Privacy Practices

Our notice tells how your medical information may be used and disclosed, and how you can get access to this information. Please review it carefully.

UPPER VALLEY MEDICAL CENTER
NOTICE OF PRIVACY PRACTICES 

Uses and Disclosures: We will use and disclose elements of your protected health information (PHI) in the following ways:

Without your signed authorization:

• Treatment: from UVMC, doctors, and nurses who treat you, and other healthcare providers who care for you while you are here;
• Payment: for those health professionals and facilities that treated or provided services to you;
• Health care operations: including clinical improvement, professional peer review, business management, and accreditation and licensing, etc;
• When release is required by law, including in judicial settings, and to health oversight regulatory agencies and law enforcement;
• In emergency situations or to avert serious health/safety situations;
• To medical examiners, coroners, or funeral directors to aid in identifying you or to help them in performing their duties;
• To organ, tissue, and other donations organization, upon or proximate to your death, if we have no indication on hand about your donation purposes (or a positive indication);
• For any purpose required by law.

Special cases:

• To contact you about appointment reminders, treatment alternatives, and other health related benefits and services;
• In fundraising for ourselves;
• To the sponsor of your health plan.

Confidentiality of Alcohol and Drug Abuse Patient Records

• These records are maintained by UVMC and are protected by federal law and regulations. We may not disclose to any person outside the program that you attend a drug or alcohol program, or disclose any information identifying you as an alcohol or drug abuser unless: you consent in writing; the disclosure is allowed by court order; or, the disclosure is made to medical personnel in a medical emergency, or as mandated by Federal Law.

Other

• All other uses and disclosures by us will require us to obtain from you a written authorization in addition to any other permission you will provide us.

Your rights: You have the following rights concerning your PHI:

• Restrictions: To request restricted access to all or part of your PHI. To do this you must contact Health Information Services (Medical Records). We are not required to grant your request.
• Confidential communications: To receive correspondence of confidential information by alternate means or location. To do this you must contact in writing the HIPAA Coordinator, Upper Valley Medical Center, N. Dixie Highway to N. County Rd. 25-A
• Access: To inspect or receive copies of your protected health information. To do this you contact Health Information Services (Medical Records).
• Amendments: To request changes be made to your PHI. To do this, you must contact Health Information Services (Medical Records). We are not required to grant your request.
• Accounting: To receive an accounting of the disclosures by us of your PHI in the six years prior to your request. To do this, you must contact Health Information Services (Medical Records).
• This notice: To get updates or reissue of this notice, at your request.
• Complaints: To complain to us or the U.S. Department of Health & Human Services if you feel your privacy rights have been violated. To register a complaint with us, please contact the HIPAA Coordinator at (937) 440-7140. The law forbids us from taking retaliatory action against you if you complain.

Our duties: We are required by law to maintain the privacy of your PHI. We must abide by the terms of this notice or any update of this notice.

Privacy contact: For more information about our privacy practices, please contact:

HIPAA Coordinator
(937) 440-7140
Upper Valley Medical Center
3131 N. Dixie Highway
Troy, OH 45373

Effective date: April 14, 2003