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Asbury Health Center
Your Right to Privacy
Understanding How Your Health Information May Be Used
Your health is an intensely personal matter. As your health care provider, we recognize that and work hard to assure your privacy. We train our staff and volunteers to be sensitive about confidentiality and patient privacy. We restrict access to information about you to only those who need to know that information under state and federal laws and regulations to those who provide, pay for and improve your care. We maintain physical, electronic and procedural safeguards to protect your health information.
Our goal is to assure your privacy. We also strive to comply with all state and federal privacy requirements, such as the Health Insurance Portability and Accountability Act, known as HIPAA.
Updated 2/19/03
Asbury Health Center
Notice of Privacy Practices
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.
Asbury Health Center (AHC) is dedicated to protecting the privacy of your personal health information and is committed to maintaining our patients’ confidentiality. This Notice applies to all information received or created by our employees, staff, volunteers and physicians. This Notice informs you about your right and our obligations regarding your personal health information. If AHC revises the terms of this Notice, it will post a revised notice at the facility and will make paper copies of the Notice available upon request.
We are required, by law, to:
- Maintain the privacy of your protected health information;
- Provide to you this detailed Notice of our legal duties and privacy practices relating to your personal health information; and
- Abide by the terms of the Notice that are currently in effect.
We may use and disclose your personal health information for treatment, payment and health care operations.
For Treatment: We will use and disclose your personal health information in providing you with treatment and services. We may disclose your personal health information to facility and non-facility personnel who may be involved in your care, such as physicians, nurses, nurse aides and therapists. For example, a nurse caring for you will report any change in your condition to your physician. We also may disclose personal health information to individuals who will be involved in your care after you leave the facility.
Asbury Health Center philosophy of care is one of compassionate, high quality care. This model of care strives to create a sense of community among staff and residents that live and work in close proximity to each other on a daily basis. We may use and disclose your personal health information to promote a more home-like environment in the following ways: placing your name and/or picture by your room, celebrating your birthday (by day, not year), memorial services, anniversaries, thank you notes, using certain historical information like occupation, home town, children/grandchildren, as part of reminiscence therapy, pictures of events on bulletin boards and internal communications such as newsletters, etc.
I object in the following way:
For Payment: We may use and disclose your personal health information so that we can bill and receive payment for the treatment and services you receive at our facility. For billing and payment purposes, we may disclose your personal health information to your representative, insurance or managed care company, Medicare, Medicaid or another third party payor. For example, we may contact Medicare or your health plan to confirm your coverage or to request prior approval for a proposed treatment or service.
For Health Care Operations: We may use and disclose your personal health information for facility operation. These uses and disclosures are necessary to manage the facility and to monitor our quality of care. For example, we may use personal health information to evaluate our facility’s services, including the performance of our staff.
We may use and disclose personal health information about you for other specific purposes.
Facility Directory: Unless you object, we will include certain limited information about you in our facility directory. This information may include your name, your location in the facility, your general condition and your religious affiliation. Our directory does not include specific medical information about you. We may release information in our directory, except for your religious affiliation, to people who ask for you by name. We may provide the directory information, including religious affiliation, to any member of the clergy.
I object in the following way:
Individuals Involved in Your Care or Payment for Your Care: Unless you object, we may disclose your personal health information to a family member, close friend, including clergy, who is involved in your care.
I object in the following way:
Disaster Relief: We may disclose your personal health information to assist in a disaster relief effort.
As Required By Law: We will disclose your personal health information when required to do so by law.
Public Health Activities: We may disclose your personal health information for public health activities. The activities may include for example:
- Reporting to a public health agency or other government authority for preventing or controlling disease. Injury or disability, or reporting child abuse or neglect;
- Reporting to the federal Food and Drug Administration (FDA) concerning adverse events or problems with products for tracking products in certain circumstances, to enable product recall or to comply with other FDA requirements;
- To notify a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition or;
- For certain purposes involving workplace illness or injuries.
Reporting Victims of Abuse, Neglect or Domestic Violence: If we believe that you have been a victim of abuse, neglect or domestic violence; we may use and disclose your personal health information to notify a government authority as required or authorized by law.
