Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities.

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.

This Notice of Privacy Practices applies to all Holzer entities. See our updated organization's list at https://www.holzer.org/locations/.

Your Privacy Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. You have the right to:

Get an electronic or paper copy of your medical record

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have
  about you.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
• You may request a copy of your records by completing a release of information form from your provider’s office or the Holzer Health Information Management (HIM) Department.
• You may also access and download an electronic copy by registering for your Holzer patient portal account(s) online. Ask us how to do this. It is your duty to protect access to these accounts.

Ask us to correct your medical record

• You can ask us to correct health information about you that you think is incorrect or incomplete.
• You may request an amendment by completing an amendment request form. You can obtain a copy of this form from the Holzer Health Information Management (HIM) Department.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different
  address. We will say "yes" to all reasonable requests.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
• We can end the agreed restriction if we think it's necessary, and we will let you know if we do. You also have the right to end any agreed restrictions by telling the Holzer HIM Department in writing or orally.

Get a list of those with whom we've shared information

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
• You may request an accounting by completing an accounting of disclosure form. You can obtain a copy of this form
  from the Holzer HIM Department.

Get a copy of this privacy notice

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

• We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

• You can file a complaint if you feel we have violated your Privacy rights. Please see contact information at the end of this notice.
• We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share.

• If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include or exclude your information from our hospital directory
  
  

  If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

In the case of fundraising:

• We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways:

• Treat You

  • We can use your health information and share it with other professionals who are treating you.
    Example: A provider treating you for an injury asks another provider about your overall health condition.

  • We may also contact you when necessary for appointment reminders, test results, and follow up phone calls.

• Run our organization
  • We can use and share your health information to run our practice, improve your care and contact you when necessary.
    Example: We may contact you to complete a patient satisfaction survey so we may continually enhance our care.
• Bill for your services
  • We can use and share your health information to bill and get payment from health plans or other entities.
    Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

• Help with public health and safety issues
  We can share health information about you for certain situations such as:
  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications or product defects
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone's health or safety

• Do research
  Some of our entities participate in research activities. In limited circumstances, we can use or share your information for health research purposes.
  
  
• Health Information Exchange
  We participate in an electronic Health Information Exchange (HIE) system. We may electronically share your health information for treatment, payment, healthcare operations, and other purposes permitted under HIPAA with other participants in the Exchange.
  • You may opt out of participating in the HIE by completing an opt-out form and emailing a copy to the HIM Department at himexchange@holzer.org or by mailing the form to Attn: Holzer Health Information Management Director 100 Jackson Pike Gallipolis, OH 45631
  • Your decision to opt out does not affect the information that was exchanged prior to the time you chose not to participate.
• Comply with the law
  

  We will share information about you if state or federal laws require it, including with the Department of Health and Human
  Services if it wants to see that we’re complying with federal privacy law.

• Respond to organ and tissue donation requests
  We can share health information about you with organ procurement organizations.
  
  
• Work with a medical examiner or funeral director
  We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
  
  
• Address workers' compensation, law enforcement, and other government requests
  We can use or share health information about you:

  • For workers’ compensation claims

  • For law enforcement purposes or with a law enforcement official

  • With health oversight agencies for activities authorized by law

  • For special government functions such as military, national security, and presidential protective services

• Respond to lawsuits and legal actions
  We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.

• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
  
  For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Acknowledgment of Receipt of Notice

You will be asked to sign an acknowledgment form that you have been offered a copy this Notice of Privacy Practices.

Changes to the terms of this notice

• We can change the terms of this notice, and the changes will apply to all information we have about you.

• The new notice will be available upon request, at each Holzer location, and on our website.

Complaints

• If you believe your privacy rights have been violated, you can file a complaint by contacting the Holzer Compliance/Privacy Officer at 740-446-5434 or in writing at Attn: Holzer Compliance/Privacy Officer 100 Jackson Pike, Gallipolis, Ohio, 45631.
• You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

Effective Date

This revised version of the Notice of Privacy Practices is effective October 13, 2025.

Download a copy of Holzer Notice of Privacy Practices here