Monongahela Valley Association of Health Centers, Inc. (MVA)
Including MVA Fairmont Clinic, MVA Shinnston Medical Center, MVA Home Health Service, MVA North Marion Campus Wellness Center, MVA East Fairmont High School Wellness Center
Notice of Privacy Practices
Effective Date: September 16, 2013
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Monongahela Association of Health Centers, Inc.(MVA) is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices and your privacy with respect to this information. The purpose of this notice is to provide you with that information.
Any information that is about your health, the healthcare you receive, or payment for that care is considered confidential and is protected by MVA. MVA is required to abide by the terms of this notice that is currently in effect at the time your medical information is used or disclosed.
We reserve the right to change the terms of this notice and to make the new notice provisions effective for all medical information we maintain. If we change our privacy practices, we will have them available upon request. We will post a copy of the current notice in all MVA facilities.
MVA MAY USE YOUR MEDICAL INFORMATION FOR PURPOSES OF
TREATMENT, PAYMENT AND HEALTHCARE OPERATIONS.
For Treatment: We may provide medical information about you to healthcare providers, other MVA personnel, or third parties who are involved in the provision, management or coordination of your care for services such as consultations, x-rays, lab tests and prescription services. Our communications to you may be by telephone, cell phone, encrypted email, patient portal or by mail.
For Payment: We may disclose your medical information so that we can collect or make payment for the healthcare services you receive or are going to receive. For example, MVA may provide your insurance company with information about your visit and/or prescription so that the responsible party will be reimbursed for such services.
For Health Care Operations: We may disclose your medical information for MVA Health Center activities and operations. These uses and disclosures are necessary to run the covered entity and make sure that all of our patients receive quality care. For instance, your medical chart may be accessed by an accrediting organization for the purpose of reviewing our organization for quality of care standards.
MVA MAY USE OR DISCLOSE YOUR MEDICAL INFORMATION WITHOUT
YOUR WRITTEN CONSENT OR AUTHORIZATION WHEN AGREEMENT OR OBJECTION IS NOT REQUIRED.
- To a public health authority to report a birth, death, disease or injury, as partof a public health investigation, and to report child or adult abuse, or domestic violence.
- In response to a subpoena, discovery request or other legal process by a court or administrative order.
- To persons authorized to report adverse events, track products, enable product recalls, repairs, or replacement, and/or conduct post marketing surveillance. To a coroner, medical examiner, or funeral director
- To a coroner, medical examiner, or funeral director.
- To comply with laws relating to workers’ compensation or similar programs that are to provide benefits for work-related injuries or illness without regard to fault.
We will attempt to obtain your permission prior to making a disclosure for the following purposes. This permission may be oral. If we are unable to reach you, due to your incapacity or unavailability, we may use or disclose some or all this information, if (1) based on our professional judgement this is in your best interest or (2) use or disclosure of this information is consistent with your previously expressed preference.
- To a personal representitive involved in your medical care – we may release your health information to a family member, other relative, friend or other person whom you have identified to be involved in your health care or the payment of your health care;
- To family – we may use your health information to notify a family member, a personal representative or a person responsible for your care, of our location, general condition or death; and
- To disaster relief agencies – we may release your health information to an agency authorized by law to assist in disaster relief activities.
WHEN MVA IS REQUIRED TO OBTAIN AN AUTHORIZATION TO USE OR DISCLOSE YOUR HEALTH INFORMATION
Except as described in this Notice of Privacy Practices, we will not use or disclose your health information without written authorization from you. For example, uses and disclosures made for the purpose of psychotherapy, marketing and the sale of protected health information require your authorization. If your provider intends to engage in fundraising, you have the right to opt out of receiving such communications. If you do
authorize us to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time. If you revoke your authorization, we will no longer be able to use or disclose health information about you for the reasons covered by your written authorization, though we will be unable to take back any disclosures we have already made with your permission.
MVA MAY USE OR DISCLOSE YOUR MEDICAL
INFORMATION FOR OTHER PURPOSES, ONCE WE HAVE
OBTAINED YOUR WRITTEN AUTHORIZATION.
MVA will attempt to obtain written authorization for other uses and disclosures of medical information not covered by this notice. You may revoke this authorization in writing, at any time.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
- You have the right to inspect and obtain a copy of your medical records containing protected health information. You have the right to request that the copy be provided in electronic form or format. If the form and format are not readily producible, then MVA will work with you to provide it in a reasonable electronic form or format. Requests must be submitted in writing to the MVA Medical Records Director. Request will generally be approved unless there are legal or medical reasons for denial. We may charge a fee for the costs of copying, mailing or other supplies associated with your request.
- You have a right to request that MVA amend your health information that you believe is incorrect or incomplete. We are not required to change your health information and if your request is denied, we will provide you with information about our denial and how you can disagree with the denial. To make an amendment, you must make your request in writing to MVA’s Privacy Officer. You must also provide a reason for your request.
- You have the right to request restrictions on how your health information is used or to whom your information is disclosed, even if the restriction affects your treatment or our payment or health care operation activities. However, we are not required to agree in all circumstances to your requested restrictions, except in the case of a disclosure restricted to a health plan if the disclosure is for the purpose of carrying out payment of health care operations and is not otherwise required by law and the protected health information pertains solely to a health care item or service for which you, or the person other than the health plan on your behalf, has paid the covered entity in full. If you would like to make a request for restrictions, you must submit your request in writing to MVA’s Privacy Officer.
- You have the right to request that we communicate your health information to you in different ways or places. We must accommodate reasonable requests. To requeste confidential communications, you must submit your request in writing to MVA’s Privacy Officer.
- You have the right to request a list of the disclosures of your health information that we have made after April 14, 2003 in compliance with federal and state laws. This list will include the date of each disclosure who received the disclosed health information, a brief description of the health information disclosed and why the disclosure was made. To request this accounting of disclosures, you must submit your request in writing to MVA’s Privacy Officer.
- Upon your request, you may at any time receive a paper copy of this notice, even if you earlier agreed to receive this notice electronically. To obtain a paper copy of this notice, send your written request to MVA’s Privacy Officer. A copy of this notice is also available on MVA’s website, www.mvahealth.org
- MVA is required by law to maintain the privacy of protected health information and provide you with notice of its legal duties and privacy practices with respect to protected health information and to notify you following a breach of unsecured protected health information.
- If you believe your privacy rights have been violated, you may file a complaint with MVA’s Privacy Officer who will provide you with any needed assistance. We request that you file your complaint in writing so that we may better assist in the investigation of your complaint. You may also file a complaint with the Secretary of the Department of Health and Human Services. There will be no retaliation against you in any way for filing a complaint.
Monongahela Valley Association of Health Centers, Inc.
PO Box 1112
Fairmont, WV 26555-1112
For further information about matters covered by this notice you may contact our Privacy Officer at the above address or by telephone at:
(304) 367- 8740