Notice of Privacy Practices
for Protected Health Information

Please review this notice carefully.
It describes how RMH may use and disclose your personal health information,
and how you may access this information.

Contact Information
RMH Privacy Officer
235 Cantrell Ave.
Harrisonburg, VA 22801
540-433-4487 or 800-543-2201, ext. 4487

RMH HealthSource
540-433-4580 or 800-433-4580

The U.S. Department
of Health and Human Services
200 Independence Ave., S.W.
Washington, DC 20201
202-619-0257
877-696-6775 
www.hhs.gov

Notice of Privacy Practices for Protected Health Information

RMH and its departments, employees, medical staff, and other health care professionals (collectively “RMH”) are committed to protecting your medical information. We create a record of the care and services you receive in order to provide you with quality care and to meet legal requirements. This Notice applies to all records of your care generated at RMH. Please note that your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of medical information created in the doctor’s office.

We are required by law to abide by the terms of this Notice, and we reserve the right to change the terms of this Notice, making any revision applicable to all the protected health information we maintain.

This Notice of Privacy Practices applies to all the records generated by the hospital, whether made by hospital personnel or your personal doctor. This Notice of Privacy Practices describes how we may use and disclose information about you that may identify you and your health care. This Notice of Privacy Practices also describes your rights to access and control your medical information.

RMH will abide by the terms of this Notice of Privacy Practices.

You will be asked to sign a written statement acknowledging that you have received a copy of this notice. The acknowledgement serves to create a record that you have been offered a copy of the notice.

Changes to this Notice
We may change this Notice at any time. The new Notice will apply to all information that we maintain at that time. To request a revised copy, you may call our office and request that a revised copy be sent to you in the mail, or you may ask for one at the time of your next appointment. The current Notice of Privacy Practices also will be posted at registration locations and on our web site, www.rmhonline.com.

How RMH May Use and Disclose Medical Information About You
RMH wants you to understand how we may use and disclose your information. RMH has included examples of what we mean. These examples are not a complete list but should give you an idea of the types of uses and disclosures that we may make. All of the ways we are permitted to use and disclose information will fall within one of the following categories.

• For Treatment—Your information may be used and disclosed by us to provide you with medical treatment. 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. For example, a nurse gets information about you and writes it in your medical record. The doctor can read that information. We also may disclose medical information about you to people outside the hospital, such as family members, clergy or others who provide continuing care services, such as therapists or physicians.
• For Payment—We may use and disclose health information about you to bill and collect payment from you, your insurance company, including Medicaid and Medicare, or a third party that may be available to reimburse us for some or all of your health care. We may also disclose health information about you to other healthcare providers or to your health plan so they can arrange for payment relating to your care. For example, if you have health insurance, we may need to share information about your office visit with your health plan in order for your health plan to pay us or reimburse you for the visit. We may also tell your health plan about treatment for which you need to obtain your health plan’s prior approval or to determine whether your plan will cover the treatment.

   

