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|PENOBSCOT VALLEY HOSPITAL NOTICE OF PRIVACY PRACTICES
JANUARY 1, 2013
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION
ABOUT YOU MAY BE DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION
Click here to download as a pdf.
TYPES OF USES AND DISCLOSURES OF MEDICAL INFORMATION
- Appointment Reminders
- Birth Announcements
- Fund-raising Activities
- Inmates Law
- Enforcement News Media
- Public Health Risks
- Public Record As Required by Law
- Coroner/Medical Examiner
- Funeral Directors Laws and Disputes
- Military & Veterans Organ and Tissue Donation Public Interest
- Research Workers’ Compensation
- Health Oversight Activities as Required by Law
- Health-Related Benefits & Services
- Individuals Involved in Your Care or Payment of Care
- National Security & Intelligence Activities
- To Alert Serious Threat to Health or Public Safety
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us
will be made only with your written permission. If you provide us permission to use or disclose medical
information about you, you may revoke that permission, in writing, at any time. If you revoke permission,
we will no longer use or disclose medical information about you for the reasons covered by your written
YOUR RIGHTS REGARDING INFORMATION WE MAINTAIN ABOUT YOU
*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 the hospital. Your request to amend your medical information
must be in writing.
*RIGHT TO INSPECT & 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. To inspect and copy medical information that may be used to make
decisions about you, you must submit your request in writing. Your request may be denied in certain very
limited circumstances. If you are denied access to medical information, you may request that the denial be
reviewed. Another licensed healthcare professional chosen by the hospital will review your request and the
denial. The person conducting the review will not be the person who denied your request. We will comply
with the outcome of the review.
*RIGHT TO AN ACCOUNTING OF DISCLOSURES: You have the right to an “accounting of
disclosures.” This is a list of the disclosures we made of medical information about you. To request this
list or accounting of disclosures, you must submit your request in writing.
*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 with emergency care).
*RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS: You have the right to request
that we communicate with you about medical matters in a certain way or at a certain location.
*RIGHT TO A PAPER COPY OF THIS NOTICE: You have the right to a paper copy of this
Notice in its entirety. You may ask us to give you a copy of the full Notice including specific disclosure
examples at any time. You may also obtain a copy of this Notice on our website: www.pvhme.org.
*RIGHT TO FILE A COMPLAINT: If you believe your privacy rights have been violated, you may
file a complaint with the Secretary of the Department of Health & Human Services. To file a complaint
with the Hospital, contact the Privacy Officer. All complaints must be submitted in writing. You will not
be penalized for filing a complaint.
*HOW WE MAY USE OR DISCLOSE MEDICAL INFORMATION ABOUT YOU: The
following categories describe different ways we may use and disclose medical information. Not every use
or disclosure in the category will be listed. However, all the ways we are permitted to use or disclose
information will fall into one of these categories:
We may use medical information about you for medical treatment or services. We
may disclose medical information about you to physicians, mid-level providers, nurses, technicians,
medical students, or other Hospital personnel who are involved in taking care of you in the Hospital.
We may use and disclose medical information about you so that the treatment and
services you receive at the Hospital may be billed and payment may be collected from you, an insurance
company, or a third party.
FOR HEALTH CARE OPERATIONS:
We may use and disclose medical information about you for
Hospital operations. These uses and disclosures are necessary to run the Hospital and make sure that all
our patients receive quality care.
FOR HEALTH INFONET:
Penobscot Valley Hospital participates in the statewide health
information exchange (HIE) designated by the State of Maine. The HIE is a secure computer system
for health care providers to share your important health information to support treatment and
continuity of care. For example, if you are admitted to a healthcare facility not affiliated with ours,
health care providers there will be able to see important health information held in our electronic
medical record systems.
Your record in the HIE includes medicines (prescriptions) lab and test results, imaging reports,
conditions, diagnoses or health problems. To ensure your health information is entered into the
correct record, also included are identifiers such as your full name, birth date and social security
number. All information contained in the HIE is kept private and used in accordance with
applicable state and federal laws and regulations. The information is accessible to participating
providers to support treatment and healthcare operations such as mandated disease reporting to the
Maine Centers for Disease Control and Protection.
You do not have to participate in the HIE to receive care. For more information about and your
choices regarding participation, visit www.hinfonet.org or call toll-free 1-866-592-4352.
*CHANGES TO THIS NOTICE: We reserve the right to change this Notice. We also reserve the right
to make the revised or changed 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 in the Hospital with
the current effective dates.
*WHO WILL FOLLOW THIS NOTICE: This Notice describes our Hospital’s practices and that of
*Any healthcare professional authorized to enter information into your hospital chart
*All departments and units of the Hospital
*Any member of a volunteer group we allow to help you while you are in the hospital
*All employees, hospital-based physician practices, staff, and other hospital personnel.
*All owned subsidiary practices of Penobscot Valley Hospital will follow this Notice.
All these entities, sites, and locations may share information with each other for treatment,
payment or healthcare operations purposes described in this Notice.
*OUR PLEDGE REGARDING INFORMATION: We understand that medical information about
you and your health is personal. We are committed to protecting your information. We create a record of
care and services you receive at the Hospital. We need this record to provide you with quality care and to
comply with certain legal requirements. This Notice applies to all of the records your care generated by the
Hospital, whether made by Hospital personnel or your personal physician. Your personal physician may
have different policies and notices regarding the use and disclosure of your medical information created in
his/her office or clinic.
*WE ARE REQUIRED BY LAW: * To make sure that medical information that identifies you is kept
private; * To give you this Notice of our legal duties and privacy practices with respect to medical
information about you; and * To follow the terms of the Notice that is currently in effect.
IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT THE HEALTH
INFORMATION MANAGEMENT DEPARTMENT, P.O. BOX 368, 7 TRANSALPINE ROAD,
LINCOLN, MAINE 04457 TELEPHONE NUMBER: (207) 794-3321 – EXT. 139