Joint 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 this notice carefully.
When it comes to your information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
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. Ask us how to do this. 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.
Ask us to correct your medical record: You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may say “no” to your request, but we will 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 healthcare 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.
Get a list of those with whom we have shared information: You can ask for a list (an accounting) of the times we have shared your health information for six years prior to the date you ask, whom we shared it with and why. We will include all the disclosures except for those about treatment, payment, and healthcare operations, and certain other disclosures, such as any you asked us to make. We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
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 have beenviolated: You can complain if you feel we have violated your rights. Contact the privacy officer using the contact information at the end of this notice.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Ave. SW, Washington, D.C. 20201; calling 877.696.6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.
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 your information in a hospital directory.
- Contact you for fundraising efforts.
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.
Authorization: We will not use or disclose your health information for any purpose that is not listed in this notice without your written authorization.
We never share your information unless you give us written permission in these cases:
- 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.
Other uses and disclosures: How do we typically use or share your health information? We typically use or share or use your health information to do the following:
Treat you: We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.
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 use health information about you to manage your treatment and services.
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: hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html. We may share your health information to do the following:
- 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, reporting suspected abuse, neglect or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.
- Do research: We can use or share your information for health research.
- 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, and 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.
- Clergy: We can share your name and location with the clergy of your specified church while you are an inpatient, unless you ask us not to do so.
- To avert a serious threat: We may disclose your health information if we decide that the disclosure is necessary to prevent serious harm to the public or to an individual.
Pennsylvania state law
The following categories of information receive special protection and will be used and disclosed only as allowed by state or federal law: HIV-related information; mental health treatment records; and substance abuse records.
If you are under 18 years of age and are not emancipated, your parent or guardian will control access to and disclosure of your health information, subject to the provisions of this notice with the following exceptions:
- Communicable diseases: If you are being diagnosed or treated for a sexually transmitted disease or any other disease or condition that we are required by law to report to the government or health authorities, you (the minor) will control the access to and disclosure of your health information that is related to that diagnosis or treatment.
- Mental health: If you are over 14 years of age and you are able to understand the nature of your mental health records and the purpose of releasing them, you will control access to, and disclosure of the health information.
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: hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
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, in our office and on our website.
Effective date: July 2019
This Notice of Privacy Practices applies to the following organizations: Indiana Healthcare Corporation and its affiliates and subsidiaries including: Indiana Regional Medical Center, Indiana Physicians Group, Indiana Total Therapy, IRMC Cancer Center, in partnership with UPMC Hillman Cancer Center and Indiana Ambulatory Surgical Associates. This notice applies to all sites at which these organizations deliver care. These organizations may share your health information with one another as necessary to provide treatment, obtain payment for their services, and carry out necessary administrative functions.
Whom to contact
Effective date: July 12, 2019
Revised 1/90, 7/91, 2/92, 1/93, 4/94, 3/95, 6/99, 3/02, 8/13 (ADM.PAT.zcus.adm.form9)