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Notice of Privacy Practices

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.

OUR RESPONSIBILITIES
The Good Samaritan Regional Medical Center, its various service sites and its affiliated entities takes the privacy of your health information seriously. Examples of our service sites include, the hospital, Good Samaritan North, Good Samaritan South, Seton Medical Group, the Good Samaritan Healthplex, etc. We are required by law to maintain that privacy and to provide you with this Notice of Privacy Practices. This Notice is provided to tell you about our duties and practices with respect to your information. We are required to abide by the terms of this Notice that is currently in effect pursuant to the standards set forth by the Health Insurance Portability and Accountability Act (HIPAA) or those Federal and State laws which are even more stringent.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
The following categories describe different ways that we use and disclose your health information. For each category we 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 health information about you to provide you with treatment, health care or other related services without the need to obtain a signed authorization from you, according to the Health Insurance Portability and Accountability Act (HIPAA). We may disclose your health information to doctors, nurses, aids, technicians or other employees who are involved in taking care of you. Additionally, we may use or disclose your health information to manage or coordinate your treatment, health care or other related services. An example of such practices would be providing your referring physician (your family doctor) with a copy of your lab test reports. Physicians such as a radiologist who reads your x-ray film or a pathologist who views your tissues from a biopsy or surgery, will be given access to your medical information, in order to perform their jobs in the interest of assisting in the diagnosis and/or treatment of you. There are individuals outside of the hospital who also may receive your medical information in order to assist in your care during or after your hospital stay. Examples may include, a contracted outside laboratory, a home health agency or health care providers at another hospital or nursing home where you are transferred to.
  • For Payment: We may use and disclose your health information to bill and collect for the treatment and services we provide to you without the need to obtain a signed authorization from you, according to the Health Insurance Portability and Accountability Act. We may send your health information to an insurance company or other third party for payment purposes including to a collection service. This would include situations like giving your health information to your insurance company in order to provide proof of the treatment you received. Many insurance companies use an outside contracted company to review patient charts for completeness and audit of the patient bills. These records would be provided to the agency for review, in order for the hospital to receive payment.
  • For Health Care Operations: We may use and disclose your health information for health care operations. These uses and disclosures are necessary to run the Good Samaritan Regional Medical Center and its affiliated entities, to make sure you receive competent, quality health care, and to maintain and improve the quality of health care we provide. Essentially, your health information may be reviewed for quality control purposes and operational purposes by employees of the hospital or consultants who were not actually involved in your actual care or treatment. We may also provide your health information to various governmental or accreditation entities to maintain our license and accreditation. For example, the Department of Health may enter the hospital at any time and review records of any patient. Accreditation agencies, such as the Joint Commission for the Accreditation of Health Organizations (JCAHO) or the American College of Surgeons will come to the hospital from time to time to survey the hospital and measure our ability to run the hospital within the standards set by these national healthcare organizations.
  • As Required By Law: We will disclose your health information when required to do so by federal, state or local law. For example, if you are treated for a seizure, the Department of Motor Vehicles requires, by law, that we report the incident to them. All patients diagnosed with a malignant cancer must have their case reported to the Pennsylvania Cancer Registry. The Pennsylvania Health Care Cost Containment Council requires the reporting of patient information for all inpatients (patients who were admitted to the hospital) and many outpatients. A State law requires this reporting process and all hospitals must comply.
  • For Public Health Purposes: We may disclose your health information for public health activities. While there may be others, public health activities generally include the following:
    • Preventing or controlling disease, injury or disability; (such as; TB [Tuberculosis] and sexually transmitted diseases)
    • Reporting births and deaths;
    • Reporting defective medical devices or problems with medications;
    • Notifying people of recalls of products they may be using; and
    • Notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition. (such as Tuberculosis)
  • About Victims of Abuse: We may disclose your health information to notify the appropriate government authority if we believe an individual 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, such as in the case of suspected child abuse.
  • Health Oversight Activities: We may disclose your health information to a health oversight agency for activities authorized by law. These oversight activities might include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government benefit programs, and compliance with civil rights laws.
  • Judicial Purposes: We may disclose your health information in response to a court or administrative order. We may also disclose your health information in response to a subpoena, discovery request, or other lawful process.
  • Law Enforcement: The HIPAA regulations require us to release your health information if asked to do so by a law enforcement official, if such disclosure is:
  • Required by law: In response to a court order, subpoena, search 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 on the premises of The Good Samaritan Regional Medical Center or its affiliated sites; or
