|
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
We are required by law to maintain the privacy of protected health information and to provide you with a notice of our
legal duties and privacy practices with respect to protected health information and to abide by the terms of the notice
currently in effect. If you have any questions about this Notice, please call the Valley Health Privacy Officer at (540) 536-
8993 or write to: Valley Health, Attention: Nancy Merritt, System Support Bldg, Suite 402, 220 Campus Blvd, Winchester
VA, 22601.
Effective Date: April 1, 2006
______________________________________________________________________________________
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical
information about you to doctors, nurses, technicians, students, or other personnel who are involved in taking care of you. For example, a doctor
treating you for a broken hip may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may
need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. We also may disclose medical information about you
to people outside Valley Health who may be involved in providing services that are part of your medical care, such as doctors, nurses, therapists,
home health agencies, nursing homes and medical equipment providers.
For Payment. We may use and disclose medical information about you so that the treatment and services you receive from Valley Health may
be billed to and payment collected from you, an insurance company, or a third party. For example, we may need to give your health plan
information about treatment you received at one of our hospitals so your health plan will pay us or reimburse you for the treatment. We may also
tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the
treatment. We also may disclose information about you to another health care provider, such as a hospital or nursing home, for their payment
activities concerning you.
For Healthcare Operations. We may use and disclose medical information about you for Valley Health operations. These uses and disclosures
are necessary to run the organization and make sure that all of our patients receive quality care. For example, we may use medical information to
review our treatment and services and to evaluate the performance of our staff in caring for you. We may also disclose information to doctors,
nurses, technicians, students, and others for review and learning purposes. We also may disclose information about you for the health care
operations of another provider or organization if you have also received care from them.
Appointment Reminders. We may contact you to provide appointment reminders.
Treatment Alternatives. We may use and disclose medical information to tell you about, or recommend, possible treatment options or
alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that
may be of interest to you.
Fundraising Activities. We may use medical information about you to contact you in an effort to raise money for Valley Health, its operations,
and community services provided by Valley Health. We may disclose medical information to a business partner or a foundation related to Valley
Health so that the business partner or foundation may contact you in raising money for Valley Health or one of its entities. If you do not want to
be contacted for fundraising efforts, you must notify our Privacy Officer in writing.
Patient Directory. Unless you tell us otherwise, we may include certain limited information about you in a patient directory while you are a
patient with Valley Health. This information may include your name, location in the hospital, your general condition (e.g., fair good, 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 rabbi, even if they don’t ask for you by name. If
you do not want anyone to know this information about you, if you want to limit the amount of information that is disclosed, or if you want to
limit who gets this information, you must either notify the person who is registering you as a patient or notify our Privacy Officer in writing.
Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to a friend or family member
who is involved in your medical care or to a personal representative. This would include persons named in any durable power of attorney or
similar document provided to us. We may also give information to someone who helps pay for your care. In addition, we may disclose medical
information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
You can object to these releases by telling us that you do not wish any or all individuals involved in your care to receive this information. We
may use our professional judgment to decide whether it is in your best interest to release relevant information to someone who is involved in
your care or to an entity assisting in a disaster relief effort.
Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research
project may involve comparing the health and recovery of all patients who received one medication to those who received another for the same
condition. Before we use or disclose medical information for a research project, the project will have been approved through a special research
approval process. We may disclose medical information about you to people preparing to conduct a research project, for example, to help them
look for patients with specific medical needs, so long as the medical information they review does not leave the premises.
As Required By Law. We will disclose medical information about you when required to do so by federal, state, or local law.
To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious
threat to your health and safety or the health and safety of the public or another person.
Organ and Tissue Donation. If you are an organ donor, we may release medical 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.
Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military
command authorities. We may use and disclose to components of the Department of Veterans Affairs medical information about you to
determine whether you are eligible for certain benefits.
Workers’ Compensation. We may release medical information about you as authorized by Workers’ Compensation laws or similar regulations.
Public Health Activities. We may disclose medical information about you for public health activities. These activities generally include the
following: to prevent or control disease, injury, or disability; to report deaths; to report reactions to medications or problems with products; to
notify people of recalls of products they may be using or, to notify the appropriate government authority if we believe a patient has been the
victim of abuse, neglect, or domestic violence.
Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These
oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to
monitor the healthcare system, government programs, and compliance with civil rights laws.
Legal Proceedings. We may disclose medical information about you in response to a valid court or administrative order. We may also disclose
medical information about you in response to a subpoena, discovery request, or other lawful process.
Law Enforcement. We may release medical information if asked to do so by a law enforcement official: in response to a valid court order,
subpoena, warrant, summons, similar process or with your consent; 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 within Valley
Health; 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 release medical information to a coroner or medical examiner. We may also
release medical information about deceased patients of the hospital to funeral directors as necessary to carry out their duties upon the request of
the patient’s family.
National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence,
counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others. We may disclose medical information about you to authorized federal officials so they may
provide protection to the President, other authorized persons, or foreign heads of state, or conduct special investigations.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical
information about you to the correctional institution or law enforcement official.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care.
Usually, this includes medical and billing records, but does not include psychotherapy notes and other mental health records under certain
circumstances. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing
to the appropriate medical records or billing office. 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. If you agree, we may provide you with a summary of the information instead of
providing you with access to it, or provide you with an explanation of the information instead of a copy. Before providing you with a summary
or explanation, we first will obtain your agreement to pay the fees, if any, for preparing the summary or explanation. We may deny your request
to inspect and copy medical information in certain circumstances. If you are denied access to medical information, you may request that the
denial be reviewed.
Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information.
You have the right to request an amendment for as long as the information is kept by or for Valley Health. To request an amendment, your
request must be made in writing and submitted to the appropriate medical records or billing department. 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 medical information kept by or for Valley Health; 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 an accounting of disclosures. This is a list of the disclosures we made of
medical information about you other than disclosures made to you, disclosures which you authorized, disclosures for treatment, payment or
operations, or certain disclosures required by law. To request this list or accounting of disclosures, you must submit your request in writing to
the appropriate medical records department. Your request must state a time period that may not be longer than six years and may not include
dates before April 14, 2003. Your request should indicate in what form you want the list (for example: on paper, electronically). The first list
you request within a 12-month period will be free. For additional lists, we may charge you for providing the list. We will notify you of the
charge involved, and you may choose to withdraw or modify your request at that time before any charges are incurred.
Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you
for treatment, payment, or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to
someone who is involved in your care or the payment for your care, like a family member or friend. 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 to the appropriate medical records or billing office. 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, for
example, disclosures to your spouse.
Right to Confidential Communications. You have the right to request to receive communications from us on a confidential basis by using
alternative means for receipt of information or by receiving the information at alternative locations. For example, you can ask that we only
contact you at work or by mail, or at another mailing address, besides your home address. We must accommodate your request, if it is
reasonable. You are not required to provide us with an explanation as to the basis of your request. Contact our Privacy Officer or the appropriate
medical records or billing office if you require such confidential communications.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice and may ask us to give you a copy of this Notice at any
time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. To obtain a paper copy of
this Notice, request a copy from the person who is registering you as a patient, or submit a request in writing to our Privacy Officer.
CHANGES TO THIS NOTICE
We reserve the right to change this Notice. We reserve the right to make the revised Notice effective for medical 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 at our locations. The Notice will
contain on the first page, in the top right-hand corner, the effective date. A paper or electronic copy of the revised Notice will be available upon
request on or after the effective date of the revision.
OTHER USES AND DISCLOSURES OF MEDICAL INFORMATION
Other uses and disclosures not covered by this Notice may be made with your written authorization. If you provide us authorization to use or
disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no
longer use or disclose medical information about you for the reasons covered by the authorization. You understand that we cannot recall any
disclosures we have already made with your authorization and that we are required to retain our records of the care that we provided to you.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the Secretary of the Department of Health and Human
Services or our Privacy Officer. All complaints must be submitted in writing. You will not be retaliated against for filing a complaint.
