Please review this notice carefully to learn how your medical information may be used and disclosed and how you can obtain access to this information.
Pleasant Valley Hospital, Inc. and other health care providers, which are members of our system, include the following:
We are required to protect the privacy of health information about you and that can be identified with you, which we call “protected health information” (“PHI”).
We may use and disclose PHI about you to provide, coordinate or manage your health care and related services. This may include communicating with other health care providers regarding your treatment and coordinating and managing your health care with others. For example, we may disclose your PHI to a pharmacy to fulfill a prescription, to a laboratory to order a blood test or to a home health agency that is providing care in your home.
We may use and disclose your medical information to bill and collect payment for the treatment and services provided to you. Before you receive scheduled services, we may share information about these services with your health plan(s). For example, if certain procedures are recommended, we may need to disclose information to your health insurer to get prior approval for the procedure. We may also disclose protected health information to your insurance company to determine whether you are eligible for benefits or whether a particular service is covered under your health plan.
We may use and disclose PHI in performing business activities, which we call “health care operations.” These health care operations allow us to improve the quality of care we provide and reduce health care costs. Examples of the ways we may use or disclose PHI about you for health care operations include the following:
In certain situations, we may also disclose patient information to another provider or health plan for their health care operations.
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, including:
Unless you object, we may use or disclose PHI about you in the following circumstances:
We may use and/or disclose PHI to contact you with a reminder about an appointment you have for treatment or medical care.
We may use and/or disclose PHI to manage or coordinate your health care. This may include telling you about treatments, services, products and/or other health care providers. We may also use and/or disclose PHI to give you gifts of a small value.
We may use and/or disclose PHI about you, including disclosure to a foundation, to contact you to raise money for the hospital and its operations. In this circumstance, we only release your contact information and the dates you received treatment or services at the hospital. If you do not want to be contacted in this way, you must notify in writing our contact person listed on the last page of this notice.
Under any circumstances other than those listed above, we will ask for your written authorization before we use or disclose PHI about you. If you sign a written authorization allowing us to disclose PHI about you in a specific situation, you can later cancel your authorization in writing. If you cancel your authorization in writing, we will not disclose PHI about you after we receive your cancellation, except for disclosures which were being processed before we received your cancellation.
You have the right to request that we restrict the use and disclosure of PHI about you. We are not required to agree to your requested restrictions. However, even if we agree to your request, in certain situations your restrictions may not be followed. These situations include emergency treatment, disclosures to the Secretary of the Department of Health and Human Services and uses and disclosures described in the previous section of this notice. You may request a restriction by contacting the Pleasant Valley Hospital privacy officer at 304.675.4340, ext. 1161
You have the right to request how and where we contact you about PHI. For example, you may request that we contact you at your work address or phone number or by email. Your request must be in writing. We must accommodate reasonable requests, but, when appropriate, our accommodation may depend on your providing us with information regarding how payment, if any, will be handled and your specification of an alternative address or other method of contact. You may request alternative communications by contacting the Pleasant Valley Hospital privacy officer at 304.675.4340, ext. 1161.
You have the right to request to see and receive a copy of PHI contained in clinical, billing and other records used to make decisions about you. Your request must be in writing. We may charge you related fees. Instead of providing you with a full copy of the PHI, we may give you a summary or explanation of the PHI about you, if you agree in advance to the form and cost of the summary or explanation. There are certain situations in which we are not required to comply with your request. Under these circumstances, we will respond to you in writing, stating why we will not grant your request and describing any rights you may have to request a review of our denial. You may request to see and receive a copy of your PHI by contacting the Pleasant Valley Hospital privacy officer at 304.675.4340, ext. 1161
You have the right to request that we make amendments to clinical, billing and other records used to make decisions about you. Your request must be in writing and must explain your reason(s) for the amendment. We may deny your request for the following reasons:
You may request an amendment of your PHI by contacting the Pleasant Valley Hospital privacy officer at 304.675.4340, ext. 1161.
If you ask our contact person in writing, you have the right to receive a written list of certain disclosures we have made of PHI about you. You may ask for disclosures made up to six years before your request (not including disclosures made prior to April 14, 2003). We are required to provide a listing of all disclosures, except disclosures that were made:
The list will include the date of the disclosure, the name (and address, if available) of the person or organization receiving the information, a brief description of the information disclosed and the purpose of the disclosure. If, under permitted circumstances, PHI about you has been disclosed for certain types of research projects, the list may include different types of information.
If you request a list of disclosures more than once in 12 months, we may charge you a reasonable fee. You may request a listing of disclosures by contacting the Pleasant Valley Hospital privacy officer at 304.675.4340, ext. 1161.
You have the right to request a paper copy of this notice at any time by contacting the Pleasant Valley Hospital privacy officer at 304.675.4340, ext. 1161. We will provide a copy of this notice no later than the date you first receive service from us (except for emergency services, and then we will provide the notice to you as soon as possible).
If you think we have violated your privacy rights, or you want to complain to us about our privacy practices, you can contact the privacy officer listed below:
Pleasant Valley Hospital
2520 Valley Drive
Point Pleasant, WV 25550
Phone: 304.675.4340, ext. 1161
You may also send a written complaint to the United States Secretary of the Department of Health and Human Services. If you file a complaint, we will not take any action against you or change our treatment of you in any way.
Effective date of this notice: This Notice of Privacy Practices is effective on April 14, 2003.