Notice of Privacy Practices

The terms of this Notice of Privacy Practices apply to Holzer entities operating as a clinically integrated healthcare arrangement composed of Holzer locations and its Medical Staff, including Holzer Medical Center-Jackson, Holzer Medical Center-Gallipolis, Outpatient Clinic locations, Holzer Home Care, Holzer Hospice, Holzer Extra Care, Holzer Senior Care Center, Holzer Assisted Living-Jackson, Holzer Assisted Living-Gallipolis, Holzer Family Care Center, Jenkins Memorial Health Clinic and Dental Health Partners. The members of this clinically integrated health care arrangements work and practice in southeastern Ohio and western West Virginia. All of the entities listed will share personal health information as necessary to carry out treatment, payment, and health care operations as permitted by law.

We are required by law to maintain the privacy of our patients’ personal health information and to provide patients with notice of our legal duties and privacy practices with respect to your personal health information. We are required to abide by the terms of this Notice of Privacy Practices so long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make the new Notice effective for all personal health information maintained by us. You may receive a copy of the revised notices at any Registration Area of the entities described above or a copy may be obtained by mailing a request to the Holzer Director of Health Information Management, 100 Jackson Pike, Gallipolis, Ohio 45631.

Uses and Disclosures of Your Personal Health Information

Your Authorization. Except as outlined below, we will not use or disclose your personal health information for any purpose unless you have signed a form authorizing the use and disclosure. You have the right to revoke that authorization in writing unless we have taken any action in reliance on the authorization. We cannot refuse to treat you if you revoke the authorization. Situations that will require your authorization include most uses and disclosures of psychotherapy notes, PHI for marketing purposes, and disclosures that constitute a sale of PHI.

Uses and Disclosures for Treatment. We will make uses and disclosures of your personal health information as necessary for your treatment. For instance, doctors and nurses and other professionals involved in your care will use information in your medical record and information you provided about your symptoms and reactions to plan a course of treatment for you that may include procedures, medications, test, etc. We may also release your personal health information to another health care facility or professional who is not affiliated with our organization but who is or will be provided treatment to you. For instance, if, after you leave the hospital, you are going to receive home health, we may release your personal health information to that home health agency so a plan of care can be prepared for you. Additionally we may use your personal health information to contact you to remind you of appointments, and to give you information about treatment options, or other health-related benefits and services that may be of interest to you. However, when communicating appointment reminders, treatment options, or other related benefits and services that the organization receives cash or cash equivalents for, you will be asked for your authorization. Holzer typically does not receive cash or cash equivalents for such reminders.

And finally, our entities have transitioned or in the process of transitioning to an electronic medical record. In order to meet the requirement that we allow your health care providers to efficiently access and use your pertinent medical information necessary for treatment and other lawful purposes, 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 participation in the HIE by contacting our Health Information Management Department at 740-446-5361 or email himexchange@holzer.org to request an Opt Out Form. The Opt Out Form must be completed and returned to the Health Information Management Department for your participation in the HIE to be terminated. Please be advised that opting out does not preclude any participating organization that has received PHI via the HIE prior to the opt out request, and incorporated such PHI in its records, from retaining such information in its records.

Uses and Disclosures for Payment. We will make uses and disclosures for your personal health information as necessary or the payment purposes of those health professionals and facilities that have treated you or provided services to you. For instance, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you, or we may use your information to prepare a bill to send to you or to the person responsible for your payment.

If you have Medicare and are enrolled in a Medicare Advantage plan (Medicare HMO), your plan may be required by the Centers for Medicare and Medicaid services to collect Healthcare Effectiveness Data and Information Set (HEDIS) in order to provide HMO services to you. This data is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). It was originally designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks. Upon request by your plan and with the appropriate agreements in place, we may disclose your personal health information for these purposes.

Uses and Disclosures for Operations. We will use and disclose your personal health information as necessary, and as permitted by law, for our health care operations, which may include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance we may use and disclose your personal health information for purposes of improving the clinical treatment and care of our patients. We may also disclose your personal health information to another health care facility, health care professional or health plan for such things as quality assurance and case management, but only if the facility, professional, or plan also has or had a patient relationship with you. In addition we may have students, trainees, or other health care personnel, as well as some non-health care personnel, who come to our entities to learn under our guidance to practice or improve their skills.

Our Facility Directory. The following paragraph does not apply to home care services. We maintain a facility directory listing the name, room number and general condition. Unless you choose to have your information excluded from this directory, the information will be disclosed to anyone who requests it by asking for you by name. You have the right during registration to have your information excluded from this directory.

Family and Friends involved in Your Care. With your approval, we may from time to time disclose your personal health information to designated family, friends, and others who are involved in your care or in payment of your care in order to facilitate that person’s involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation and we determine that a lifted disclosure may be in your best interest, we may share limited personal health information with such individuals without your approval. We may also disclose limited personal health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.

Business Associates. Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, legal services, or consultants /collaborators who help us design efficient business processes (i.e. CrossCx). At times it may be necessary for us to provide certain components of your personal health information to one or more of these outside persons or organizations which assists us with health care operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information.

Appointments and Services. We may contact you to provide appointment reminders, test results, follow up phone calls or patient satisfaction surveys. You have the right to request, and we will accommodate reasonable requests by you to receive communications regarding your personal health information from us by alternative means or at alternative locations. For instance, if you wish appointment reminders not be left on voice mail or sent to a particular address, we will accommodate reasonable requests. You may request such confidential information in writing and may send your request to the Holzer Business Office, 100 Jackson Pike, Gallipolis, Ohio 45631.