APPLICABILITY
This Notice applies to the records of your care owned by the entities and departments of Valley Health listed in the Contact Information below,
whether made by Valley Health personnel, contractors, or your personal doctor. Your personal doctor may have different policies or notices
regarding the doctor’s use and disclosure of medical information owned by your doctor.
CONTACT INFORMATION
Service Provider
|
Medical Records Department
|
Billing Office
|
| Lynn Care Center |
Attn: Medical Records
1000 N. Shenandoah Ave.
Front Royal, VA 22630
(540) 636-0606 |
Attn: Business Office
1000 N. Shenandoah Ave
Front Royal, VA 22630
(540) 636-0326 |
Physician Offices:
Mt. View Orthopedics
Mt. Jackson Family
Health
Shenandoah Women’s
Care |
Physician Office Manager
c/o Shenandoah Memorial
Hospital
759 South Main St.
Woodstock, VA 22664
(540) 459-1100 |
Physician Office
Manager c/o Shenandoah
Memorial Hospital
759 South Main St.
Woodstock, VA 22664
(540) 459-1100 |
Shenandoah Memorial
Hospital |
Attn: Health Information
Management
759 South Main Street
Woodstock, VA 22664
(540) 459-1195 |
Attn: Patient Accounts
System Support Bldg.
Suite 210
220 Campus Blvd.
Winchester, VA 22601
(540) 536-7654 |
Surgi-Center of
Winchester |
Attn: Medical Records
1860 Amherst St.
Winchester, VA 22601
(540) 536-8934 |
Attn: Patient Accounts
System Support Bldg.
Suite 210
220 Campus Blvd.
Winchester, VA 22601
(540) 536-7654 |
| Urgent Care Center |
Attn: Medical Records
607 E. Jubal Early Dr.
Winchester, VA 22601
(540) 536-2231 |
Attn: Patient Accounts
System Support Bldg.
Suite 210
220 Campus Blvd.
Winchester, VA 22601
(540) 536-7654 |
Valley Home Care:
Winchester
Front Royal
Woodstock |
Attn: Billing Dept.
System Support Bldg.
Suite 200
220 Campus Blvd.
Winchester, VA. 22601
(540) 536-5229 |
System Support Bldg.
Suite 200
220 Campus Blvd.
Winchester, VA 22601
(540) 536-5229 |
| Valley Medical Transport |
Attn: Billing Dept.
System Support Bldg.
Suite 200
220 Campus Blvd.
Winchester, VA 22601
(540) 536-5422 |
System Support Bldg.
Suite 200
220 Campus Blvd.
Winchester, VA 22601
(540) 536-5422 |
| Valley Pharmacy |
190 Campus Blvd.
Winchester, VA 22601
(540) 536-8899 |
190 Campus Blvd.
Winchester, VA 22601
(540)536-8899 |
Warren Memorial
Hospital |
Attn: Health Information
Management
1000 N. Shenandoah Ave.
Front Royal, VA 22630
(540) 636-0419 |
Attn: Patient Accounts
System Support Bldg.
Suite 210
220 Campus Blvd.
Winchester, VA 22601
(540) 636-0326 |
Winchester Medical
Center |
Attn: Health Information
Management
Release of Information
P.O. Box 3317
Winchester, VA 22604
(540) 536-8080 |
Attn: Patient Accounts
System Support Bldg.
Suite 210
220 Campus Blvd.
Winchester, VA 22601
(540) 536-7654 |
Winchester Medical
Center Home Health |
WMC Home Health.
333 Cork St.
Suite 135
Winchester, VA 22601
(540) 536-5200 |
WMC Home Health
333 Cork St.
Winchester, VA 22601
(540) 536-5200 |
Winchester
Rehabilitation Center |
Attn: Medical Records
Release of Information
1840 Amherst St.
Winchester, VA 22601
(540) 536-8080 |
Attn: Patient Accounts
System Support Bldg.
Suite 210
220 Campus Blvd.
Winchester, VA 22601
(540) 536-7654 |
PRIVACY OFFICER
Telephone: (540) 536-8993
Address: Valley Health , Attention: Nancy Merritt, System Support Bldg. Suite 402, 220 Campus Blvd., Winchester, VA, 22601 |