Notice of Privacy Practices

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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 it carefully.


Our Uses and Disclosures

This section describes how we typically use or share your health information.

To 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.

To run our organization

  • We can use and share your health information to run our hospital or physician practice, to improve your care, and to contact you when necessary.
    • Example: We use health information about you to manage your treatment and services.

To bill for services provided to you

  • We can use and share your health information to bill and receive payment from your health insurance or other entities for services provided to you.

We are also allowed or required to share your information in other ways – usually ways that contribute to the public good.  We have to meet many conditions in the law before we do.  The information below describes some of these purposes.  For more information go to:  www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

To 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
    • Preventing or reducing a serious threat to anyone’s health or safety

To do research

  • We can use or share your information for health research.

To 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 are complying with the federal privacy law.

To respond to organ and tissue donation requests

  • We can share health information about you with procurement organizations to facilitate organ, eye, or tissue donations.

To work with a medical examiner or funeral director

  • We can share health information with a coroner, medical examiner, or funeral director to assist them with their official duties.

To 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, such as audits or investigations
    • For special government functions, such as military, national security, criminal corrections, and presidential protective services

To 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.

State law provides special protection for the following categories of information, and we will use and disclose these types of information only as allowed by state law:

  • HIV related information
  • Mental health treatment records
  • Substance abuse treatment records


Your Rights

This section explains your rights and some of our responsibilities to 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.  Contact our Medical Records Release of Information area at 570-476-3388.
  • 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.  Contact our Privacy Officer using the contact information at the bottom of the page.
  • 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 cell phone) or 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 will probably say “no” if it would affect your care.

  • If you pay for a service or health care item out-of -pocket in full, you can ask us not to share that information with your health insurer for the purpose of payment or our health care operations.
    • 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), for six years prior to the date you ask, of the times we have shared your health information, with whom we shared it, and why.
  • We will include all disclosures except for those about treatment, payment, and health care operations, and certain other disclosures, such as any you asked us to make.  We will provide one accounting per 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 at any time, and we will promptly provide, a paper copy of this privacy notice.

Choose someone to act on your behalf

  • 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 the authority to act for you before we take any action.

File a complaint if you feel your rights are violated

  • You can make a complaint if you feel we have violated your rights. Contact our Privacy Officer using the contact information at the bottom of this page.
  • 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., S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not take any action against you for filing a complaint.


Your Choices

This section describes the times when you can tell us your choices about what we share.  If you have a clear preference in these types of situations, tell us what you want us to do and we will follow your wishes.

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 or not include your information in our hospital directory

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 to do so.

In these cases, we never share your information unless you give us written permission (authorization):

  • For marketing purposes
  • For sale of your information
  • For most sharing of psychotherapy notes

In the case of fundraising:

  • We may contact you for our fundraising efforts, but you can tell us not to contact you again for this.


Our Responsibilities

  • 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, go to:  www.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.  

This Notice of Privacy Practices is effective on September 23, 2013.

This Notice of Privacy Practices applies to Pocono Health System, Pocono Medical Center, our affiliated physician practices (PMC Physician Associates), PMC Immediate Care Centers, and all Pocono Health System employees.  It does not apply to care provided to you in your physician’s office or in the office of any other health care provider if such physician or provider is not affiliated with Pocono Health System as listed here.

Pocono Health System
206 East Brown Street
East Stroudsburg, PA  18301
570-421-4000

Privacy Officer
570-476-3534
pwatkins@poconomedicalcenter.org


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