Detailed Notice of Privacy Practices

THIS DETAILED 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.

Halifax Regional Hospital
Privacy Officer
2204 Wilborn Avenue
South Boston, VA 24592
(434) 517-3100

The Woodview and Seasons at The Woodview
Privacy Officer
103 Rosehill Drive
South Boston, VA 24592
(434) 572-4906

MeadowView Terrace
Privacy Officer
184 Buffalo Road
Clarksville, VA 23927
(434) 374-4141

KINDS OF INFORMATION THAT THIS NOTICE APPLIES TO
This notice applies to any information in our possession that would allow someone to identify you and learn something about your health or health care or payment for your health care. It does not apply to general health information that could reasonably be used to identify you.

WHO MUST ABIDE BY THIS NOTICE
Halifax Regional Health System

• Halifax Regional Hospital
• The Woodview
• MeadowView Terrace
• All members of the HRHS Medical staff
• All employees, staff, students, volunteers and other personnel whose work is under the direct control of HRHS.

The people and organizations to which this notice applies (referred to as “we,” “our,” and “us”) have agreed to abide by its terms. We may share your information with each other for purposes of treatment and, as necessary, for payment and operations activities as described below.

This notice applies to services you receive in HRHS facilities, including services from physicians who are not employed by HRHS. If you also receive services from any of these physicians in their own offices, they may give you their own version of the Notice of Privacy Practices.

OUR LEGAL DUTIES

• We are required by law to maintain the privacy of your health information
• We are required to provide this notice of our privacy practices and legal duties regarding health information to anyone who asks for it.
• We are required to abide by the terms of this notice until we officially adopt a new notice.

HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION.
We may use your health information or disclose it to others for a number of different reasons. This notice describes these reasons. For each reason, we have written a brief explanation and provide some examples. These examples do not include all of the specific ways we may use or disclose your information, but any time we use your information or disclose it to someone else, it will fit one of the reasons listed here.

1. Treatment. We will use your health information to provide you with medical care and services. This means that our employees, staff, students, volunteers, and others whose work is under our direct control, may read your health information to learn about your medical condition and use it to make decisions about your care. For instance, a hospital nurse may read your medical chart in order to care for you properly. We will also disclose your information to others who need it in order to provide you with medical treatment or services. For instance, we may send your doctor the results of laboratory tests we perform.
2. Payment. We will use your health information and disclose it to others, as necessary, to obtain payment for the services we provide to you. For instance, an employee in our business office may use your health information to prepare a bill, and we may send that bill and any health information it contains, to your insurance company. We may also disclose some of your health information to companies with whom we contract for payment-related services. For instance, we may give information about you to a collection company that we contract with to collect bills for us. We will not use or disclose more information for payment purposes than is necessary.
3. Health Care Operations. We may use your health information for activities that are necessary to operate HRHS. This includes reading your health information and the information of other patients/residents to plan what services we need to provide, expand or reduce. We may disclose your health information as necessary to others who we contract with to provide administrative services. This includes our lawyers, auditors, accreditation services, and consultants, for instance.
4. Legal Requirement to Disclose Information. We will disclose your information when we are required by law to do so. This includes reporting information to government agencies that have the legal responsibility to monitor the health care system. . We will also disclose your health information when we are required to do so by a court order or other judicial or administrative process.
5. Public Health Activities. We will disclose your health information when required to do so for public health purposes. This includes reporting births, deaths, certain diseases and reactions to certain medications. It may also include notifying people who have been exposed to a disease.
6. To Report Abuse. We may disclose your health information when the information relates to a victim of abuse, neglect or domestic violence. We will make this report only in accordance with laws that require or allow such reporting, or with your permission.
7. Law Enforcement. We may disclose your health information for law enforcement purposes. This includes providing information to help locate a suspect, fugitive, material witness or missing person, or in connection with suspected criminal activity. We must also disclose your health information to a federal agency investigating our compliance with federal privacy regulations.
8. Specialized Purposes. We may disclose the health information of members of the armed forces as authorized by military command authorities. We may disclose your health information for a number of other specialized purposes. We will only disclose as much information as is necessary for the purpose. For instance, we may disclose your information to coroners, medical examiners and funeral directors; to organ procurement organizations (for organ, eye or tissue donation); or for national security, intelligence, and protection of the president. We also may disclose health information about an inmate to a correctional institution or to law enforcement officials, to provide the inmate with health care, to protect the health and safety of the inmate and others, and for the safety, administration, and maintenance of the correctional institution. We may also disclose your health information to your employer for purposes of workers’ compensation and work site safety laws (OSHA, for instance).
9. 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. The disclosure will only be made to someone who is able to prevent or reduce the threat.
10. Family and Friends. We may disclose your health information to a member of your family or to someone else who is involved in your medical care or payment for care. We may notify family or friends if you are in the hospital and tell them your general condition. In the event of a disaster, we may provide information about you to a disaster relief organization so they can notify your family of your condition and location. We will not disclose your information to family or friends if you object.
11. Facility Directory (Patient Inquiry). We may list you in our directory if you are admitted to the hospital. The directory listing includes name, general condition, and location in the hospital. We will disclose the information in the directory only to visitors who ask for you by name. To members of the clergy only, we will also reveal such information as you disclose to us respecting your religious affiliation, if any. If you ask, we will not list you in the directory, or we will omit any information you ask us to omit.
12. Research. We may disclose your health information in connection with medical research projects. Federal rules govern any disclosure of your health information for research purposes without your authorization.
13. Information to Patients/Residents. We may use your health information to provide you with additional information. This may include sending appointment reminders to your address or leaving messages on your answering machine. This may also include giving you information about treatment options or other health-related services that we provide.
14. Fund Raising. We may use your information to contact you to ask for donations to HRHS. We may disclose your information to a related foundation for the same purpose.

