrictive laws that provide more protection for records included in these categories.
• Organ and Tissue Donations: 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 facilitate 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 medical information about foreign military personnel to the appropriate foreign military authority.
  
• 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.
  
• Public Health Risk: We may disclose medical information about you for public health activities. These activities generally include the following:
  • To prevent or control disease, injury or disability
  • To report births and deaths
  • To report cancer diagnosis and treatment
  • To report child abuse or neglect
  • To report reactions to medications or problems with products
  • To notify people of recalls of products they may be using
  • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
  • To 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.
    
• Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the requested information.
  • In response to a court order, subpoena, warrant, 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 result of criminal conduct
  • About criminal conduct at the Hospital
  • 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.
    
• Law Enforcement: We may release medical information if asked to do so by a law enforcement official:
• 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 of the Hospital to funeral directors as necessary to carry out their duties.
  
• National Security and Intelligence Activities: We may release medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
  
• 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 healthcare; (2) to protect your health and safety or health and safety of others; or (3) for the safety and security of the correctional institution.
  
• Incidental disclosures: While we will take reasonable steps to safeguard the privacy of your protected health information, certain disclosures of your protected health information may occur during or as an unavoidable result of our otherwise permissible uses or disclosures of your health information. For example, during the course of a treatment session, other patients in the treatment area may see or overhear discussions of your health information.

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 copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
  • To inspect and copy medical information that may be used to make decisions about you, you must submit a signed Authorization for Release of Information or a Written Request to our Medical Records department: If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
  • We may deny your request to inspect and copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. If you are denied access to medical information, 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 the outcome of the review.
    
• Right to Amend: If you feel medical 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 or for the 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 to support your request. We may deny your request for the 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:
  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment
  • Is not part of the medical information kept by or for the Hospital
  • Is not part of the information which you would be permitted to inspect and copy
  • Is accurate and complete
    
• Right to an Accounting of Disclosures: 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 healthcare operations, or disclosures that were made with your authorization or consent. To request this list or accounting of disclosures, you must submit your request in writing to our 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. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12- month period will be free. For additional lists, we may charge you for the costs of providing 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.
  
• Right 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 healthcare 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.
  • To request restrictions, 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.
  • We are not required to agree to your request. However, even if we agree to your request, in certain situations your restriction will not be followed. These situations include emergency treatment, disclosures to the Secretary of Health and Human Services, and uses and disclosures as described on page four of this Notice, under the heading, ” We may use and disclose PHI under other circumstances without your authorization or an opportunity to agree or object.“
    
• 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.
  
• Right 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 obtain a copy of this notice at our website at www.bloomhealth.net.
  • You may obtain a paper copy of this notice at areas of registration, admission or services in the Hospital.

Forms and preaddressed, postage paid envelopes are available for you to use to submit your specific requests about your rights to our Privacy Officer.

Change to This Notice

We reserve the right to change this notice. We reserve the right to make the revised or changed notice 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 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 healthcare services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the Hospital. To file a complaint with the Hospital, contact our Privacy Officer. All complaints must be submitted in writing.

• Bloomsburg Hospital
• Attention: Privacy Officer
• 549 East Fair Street
• Bloomsburg, PA 17815
• Phone:(570) 387-2128 x2178
• Fax: (570) 387-2444

Or to file a complaint with the Secretary of Health and Human Services:

• Region III
• Office of Civil Rights
• U.S. Department of Health and Human Services
• 150 S. Independence Mall West, Suite 372
• Public Ledger Building
• Philadelphia, PA 19106-9111

• Main Number: (215) 861-4441
• Toll-Free: 800-368-1019
• Fax: (215) 861-4431
• TDD: (215) 861-4440

You will not be penalized for filing a complaint.

Other Uses of Medical Information

Other uses and 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, in writing, you may revoke that permission 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 retain our records of the care that we provided to you.

• Bloomsburg Hospital
• 549 Fair Street
• Bloomsburg, PA 17815
• (570) 387-2100

• Privacy Officer
• (570) 387-2128 x2178

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