Printable NOTICE OF PRIVACY PRACTICE

For Treatment:  We may use medical information about you to provide you with medical treatment or services. We may disclose your medical information to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you at our facility.   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 that we can arrange for appropriate meals.  Different departments of the facilities 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 other  people outside the facility who may be involved in your medical care after you leave, such as family members, clergy, or others we use to provide services that are part of your care.

For Payment:  We may use or disclose medical information about you so that treatment and services you receive maybe bill to and payment may be collected from you, an insurance company, or 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 treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. 

For Healthcare Operations:  We may use and disclose medical information about you for facilities operations.  These uses and disclosures are necessary to run the facility and make sure that all of our patients are receiving quality care.  For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you...  We may also combine medical information about many hospital patients to decide what additional services the hospital should offer, what services are not needed, and whether any new treatments are effective.  We may also disclose information to doctors, nurses, technicians, medical students, and other hospital personnel for review and learning purposes.  We may also combine the medical information we have with medical information from other hospitals to compare how we are doing and see where we can make improvements in the care and services we offer. 

Appointment Reminders:  We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care. 

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 disclosed medical information to tell you about health related benefits were services that may be of interest to you. 

Lending Activities:  We may use medical information about you to contact you in an effort to raise money for the corporation and its operations.  We may disclose medical information to a foundation related to the hospital so that the foundation may contact you in raising money for the hospital.  We only would release contact information, such as your name, address, and 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 notify the Corporate Compliance Officer in writing.   

Hospital Directory:  We may include certain limited information about you in the hospital directory while you are patient at the hospital.  This information may include your name, location in the hospital, you general condition (e.g., fair, stable, etc.)  The directory information may also be released to people who 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 You:  We may release medical information about you to a friend or family member who is involved in your medical care unless you request a restriction to such release.  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.  In addition, we may disclose medical 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.

Research:  Under certain circumstances, we may use and disclose medical information about you for research purposes.  For example a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition.  All research projects, however, are subject to a special approval process.  We may disclose medical information about you two people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave the hospital.  We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the hospital. 

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

To Avert A Serious Threat To Health or Safety:  We may use and disclose medical 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.  Any disclosure, however, would only be to someone able to help prevent the threat.    (Top)  (Home)

SPECIAL SITUATIONS:

Organ and Tissue Donation:  We may release medical information to organizations that handle organ procedure 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 released 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 illnesses. 

Public Health Risks:  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 birth and deaths;

• To report child abuse or neglect;

• To report reactions to medications or problems with products;

• To notify people of recalls of the 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;

• Two notified the appropriate government authority if we believe that 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 health oversight activities 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 systems, government programs, and compliance with civil rights laws. 

Lawsuits and Disputes:  If you are involved in a lawsuit or 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 unless you obtain an order protecting the information requested. 

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

• In response to a court order or subpoena;

• To identify or locate a suspect, fugitive, material witness, or missing person;

• About the victim of a crime of, 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; and

• 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. 

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 a 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 of intelligence, counterintelligence, and other national security activities authorized by law.

Protective Services For The President and Others:  We may disclose 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 the 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.    (Top)  (Home)

your rights regarding medical
information about you

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

Rights To Inspect and Copy:  You have the right to request to inspect and obtain a copy of your 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 receive a copy of your medical information that may be used to make decisions about you, you must submit your request in writing to the Health Information Management Department.  If you request a copy of the information, we may charge a fee for the cost of copying, mailing or other supplies associated with your request. 

We may deny your request to inspect and obtain a copy in certain very limited circumstances.  If you are denied access to medical information, you may request that the denial be reviewed.

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.  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 the Health Information Management Department.  In addition, you must provide a reason that supports your request. 

We 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 asked 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;
• It is not part of the information which you would be permitted to inspect and obtain a copy;
  
  or
• Is accurate and complete.

Right To An Accounting of Disclosures:  You have the right to request an "accounting of disclosures" other than for treatment, payment, internal operations, hospital directory, and certain law enforcement disclosures.  This is a list of the disclosures we made of medical information about you which did not require you to sign an authorization for this release of medical information.

To request this list or accounting of disclosures, you must submit your request in writing to the Health Information Management Department.  Your request must state a time period that 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 made charge you for the cost of providing the list.  We will notify you of the costs 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 to disclose about you for treatment, payment, or health care operations.  For example, you may request that your information not be included in our facility directory. 

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 restrictions of medical information or confidential, communications, you must make your request in writing and submit it at the time of registration or during your hospital stay.  We are not required to fulfill all requests but will attempt to accommodate all reasonable requests.

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 received this notice electronically, you are still entitled to a paper copy of this notice.

You may also obtain a copy of this notice at our website, www.nchosp.org.

To obtain a paper copy of this notice, contact the Compliance Officer or request one at your next visit to our facility.    (Top)  (Home)

Changes to this notice

We reserve the right to change this NOTICE.  We reserve the right to make the revised or change NOTICE effective for medical information we already have about you as well as any information we will receive in the future.  We will post a copy of the current NOTICE at our facility.  The effective date is noted on the first page.  In addition, each time you register at or are treated at any of our facilities as an impatient for outpatient, we may offer you a copy of the current NOTICE in effect.

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 authorization.  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 authorization, we will not 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 that we are required to retain our records for the care that we provided to you. 

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with any of our facilities or with the Secretary of the Department of Health and Human Services.  To file a complaint with the facility, call the Compliance Hotline Number at (276) 679-8355, contact our Privacy Officers at Norton Community Hospital or Dickinson Community Hospital, or a customer service representative.  To file a written complaint with the Department of Health and Human Services you may contact our Corporate Compliance Officer at (276) 679-9075. 

You will not be penalized for filing a complaint.    (Top)  (Home)

100 Fifteenth Street NW
Norton, VA 24273