    • 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 disclose health information concerning an expired patient 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 health information about individuals to funeral directors as necessary to carry out their duties.
  • Organ and Tissue Donation: We may disclose your health 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.
  • Research: Under certain circumstances, we may use and disclose health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all individuals who received one medication to those who received another. All research projects, however, are subject to a special approval process. This process includes evaluating a proposed research project and its use of health information, trying to balance the research needs with your need for privacy of your health information. Before we use or disclose health information for research, the project will have been approved through this research approval process. Additionally, when it is necessary for research purposes and so long as the health information does not leave the Good Samaritan Regional Medical Center or its affiliated sites, we may disclose your health information to researchers preparing to conduct a research project, for example, to help the researchers look for individuals with specific health needs. Lastly, if certain criteria are met, we may disclose your health information to researchers after your death when it is necessary for research purposes.
  • To Avert a Serious Threat to Health or Safety: We may use and disclose your health information when we believe it is 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 or lessen the threat or to law enforcement authorities in particular circumstances.
  • Military and Veterans: If you are a member of the armed forces, we may release your health information as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.
    • If you are receiving treatment at our Veterans Administration clinic, we may disclose to the Department of Veterans Affairs your health information upon your separation or discharge from military services for the purpose of a determination by the department of Veterans Affairs of your eligibility for or entitlement to certain benefits. We may use and disclose to components of the Department of Veterans Affairs health information about you to determine whether you are eligible for certain benefits.
  • National Security and Intelligence Activities: HIPAA regulations require that we release your health information to authorized federal officials for lawful intelligence, counterintelligence, and other national security activities authorized by law.
  • Disaster Relief: We may use or disclose protected health information, without your consent, to federal, state or local government agencies engaged in disaster relief activities, as well as to private disaster relief or disaster assistance organizations (such as the Red Cross) authorized by law or by their charters to assist in disaster relief efforts, to allow these organizations to carry out their responsibilities in a specific disaster situation.
  • Protective Services for the President and Others: We may disclose your health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or for the conduct of special investigations.
  • Custodial Situations: If you are an inmate in a correctional institution and if the correctional institution or law enforcement authority makes certain representations to us, we may disclose your health information to a correctional institution or law enforcement official.
  • Workers' Compensation: We may disclose your health information as authorized by and to the extent necessary to comply with workers' compensation laws or laws relating to similar programs. In the State of Pennsylvania, a workman's compensation carrier has authority to receive medical information from your files, if you have named the carrier, or their subcontractors as the insurance carrier responsible for your hospital bill.
  • Treatment Alternatives, Appointment Reminders and Health-Related Benefits: We may use and disclose your health information to tell you about or recommend possible treatment alternatives or health-related benefits or services that may be of interest to you. Additionally, we may use and disclose your health information to provide appointment reminders. If you do not wish us to contact you about treatment alternatives, health-related benefits or appointment reminders, you must notify us in writing, and state from which of those activities you wish to be excluded. Send your written notice to the HIPAA Privacy Officer whose address is on the last page of this Notice.
  • Fundraising Activities: We may use demographic information (name, address, telephone number, date of birth, the dates you were here, etc.) to contact you concerning fund raising activities for The Good Samaritan Regional Medical Center and its affiliates, including the Good Samaritan Foundation and its operations. If you do not want us to contact you for fundraising efforts, you must notify, in writing, the person listed on the last page of this Notice (The Privacy Officer).
  • Facility Directory: We may include certain limited information about you in our directory. This information may include your name, location in the hospital, your general health status (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also 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 minister, even if they do not ask for you by name. If you do not wish to be included in the facility directory please notify us at the time of admission. Patients enrolled in a behavioral health program (i.e. substance abuse) are excluded from the facility directory.
  • Individuals Involved in Your Care or Payment for Your Care: We may release health information about you to a family member, other relative, or any other person identified by you who is involved in your health care. We may also give information to someone who helps pay for your care. We may also tell your family, friends, personal representative or other person responsible for your health care your health status and that you are at the hospital (unless you have directed otherwise concerning the Facility Directory, see above).
  • Third Parties: We may disclose your health information to third parties with whom we contract to perform services on our behalf. If we disclose your information to these entities, we will have an agreement by them to safeguard your information.