If you do not want us to do this, contact the person listed under “Whom to Contact” at the end of this notice.

YOUR RIGHTS

1. Authorization. We will not use or disclose your health information for any purpose that is not listed in this notice without your written authorization. If you authorize us to use or disclose your health information, you have the right to revoke the authorization at any time. For information about how to authorize us to use or disclose your health information, or about how to revoke an authorization, contact the person listed under “Whom to Contact” at the end of this notice. You may not revoke an authorization for us to use and disclose your information to the extent that we have taken action in reliance on the authorization. If the authorization is to permit disclosure of your information to an insurance company as a condition of obtaining coverage, the law may allow the insurer to continue to use your information to contest claims or your coverage, even after you have revoked the authorization.
2. Request Restrictions. You have the right to ask us to restrict how we use or disclose your health information. We will consider your request, but we are not required to agree. We will not refuse reasonable requests. If we do agree, we will comply with the request unless the information is needed to provide you with emergency treatment. We cannot agree to restrict disclosures that are required by law.
3. Confidential Communication. You have the right to ask us to communicate with you at a special address or by a special means. For example, you may ask us to send mail to a different address rather than to your home. Or you may ask us to speak to you personally on the telephone rather than sending your health information by mail. We will not ask you to explain why you are making the request. We will agree to any reasonable request.
4. Inspect And Receive a Copy of Health Information. You have a right to inspect and receive a copy of the health information about you that we have in our records. This right is limited to information about you kept in records used to make decisions about your care. For instance, this includes medical and billing records. If you want to review or receive a copy of these records, you must make the request in writing. We may charge a fee for the cost of copying and mailing the records. To ask to inspect your records, or to receive a copy, contact the person listed under “Whom to Contact” at the end of this notice. We will respond to your request within 15 days. We may deny you access to certain information. If we do, we will give you the reason in writing. We will also explain how you may appeal such a decision.
5. Amend Health Information. You have the right to ask us to amend health information about you that you believe is not correct or not complete. You must make this request in writing, and give us the reason you believe the information is not correct or complete. We will respond to your request in writing within 30 days. We may deny your request if we did not create the information, if it is not part of the records we use to make decisions about you, if the information is something you would not be permitted to inspect or copy, or if it is complete and accurate as it stands.
6. Accounting of Disclosures. You have a right to receive an accounting of certain disclosures of your information to others. This accounting will list the times we have given your health information to others. The list will include dates of the disclosures, the names of the people or organizations to whom the information was disclosed, a description of the information and the reason. We will provide the first list of disclosures you request at no charge. We may charge you for any additional lists you request during the following 12 months. You must tell us the time period you want the list to cover. You may not request a time period longer than six years. We cannot include disclosures made before April 14, 2003. Disclosures for the following reasons will not be included on the list: disclosures for treatment, payment, health care operations, disclosures of information in a facility directory, disclosures for national security purposes, disclosures to correctional or law enforcement personnel, disclosures that you have authorized and disclosures made directly to you.
7. Paper Copy of this Privacy Notice. You have a right to receive a paper copy this notice upon request. If you have received this notice electronically, you may receive a paper copy by contacting the person listed under “Whom to Contact” at the end of this notice.
8. Complaints. You have a right to complain about our privacy practices if you think your privacy has been violated. You may file your complaint with the person listed under “Whom to Contact” at the end of this notice. You may also file a complaint directly with the Secretary of the U. S. Department of Health and Human Services, at the Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington, D.C. 20201. All complaints must be in writing. We will not retaliate against you if you file a complaint.

OUR RIGHT TO CHANGE THIS NOTICE
We reserve the right to change our privacy practices, as described in this notice, at any time. We reserve the right to apply these changes to any health information that we already have, as well as to health information we receive in the future. Before we make any change in the privacy practices described in this notice, we will write a new notice that includes the change. We will post the new notice in the main lobby or designated area of each hospital and long-term home facility, and on the HRHS website. The new notice will include an effective date. You will be entitled upon request to a paper copy of any such amended notice.

WHOM TO CONTACT.
Contact the Privacy Officer listed on the first page of this document:

• For more information about this notice, or
• For more information about our privacy policies, or
• If you want to exercise any of your rights, as listed on this notice, or
• If you want to request a copy of our current notice of privacy practices.