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.
Merrimack Valley Health Services, Inc. is required to comply with this Notice of Privacy Practices. We may change its terms in the future and the revised notice will then be effective for all Protected Health Information maintained on or after that date. Our current Notice of Privacy Practices is posted on our website – www.mvhs.org. You may obtain a copy at your next appointment or you may ask our Health Information Liaison to send a copy to you.
“Protected Health
Information” is information about you, including demographic
information, that may identify you and that relates to your past, present or
future health and related health care services.
This Notice of Privacy Practices describes how Merrimack Valley Health
Services may use and disclose your Protected Health Information for
treatment, payment and health care operations.
It also discusses other purposes permitted or required by law.
Additionally, this notice describes your rights of access and control of
your Protected Health Information.
Permitted Routine Uses and Disclosures
for Treatment, Payment and Health Care Operations
Descriptions and examples of these
permitted routine uses and disclosures include:
Treatment:
We will use and disclose your Protected Health Information so that we can
provide services to you and to allow us to work with others assisting us with
your care. For example, we may
disclose your Protected Health Information to your physician to give them
information necessary to diagnose and treat your condition.
We may also disclose your Protected Health Information to others such as
pharmacy, medical record and radiology entities as necessary.
Payment: We will use your Protected Health Information so that we can obtain payment for our services. Your insurance carrier may require us to disclose your Protected Health Information before and/or after services are provided to you. This may include determination of eligibility, verification of your insurance benefits, determination of medical necessity, pre-authorization and insurance billing.
Health
Care Operations: We will use your Protected Health Information for the
effective and efficient delivery of services to you. This includes quality
assessment, employee training, support and maintenance of our equipment and
systems, organization accreditation and coordination with our business partners
and suppliers.
Specifically, we may disclose your Protected Health Information to the facility where you are obtaining your services to allow the local storage of scan films and medical records. Before your appointment, we may contact you by telephone to confirm its time and location. At the time of your appointment, you may be asked to “sign in” and we may call you by name when it is time for you to be seen.
We
may also share your Protected Health Information with third party “business
associates” that perform certain activities (e.g., billing, transcription
services, billing and collections, etc.) on our behalf.
In these instances, Merrimack Valley Health Services will have written
agreements in place to protect the privacy of your Protected Health Information.
Possible Uses and Disclosures For Which You Do Not Have an
There are also some circumstances that require Merrimack Valley Health Services to use or disclose your information. We must do so without your authorization and you will not have the opportunity to object.
General situations include:
When
Required By Law: We may use or disclose your Protected Health
Information to the limited extent required by law. You will be notified, if
required by law, of any such uses or disclosures.
To Demonstrate Our Compliance: The Department of Health and Human Services or similar regulatory agency may require us to disclose your Protected Health Information so that we can demonstrate our compliance with laws or if non-compliance is suspected.
Specific situations include:
Abuse or Neglect: Consistent with applicable federal and state laws, we may be required to provide Protected Health Information to a public health or civil authority when child abuse, neglect, or domestic violence may have occurred.
Criminal Activity: We may disclose your Protected Health Information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Law
Enforcement: We may disclose Protected Health Information for law
enforcement purposes. These purposes include 1) limited information requests for
suspect identification and location, 2) identifying victims or researching
victims of a crime, 3) suspicion of criminal conduct related to a death, 4)
investigation of a crime that occurred on our premises, and 5) when a medical
emergency has occurred off of our premises and it is likely that a crime has
been committed.
Legal Proceedings: We may disclose Protected Health Information in judicial or administrative proceedings, in response to a court order or administrative hearing (if expressly authorized), and, in certain conditions, in response to a subpoena, discovery request or other lawful process.
Public
Health: We may disclose your Protected Health Information to a
public health authority for public health activities such as controlling
disease, injury or disability.
Communicable
Diseases: We may disclose your Protected Health Information to a
person who may have been exposed to certain communicable diseases or may be at
risk of contracting or spreading the disease or condition.
Health
Oversight: We may disclose Protected Health Information to health
oversight, regulatory and accreditation agencies for purposes such as audits,
investigations, and inspections.
Food
and Drug Administration: We may disclose your Protected Health Information as
required by the Food and Drug Administration to report adverse events, product
defects or problems, biologic product deviations, track products (to enable
product recalls, repairs or replacements) or to perform oversight.
Inmates: If you are in custody, we may disclose your Protected Health Information to your correctional facility or to law enforcement related to your care, to ensure the health and safety of others related to your custody or institution, or to maintain the safety, security, law and order of the facility.
Workers’
Compensation: We may disclose your Protected Health Information to
comply with workers’ compensation laws and other similar programs.