OTHER USES OF HEALTH INFORMATION
Other uses and disclosures of health 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 authorization to use or disclose your health information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose health 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 under the authorization, and that we are required to retain our records of the care that we provided to you, for the duration required by the Pennsylvania Department of Health regulations.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding health information we maintain about you:

  • Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care.

    We are not required to agree to your request.

    If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

    To request restrictions, you must make your request in writing using the Good Samaritan Regional Medical Center's HIPAA RESTRICTION form, addressed to The HIPAA Privacy Officer at the address found on the last page of this Notice. 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.
  • Right to Request Confidential Communications. You have the right to request that we communicate with you or your responsible party about your health care in an alternative way or at a certain location.

    To request confidential communications, you must make your request in writing using the Good Samaritan Regional Medical Center's REQUEST for CONFIDENTIAL COMMUNICATIONS to The HIPAA Privacy Officer at the address found on the last page of this Notice. 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 Inspect and Copy. You have the right to inspect and obtain copies of your health information, from the designated record set, that may be used to make decisions about your care.

    To inspect and obtain copies of your health information, you can submit your request in writing to the:

    Correspondence Secretary
    Medical Records Department
    Good Samaritan Regional Medical Center
    700 East Norwegian Street
    Pottsville, PA 17901

    The request must be in writing using the Good Samaritan Regional Medical Center's RELEASE OF INFORMATION AUTHORIZATION form, completed in its entirety as required by the HIPAA regulations.

    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.
  • Right to Amend. You have the right to ask us to amend your health and/or billing information for as long as the information is kept by us.

    To request an amendment, your request must be made in writing on the Good Samaritan Regional Medical Center's REQUEST TO AMEND form and submitted to The HIPAA Privacy Officer at the address found on the last page of this Notice. 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 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 health information kept by or for us;
    • Is not part of the information which you would be permitted to inspect and copy; or
    • Is accurate and complete.
  • Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures that we have made of your health information.

    To request this list of disclosures, you must submit your request in writing to the HIPAA Privacy Officer at the address found on the last page of this Notice. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a twelve-month period will be free. For additional lists, during such twelve-month period, 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. The charging for disclosures is pursuant to the HIPAA regulations concerning the accounting of disclosures.
  • 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. You may obtain a copy of this Notice at our web site at www.gsrmc.com or contact the HIPAA Privacy Officer at the address listed at the end of this Notice.

WHO THIS NOTICE APPLIES TO
This Notice describes The Good Samaritan Regional Medical Center and its affiliates practices and those of:

  • Any health care professional authorized to enter information into or consult your medical record.
  • All departments and units of The Good Samaritan Regional Medical Center.
  • Any member of a volunteer group we allow to help you.
  • All employees, medical staff and other Good Samaritan Regional Medical Center personnel.
  • The Good Samaritan Regional Medical Center, its various service sites and its affiliated entities and the medical staff of the Good Samaritan Regional Medical Center are all members of an organized health care arrangement who have agreed to follow the terms of this Notice. In addition, these entities, sites and locations may share health information with each other for treatment, payment or operations purposes described in this Notice.

CHANGES TO THIS NOTICE
We reserve the right to change this Notice. We reserve the right to make the revised Notice effective for health 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 a clear and prominent location to which you have access. The Notice is also available to you upon request. The Notice will contain on the first page, in the top right-hand corner, the effective date. In addition, if we revise the Notice, we will offer you a copy of the current Notice in effect at your request.

COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the Good Samaritan Regional Medical Center or with the Secretary of the Department of Health and Human Services. (Office for Civil Rights 150 South Independence Mall West, Suite 372 Philadelphia, PA 19106-3499 215-861-4450)

To file a complaint with us, contact the HIPAA Privacy Officer at the address listed below. All complaints must be submitted in writing. We have also set up a telephone voice mailbox, if you wish to leave a message to ask for assistance in clarification of any part of this Notice. That telephone number is 570-621-4422. We will monitor this voice mailbox for messages during regular business hours Mondays through Fridays. We are as concerned about your privacy as you are. You will not be penalized for filing a complaint. We want to do everything possible to protect your privacy.

If you have any questions about this Notice, please contact the:

HIPAA Privacy Officer
Good Samaritan Regional Medical Center
700 East Norwegian Street
Pottsville, PA 17901
570-621-4422


700 East Norwegian Street, Pottsville, PA, 17901Phone: 570-621-4000
Copyright © 2005, Good Samaritan Regional Medical Center