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SUMMARY OF NOTICE OF PRIVACY INFORMATION PRACTICES
THIS SUMMARY DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our organization’s policy regarding your protected health information (PHI).
We are committed to preserving the privacy and confidentiality of your protected
health information created and/or maintained at our organization. Certain state and
federal laws and regulations require us to implement policies and procedures to
safeguard the privacy of your protected health information.
Uses or disclosures of your protected health information.
We may use or disclose your protected health information in one of following ways:
1) For purposes of treatment, payment or health care operations
2) Pursuant to your written authorization (for purposes other than treatment,
payment or health care operations)
3) Pursuant to your verbal agreement (for use in our organization directory or to
discuss your health condition with family or friends who are involved in your care)
4) As permitted by law
· Health oversight activities.
· Worker’s compensation.
· Organ procurement organizations or tissue banks.
· Research.
· To avert a serious threat to health or safety.
· Military and veterans.
· National security and intelligence activities.
5) As required by law
a) Public health activities
b) Judicial or administrative proceedings
c) Law Enforcement official
Your rights regarding your protected health information
You have the following rights regarding your protected health information, which
we create and/or maintain:
1. Right to inspect and copy. To inspect and copy your protected health information,
you must submit your request in writing. If you request a copy of the information, we
may charge a fee for the costs of copying, mailing, or other supplies associated with
your request.
2. Right to request an amendment. If you feel that the protected health 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 our organization. To request an amendment, your request must be made in writing.
Your request for Amendment may be denied. Please see the Privacy Notice for details.
3. Right to an accounting of disclosures. You have the right to request an accounting
of the disclosures, which we have made of your protected health information. To
request an accounting of disclosures, you must submit your request in writing.
4. Right to request restrictions. You have the right to request a restriction or
limitation on the protected health information we use or disclose about you for treatment,
payment, or health care operations. You also have the right to request a limit on the
protected health information we disclose about you to someone, such as a family member
or friend, who is involved in your care or in the payment of your care. To request restrictions,
you must make your request in writing.
5. Right to request confidential communications. To request confidential communications,
you must make your request in writing.
6. Right to a paper copy of this notice. A full copy has been provided to you. Additional
copies can be obtained from our website at www.rockhillmennonite.org.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our organization,
by using our confidential hotline service, the Friends Compliance Line at 1-800-211-2713 or with
the secretary of the Department of Health and Human Services. All complaints must be submitted
in writing. You will not be penalized for filing a complaint. To file a complaint with our organization
or if you have any questions regarding this notice, contact:
Director of Corporate Compliance/Privacy Officer
1777 Sentry Parkway West
Dublin Hall, Suite 208
Blue Bell, PA 19422
(215) 619-7949
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