Notice of Privacy Practices


The following categories describe different ways that we use and disclose medical information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information without special authorization will fall in one of the categories.

For treatment: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students or other hospital personnel who are involved in taking care of you at the hospital. We may also disclose health information about you to people outside the hospital who may be involved in your medical care after you leave the hospital, such as family members, clergy or others we use to provide services that are part of your care. We may also tell your health plan about treatment you are going to receive in order to obtain prior approval for these services.

For payment: 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 patients receive quality care.


  • Treatment alternatives
  • Worker’s compensation
  • Organ & tissue donations
  • Health related benefits and services 
  • Health oversight activities as required by law 
  • To avert a serious threat or health hazard


You have the following rights regarding medical information we maintain about you.

Right to inspect and copy: You have the right to inspect and request a paper or electronic format copy of your medical information that may be used to make decisions about your care. Usually this includes lab test reports, medical and billing records, but does not include psychotherapy notes except for purposes related to treatment, payment or our operations to avoid a serious threat to health or safety, or as required by law. There may be a charge for copies.

To inspect and/or request a copy of your medical information that may be used to make decisions about you, your request must be submitted in writing, including name, date of birth and the time frame to the Health Information Department.

Right to amend: If you feel that the 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.

To request an amendment, your request must be made in writing and submitted to the Health Information Department.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition we may deny your request if you ask us to amend information that was not created by us; if the person or entity that created the information is no longer available to make the amendment; is not part of the medical information kept by or for the hospital; is not part of the information which you would be permitted to inspect and receive copies of; or is accurate and complete.

Right to restrict certain protected health information from health plans: You have the right to restrict disclosures to health plans if you pay out of pocket in full for your care.

Right to accounting of disclosures: You have the right to request an “accounting of disclosures”. This is a list of the disclosures we made of medical information about you other than for treatment, payment, operations or disclosure you have authorized.

To request this list of disclosures, you must submit your request in writing to the Health Information Management Department.

Rights to request restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about your treatment, payment or health care 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 will comply with you request unless the information is needed to provide you emergency treatment or the release is mandated by law.

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 opt out: You have the right to opt out of the hospital directory and any fundraising communications when you are admitted.

Right to receive notifications: You have the right to receive notifications whenever a breach of your unsecured protected health information occurs.

Right to paper copy of this notice: You have the right to a paper copy of this notice in its entirety. 


If you believe your privacy rights have been violated you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with the hospital contact the Chief Quality Officer. You will not be penalized for filing a complaint.


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 authorization, such as: use and disclosure of any protected health information for marketing purposes, disclosures that constitute the sale of protected health information and psychotherapy notes.


This notice describes our hospital’s practice and that of:

  • All health care professionals authorized to enter information into your hospital chart including surgeons, radiologists and specialists who are not employed by the hospital.
  • All departments and units of the hospital.
  • All volunteers we allow to help you while you are in the hospital.
  • All employees, physician practices, and other hospital personnel. All these entities follow the terms of this notice. In addition these entities may share medical information with each other for treatment, payment or hospital operational purposes described in this notice.


We understand that medical information about you and your health is personal. We are committed to protecting your medical information. We create a record of the 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, whether made by hospital personnel or your doctor. This notice tells you about the way in which we may use and disclose medical information. We are required by law to:

  • Make sure that medical information that identifies you is kept private;
  • Give you this notice of our legal duties and privacy practices with respect to medical information about you and;
  • Follow the terms of the notice that is currently in effect.


We reserve the right to change this notice. We reserve the right to make the revised 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 date.