National
Security and Military Activities: We may disclose your Protected
Health Information to federal officials authorized to conduct national security
and intelligence activities. If you
are in the Armed Forces, we may disclose Protected Health Information 1) for
activities deemed necessary by command authorities, 2) for benefits eligibility
determination by the Department of Veterans Affairs, or 3) to a foreign military
authority (if you are a member of their military services).
Specifically, you may limit:
Disclosure
to Family Members, Relatives or Personal Representatives:
Unless you limit it, we will disclose your Protected Health Information to
members of your immediate family, other relatives or your legally designated
health care decision maker. We will
limit disclosures to information directly related to their involvement in your
health care. You may prevent this
disclosure or you may seek to limit it. You
may also designate someone other than those listed
above (such as a close personal friend) to whom we may disclose your Protected
Health Information.
If you are physically unable to express your objection or limitation, we will proceed as noted above if we believe that doing so is in your best interest. If a family member, relative or personal representative is not present, we may use your Protected Health Information to identify a representative. In the case of emergencies and disasters, we may disclose your Protected Health Information to authorized entities assisting in response and relief efforts.
In situations not covered above, use or
disclosure of your Protected Health Information will occur only with your
written authorization. These cases include requests you make to Merrimack Valley
Health Services as well as those we may receive from third parties.
For example, you may request that we disclose some or all of your
Protected Health Information to an attorney, consultant or personal
acquaintance. Similarly, Merrimack
Valley Health Services may receive a request form a third party to disclose your
Protected Health Information.
Regardless, if the use or disclosure is
not required or permitted by law, it will be made only after Merrimack Valley
Health Services has received your written authorization.
You may later revoke your authorization, in writing, if you change your
mind.
2. Your Rights
These are your privacy rights and
how you can exercise them:
You
have the right to obtain a printed copy of this notice. You may obtain
a copy of this notice at the time of your appointment or you may contact our
Health Information Liaison at any time to request that a copy be sent to you.
You
have the right to inspect and copy your Protected Health Information. You
may review and receive a copy of your Protected Health Information contained in
our Designated Record Set for as long as we maintain the records. A
“Designated Record Set” contains medical, billing and any other records that
Merrimack Valley Health Services uses for making clinical and financial
decisions about you.
Requests
to inspect or obtain your records must be submitted in writing to our Health
Information Liaison. In some cases,
laws may restrict access to information and we may be required to deny access.
If your request is denied, you may have the right to have our decision
reviewed.
You
have the right to request that we amend your Protected Health Information. Should you disagree with any
Protected Heath Information maintained in our Designated Record Set, you may
request, in writing to our Health Information Liaison, that we change it for as
long as we maintain it. Merrimack Valley Health Services is not required to make
the changes. If your request is
denied, you have the right to file a statement of disagreement with us and we
may prepare a rebuttal. You will be
provided with a copy of any rebuttal and copies of related correspondence will
be included with your Protected Health Information.
You
have the right to request how we provide confidential communications to you. You may request special handling
for communication of confidential matters. All
such requests must be submitted in writing to our Health Information Liaison.
Merrimack Valley Health Services will accommodate reasonable requests and
we will not require you to provide a reason or explanation for your request.
We may, as a condition for our agreement, require you to provide
additional contact information or other assurances regarding payment of your
health care charges.
You
have the right to request a restrictions relating to your Protected Health
Information.
You may request restrictions on the use or disclosure of Protected Health
Information. Requests must be in
writing and specify 1) the specific restriction requested and 2) to whom you
wish it to apply. Before and at your
appointment, you may make the request to any Merrimack Valley Health Services
employee you contact. After your
appointment, restriction requests must be forwarded to our Health Information
Liaison.
Merrimack
Valley Health Services is not required to agree to restriction requests.
If we agree to the restriction, we will not use or disclose your
Protected Health Information in violation of the restriction unless it is
necessary to provide emergency treatment to you.
The restriction will take effect after it has been approved.
You
have the right to receive an accounting of certain disclosures we have made, if
any, of your Protected Health Information.
Your request must be submitted in writing to the Health Information Liaison.
The accounting excludes disclosures for treatment, payment or health care
operations as described in this notice. It also excludes disclosures we may have
made to you, your family members or designated representatives.
Other exceptions, restrictions and limitations may also apply.
The accounting will include those disclosures made after
3. Complaints
If you believe that your privacy rights
have been violated, you may file a complaint with either Merrimack Valley Health
Services or with the Secretary of Health and Human Services. Merrimack Valley
Health Services supports your right to file a complaint and will not take any
adverse action against you for doing so.
To
file a compliant with Merrimack Valley Health Services or for additional
information about the complaint process, contact the Merrimack Valley Health
Services Health Information Liaison at (714) 688-3854 or via
email sent to privacy@allianceimaging.com.
To
file a complaint with the Secretary of Health and Human Services, contact:
Office
for Civil Rights
Department of Health and Human Services
This notice is published and
effective on