Health Oversight Activities: We may disclose your personal health information to a health oversight agency for oversight activities authorized by law, including: audits, investigations, inspection and licensure actions or other legal proceedings.
Judicial and Administrative Proceedings: We may disclose information in response to a subpoena, discovery request, or other lawful process, efforts must be made to contact you abut the request or to obtain an order or agreement protecting the information.
Law Enforcement: We may disclose your personal health information for certain law enforcement purposes, such as: reporting requirements, court order, warrant, subpoena, summons, investigative demand or similar legal process; identify or locate a suspect, fugitive, material witness, or missing person; to report information about a suspicious death; to report information in emergency circumstances about a crime; or where necessary to identify or apprehend an individual in relation to a violent crime or an escape from lawful custody.
Research: We may allow personal health information of patients from our own facility to be used or disclosed for research purposes provided that the researcher adheres to certain privacy protections as stipulated by Law and our policies.
Coroners, Health Examiners, Funeral Directors, Organ Procurement Organizations: We may release your personal health information to a coroner, Health examiner, funeral director or, if you are an organ donor, to an organization involved in the donation and procurement of organs and tissue.
To Avert a Serious Threat to Health or Safety: We may use and disclose your personal health information when necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person.
Military and Veterans: If you are a member of the armed forces, we may use and disclose your personal health information as required by military command authorities.
Workers’ Compensation: We may use or disclose your personal health information to comply with laws relating to workers’ compensation or similar programs
National Security and Intelligence Activities: Protective Services for the President and Others: We may disclose personal health information to authorized federal officials conducting national security and intelligence activities or as needed to provide protection to the President of the United States, certain other persons or foreign heads of states or to conduct certain special investigations.
Fundraising: We may use certain personal health information to contact you in an effort to raise money for the facility and its operations. We may disclose personal health information to a foundation related to the facility so that the foundation may contact you in raising money for the facility. In doing so we would only release contact information such as your name, address and phone number and the dates you received treatment or services.
Your Authorization is Required for Other Uses of Personal Health Information.
We will not use and disclose your personal health information for any other purpose without your written Authorization. You may revoke you Authorization in writing at any time.
Your Rights Regarding Your Personal Health Information
Right to Request Restrictions: You have the right to request restriction on our use or disclosure of your personal health information for treatment, payment or healthcare operations. You also have the right to restrict the personal health information we disclose about you to a family member, friend or other person who is involved in your care or the payment for your care. We are required to agree to your requested restriction unless you are being transferred to another health care institution, the release of records is required by law, or the release of information is needed to provide you emergency treatment.
Right of Access to Personal Health Information: You have the right to request, either orally or in writing, your medical or billing records or other written information that may be used to make decisions about your care. We must allow you to inspect your records within 24 hours of your request. If you request copies of the records, we must provide you with copies within 2 working days of the request. We may charge a reasonable fee for our cost in copying and mailing your requested information.
Right to Request Amendment: You have the right to request an amendment to your personal health information. You must make your request in writing and must state the reason for the requested amendment.
Right to Request an Accounting of Disclosures: You have the right to request an "accounting" of the disclosures of your personal health information made by AHC in the six years prior to your request, except for disclosures for treatment, payment or healthcare operations, or certain other exceptions.
Right to a Paper Request of This Notice: You have the right to obtain a paper copy of this Notice. You may obtain a copy of this Notice at our website: www.asburyheights.org., or by calling 412-341-1030.
Right to Request Confidential Communications: You have the right to receive communications in a confidential manner. For example, you can request that we contact you only at a certain phone number.
Right to Voice Complaint: If you believe that your privacy rights have been violated, you may file a complaint in writing with the facility by contacting: Admissions, Asbury Health Center, 700 Bower Hill Road, Pittsburgh, PA 15243, or (412) 571-5182. You may also contact the Office of Civil Rights in the U.S. Department of Health and Human Services. We will not retaliate against you if you file a complaint.
For Further Information
If you have any questions about this Notice or would like further information concerning your privacy rights please contact: Sally Rich at 412-571-5169.
