THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED (SHARED) AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

SACRED HEART HEALTHCARE SYSTEM HAS A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI).
Sacred Heart Hospital, and all employees, volunteers, staff, doctors, health professionals and other personnel are legally required to follow the policies in this notice.

PHI includes information that can be used to identify you. We collect or receive this information about your past, present or future health or condition, to provide health care to you, or to receive payment for this health care. We must provide you with this notice that explains how, when and why we use and share your PHI.

WE MAY USE AND SHARE YOUR PROTECTED HEALTH INFORMATION for many different reasons. Below, we describe the different categories of when we use and share your PHI. We give you some examples of each category. All of the ways we are permitted to use and share information will fall within one of the categories.

• For treatment. We may share your PHI with physicians, nurses, medical students, and other health care personnel and agencies that provide or are involved in your health care. For example, if you are being treated for a knee injury, we may share your PHI with our physical medicine department who will treat you.

• To obtain payment for treatment. We may use and share your PHI in order to bill and collect payment for services we provide to you. It is important that you provide us with correct and up-to-date PHI. We may share portions of your PHI with our billing department and your health plan to get paid for the health care services we provided to you.

• To run our health care business. We may share your PHI in order to run our facility according to healthcare regulations. We may use your PHI to review the quality of our services and to measure the performance of our staff in caring for you.

• To business associates. There are some services such as trash removal that we contract with business associates. We may share your information with them. However, we require our business associates to protect your PHI through contracted agreements.

• When government or law enforcement agencies request your PHI. We share your PHI when a law or law enforcement agency requires that we report information about victims of abuse, neglect, domestic violence or in response to a court order, subpoena, warrant, summons or similar request.

• For public health activities. We report information about births, deaths, and various diseases to government officials and agencies such as the CDC and FDA. We provide coroners, medical examiners and funeral directors with necessary information relating to an individual’s death.

• For Military and Veterans. We may share your information as required by military command authorities. We may also share PHI about foreign military personnel with the appropriate foreign military authority.

• For National and Intelligence Activities. We may share your PHI with authorized federal officials for lawful intelligence, counterintelligence and other national security activities authorized by law.

• For Protective Services for the President and others. We may share your PHI with authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or for the conduct of special investigations.

• For purposes of organ donation. For patients that have previously agreed to organ donation, we may notify appropriate organizations to assist them in organ, eye or tissue donation and transplants.

• For worker’s compensation purposes. We share your PHI in order to meet worker’s compensation laws. If you do not want worker’s compensation notified, you must give other insurance or payment information.

• For appointment reminders and health-related benefits and services. We may use your name, address, phone number to contact you as a reminder that you have an appointment.

• For fundraising activities. We may use your name and address to mail information about our fundraising activities to you. The money raised through these activities is used to expand health care services and educational programs that we provide to the community. If you do not wish to be contacted, please contact the person listed at the end of this notice.

• For research. We may share your PHI with Sacred Heart Hospital (SHH) researchers only when our Institutional Review Board (IRB) has approved the research. Your PHI may be shared with SHH researchers as they prepare to conduct their research to help them look for patients with specific needs. Your PHI will not leave SHH property. We will ask for your specific permission to be included in any such research.

• To inmates of a correctional institution or those under the custody of law enforcement officials. We may release your demographic PHI such as name, address and phone number to the correctional institution or law enforcement official when necessary.

• Patient Directories. Unless you object, we may include your name, location in our facilities and religion in our patient directory. This information is shared with clergy and visitors who ask for you by name. Your choice to object may be made at any time.

• Information shared with family, friends or others. Unless you object, we may share your PHI with a family member, friend, or other person that you indicate is involved in your care or the payment for your health care. Your choice to object may be made at any time.

B. Your Prior Written Consent Is Required in All Other Situations. In any other situation not described in the section above, we will ask for your specific written consent before using or sharing any of your PHI. If you choose to sign a specific consent to share your PHI, you can later cancel that consent in writing. This will stop any future sharing of your PHI. You should understand that we are unable to take back any disclosures we have already made with your permission and that we are required to retain our records of the care that we provided to you.

RIGHTS YOU HAVE REGARDING YOUR PHI

A. You Have the Right to Request Limits on How We Use and Share Your PHI. If we accept your request, we will put any limits in writing and follow them except in emergency situations. You may not limit PHI that we are legally required or allowed to share.

B. You Have the Right to Choose How We Communicate PHI to You. All of our communications to you are considered confidential. You have the right to ask and we will send information to you at another address (for example, work instead of home) or by other means such as e-mail instead of regular mail. You will be billed for any additional costs.

C. You Have the Right to See and Get Copies of Your PHI. But you must make this request in writing. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing, why we denied your request. You have the right to have the denial reviewed. We will choose another licensed healthcare professional to review your request and the denial. The person doing the review will not be the person who denied your first request. You can request a summary or a copy of the entire medical record as long as you agree to the cost in advance. If your request to see the medical information is approved, we will arrange this according to current hospital policy.

D. You Have the Right to Get a List of When and to Whom We Have Shared Your PHI. This list will not include uses to which you have already consented. This list will not include uses made for national security purposes, to corrections or law enforcement personnel, or before April 15, 2003. We will respond within 60 days of receiving your request. The list we will give you will include the last six years of activity. You may request a shorter time. The list will include dates when your PHI was shared and why, with whom your PHI was shared (including their address if known), and a description of the information shared. The first list you request within a 12-month period will be free. You will be charged our cost for additional lists within that time frame.

F. You have the Right to Get This Privacy Notice by e-mail. Even if you have agreed to receive notice via e-mail, you also have the right to request a paper copy of this notice.

G. Please submit all requests for information in writing to:

Medical Records Director
Sacred Heart Hospital
421 Chew Street
Allentown, PA 18102

CHANGES TO THIS NOTICE
We may change the terms of this notice and our privacy policies at any time. Any changes to this notice will apply to the PHI that we already have. Before we make any change to our policies, we will promptly change this notice and post a new notice in our lobby. You may request a copy of this notice from the contact person listed at the end of this notice at any time. You may view a copy of the notice on our Web site at www.shh.org.

HOW TO VOICE YOUR CONCERNS ABOUT OUR PRIVACY PRACTICES. If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may send a written complaint to the person listed at the end of this notice. You may also send a written complaint to the Secretary of the Department of Health and Human Services

You will not be penalized for filing a complaint.

PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO VOICE YOUR CONCERNS ABOUT OUR PRIVACY PRACTICES
HIPAA Privacy Officer
c/o Sacred Heart Healthcare System
421 Chew Street
Allentown, PA 18102-3490
610-776-4981

EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on April 15, 2003.