Health Products and Services. We may from time to time use your personal health information to communicate to you information about treatment options, or other health-related benefits and services (i.e. appointment and prescription refill reminders) that may be of interest to you. We may want to communicate new Holzer product or services we offer, and to provide general health and wellness information. However, when communicating these treatment options, or other related benefits and services that the organization receives cash or cash equivalents for, you will be asked for your authorization. Holzer typically does not receive cash or cash equivalents for such reminders.

Research. Some of our entities participate in research activities. In limited circumstances, we may use or disclose your personal health information for research purposes. For example a research organization may wish to compare outcomes of all patients who received a particular drug and will need to review a series of medical records. In all cases where your specific authorization has not been obtained, your privacy will be protected by strict confidentiality requirements applied by an Institutional Review Board or Privacy Board that oversees research, or by representations of the researchers that limit their use and disclosure of patient information.

De-identified Databases and Limited Data Sets. We may use your personal health information for the purposes of removing information that identifies who you are, and putting it in a computer program. Your information will be completely de-identified. This information is used for research purposes. If your information is partially de-identified, it is called a “limited data set”. We may give the “limited data set” that includes your information to others for the purposes of research, public health action or health care operations. The persons who receive “limited data sets” are required to agree to take reasonable steps to protect the privacy and security of your personal health information.

Other Uses and Disclosures. We are permitted or required by law to make certain other uses and disclosures of your personal health information without your consent or authorization.

  • We may release your personal health information for any purpose required by law;
  • We may release your personal health information for public health activities, such as required reporting of disease, injury, birth and death, and for required public health investigations;
  • We may release your personal health information as required by law if we suspect child abuse or neglect; we may also release your personal health information if we believe you to be a victim of abuse, neglect or domestic violence.
  • We may release your personal health information to the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in product recalls;
  • We may also release your personal health information to your employer when we have provided health care to you at the request of your employer to determine workplace-related illness or injury; in most cases you will receive notice that information is disclosed to your employer;
  • We may release your personal health information if required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings;
  • We may release your personal health information if required to do so by subpoena or discovery request; in some cases you will have notice of such release;
  • We may release your personal health information to law enforcement officers as required by law to report wounds and injuries and crimes;
  • We may release your personal health information to coroners and/or funeral directors consistent with the law;
  • We may release your personal health information if necessary to arrange an organ or tissue donation from you or a transplant to you.
  • We may release your personal health information if in limited instances we suspect a serious threat to health or safety;
  • We may release your personal health information if you are a member of the military as required by armed forces; we may also release your personal health information if necessary for national security or intelligence activities; and
  • We may release your personal health information to workers’ compensation agencies if necessary for your workers’ compensation benefit determination.

Rights That You Have

Access to Your Personal Health Information. You have the right to copy and/or inspect much of the personal health information we retain on your behalf. All requests for access must be made in writing and signed by you or your personal representative. If you request a copy of the information, we may charge you at an amount not to exceed the limits set by Ohio Law per section 3701.741. We will also charge for postage if you request a mailed copy, and will charge for preparing a summary of the requested information if you request such a summary. You may obtain an access request form from the Holzer Health Information Management Department.

For your convenience, some of our entities will send your medical information to a patient self-service portal (Holzer Patient Portal). You must register online and set up a username and password. This allows you to take personal control of your private health information. It is your duty to protect access to this site.

Amendments to Your Personal Health Information. You have the right to request in writing that personal health information we maintain about you be amended or corrected. We are not obligated to male all requested amendment but will give each request careful consideration. All amendment requests, in order to be considered by us, must be in writing, signed by you or your representative, and must state the reasons for the amendment/correction request. If an amendment or correction you request is made by us, we may also notify others who work with us and have copies of the uncorrected record, if we believe that such notification is necessary. You may obtain an amendment request form from the Holzer Health Information Management Department.

Accounting for Disclosure of Your Personal Health Information. You have the right to receive an accounting of certain disclosures made by us of your personal health information after April 14, 2003. Requests must be made in writing and signed by you or your representative. Accounting request forms are available from the Holzer Health Information Management Department. The first accounting in any 12 month period is free. You will be charged a fee of $10.00 for each subsequent accounting you request within the same 12 month period.

Restrictions on Use and Disclosure of Your Personal Health Information. You have the right to request restrictions on certain uses and disclosures of your personal health information for treatment, payment, or health care operations. A restriction request form can be obtained from the Holzer Health Information Management Department. A restriction that Holzer is obligated to agree to is the restriction of disclosures of your personal health information to your payer if you wish to pay out of pocket in full for items or services provided to you. We are not required to agree to other restriction requests, but will attempt to accommodate reasonable requests when appropriate, and we retain the right to terminate an agreed-to-restriction if we believe that such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to-restrictions to sending such termination notice the Holzer Health Information Management Department.

Additional Rights. You have the right to opt out of communications regarding fundraising. You have the right to receive notifications of breaches of your medical information.

Complaints. If you believe your privacy rights have been violated, you may file a complaint with the Holzer Compliance/Privacy Officer at 740-446-5434 or in writing at 100 Jackson Pike, Gallipolis, Ohio, 45631. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing within 180 days of a violation of your rights. There will be no retaliation from filing a complaint.

Acknowledgment of Receipt of Notice. You will be asked to sign an acknowledgment form that you received this Notice of Privacy Practices.

For Further Information

If you have further questions or need further assistance, you may contact the Holzer Corporate Compliance/Privacy Officer, at 100 Jackson Pike, Gallipolis, Ohio 45631, or at 740-446-5434.

As a patient, you have the right to obtain a paper copy of this Notice of Privacy Practices, even if you have requested such copy by email or other electronic means.

Effective Date

This revised version of the Notice of Privacy Practices is effective September 23, 2013.

Forms

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