• For Health Care Operations—RMH may use and disclose medical information about you for RMH operational reasons such as quality improvement, utilization review or legal review. RMH also may disclose information about you to other healthcare providers involved in your care or to your health plan for use in their quality review, credentialing, legal review and/or fraud and abuse investigation. These uses and disclosures are necessary to run RMH and to make sure that all of our patients receive quality care. For example, we may use health information to review the services that we provide and to evaluate the performance of our staff in caring for you. We also may combine health information about our patients with health information from other healthcare providers to decide what additional services RMH should offer, what services are not needed, whether new treatments are effective, or to compare how we are doing with others and to see where we can make improvements.
• For Appointment Reminders—We may use or disclose your information to remind you of your appointment. Our reminder message will include the name of our office or the name of our physician and the date and time for your appointment. We may also use or disclose your information to remind you to schedule an appointment.
• For Treatment Alternatives—We may use or disclose your information to tell you about other treatments or other services that could help you. For example, we may contact several home health agencies or physical therapy providers to see if they can provide services for a patient who needs those types of services.
• For Business Associates—We may share your information with other entities known as “business associates.” These entities may provide services such as billing claims for us or typing medical information for our office. We will have a written agreement between our office and the business associate that states how the business associate will protect the privacy of your information and will prohibit them from using the medical information in any way other than what we allow. For example, RMH or your physician may hire a billing or collection company to submit claims to your insurance company. Your information will be disclosed to this billing company. In addition, this Notice will be followed by any business associates or partners with whom we share protected health information.
• For Fundraising Activities—We may use health information about you to contact you in an effort to raise money for our not-for-profit operations. We will release only contact information, such as your name, address and phone number, and the dates you received treatment or services from us. If you do not want to receive these materials, please contact HealthSource at (540) 433-4580 and ask to be taken off the mailing list, or write to our Privacy Officer.
• Others Involved in Your Health Care—If possible, we will ask your permission prior to discussing your care with others. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
• Hospital Patient Directory—We may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, general condition (e.g., fair, stable, etc.) and when you will be discharged. You may also choose to give your religious affiliation. The directory information may be released to people who ask for you by name, to florists for delivery of flowers and to individuals who deliver the mail. Your religious affiliation may be given to members of the clergy, such as a priest or rabbi, even if they do not ask for you by name. Being in our directory allows your family, friends and clergy to visit you in the hospital and generally know how you are doing. If you do not want anyone to know this information about you, tell the registration clerk or your nurse you do not want to be listed in our directory. In an emergency situation, we may disclose this information if we believe it is in your best interest.
• As Required by Law—We will disclose medical information about you when required to do so by federal, state or local law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.
• For Public Health Activities—We may disclose your information for public health purposes to a public health agency that is legally allowed to collect your information. The disclosure may be made to control disease, injury or disability. We may also disclose your information to other government agencies that are working with public health agencies, if requested by a public health agency.
• As Required by the Food and Drug Administration—We may disclose your information to a person or company required by the Food and Drug Administration to report bad side effects or problems with products, to recall products or for marketing purposes, as required.
• For Communicable Disease Exposure—We may disclose your information, if required by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of getting or spreading the disease.
• For Health Oversight Activities—We may disclose health information about you to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.
• To Your Employer—If your employer hires us to do health studies of the workplace or to review work-related injuries, we may disclose your information about a work-related injury or illness to your employer, in accordance with law.
• For Workers’ Compensation—Your information may be shared, as required by law, to comply with workers’ compensation and other state or federal programs.
• For Abuse or Neglect—We may disclose your information to a public health agency that is able to process reports of child or adult abuse or neglect. We may disclose your information if we believe that you have been a victim of abuse, neglect or domestic violence as required or permitted by Virginia law and/or federal law.
• In Legal Proceedings—We may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request or other lawful process that is not accompanied by a court or administrative order, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
• For Law Enforcement—We may also disclose your information for official law enforcement activities. Examples of these types of disclosures include the following:
  • In response to a court order, subpoena, warrant, summons or similar process
  • To identify or locate a missing person or identify an unknown patient
  • Under certain limited circumstances, about the victim of a crime
  • About a death we believe may be the result of criminal conduct
  • About criminal conduct on, in or around RMH property
  • In a medical emergency
• Threats to Health or Safety—We may disclose your information if we believe that the use or disclosure is necessary to prevent or lessen a serious and immediate threat to the health or safety of a person or the public.
• Regarding Inmates—We may use or share your information if you are an inmate and the information is requested by the correctional facility.
• To Coroners, Funeral Directors and/or Organ Donation Agencies—We may disclose your information to a coroner or medical examiner to help identify you or your kin, determine the cause of death or help the coroner or medical examiner perform other duties required by law. We may also disclose information to a funeral director to help him carry out his duties. Your information may also be used and disclosed to honor your wishes about organ donation.
• For Research—We may disclose your information to researchers when you are participating in a research study. We may disclose information to researchers when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved their research.
• For Military Activity and National Security—We may use or disclose information to Armed Forces personnel for activities deemed necessary by appropriate military authorities. We may also disclose your information to authorized federal officials who are conducting national security and intelligence activities in accordance with the law.
• For Required Uses and Disclosures—Under the law, we must give information to you and, when required, to the Department of Health and Human Services, to ensure that we follow the requirements of the Health Insurance Portability and Accountability Act and its regulations.

Your Rights
You have the following rights regarding medical information we maintain about you:

• You have the right to review and copy your information. You may review or obtain a copy of your information. The information you may review or request may include medical, billing and other records that we use for making decisions. However, under federal law, you may not review or copy the following records: psychiatry notes; information related to a civil, criminal, or administrative action; and medical information that, by law, you are not allowed to view in certain circumstances. We may deny your request to review your information if, in our professional judgment, we feel it would be harmful to you in any way. In some instances, you may have a right to have this decision reviewed. Please contact our Privacy Officer if you have questions about viewing your record.
• You have the right to request that a restriction be placed on the use or disclosure of your information. This means you may ask us not to use or share any part of your information for treatment, payment or healthcare operations. You may also ask that any part of your information not be shared with family members or friends who may be involved in your care. These requests must be in writing to our Privacy Officer and must state what you do not want shared and who should not be allowed to view the information. We are not required to agree to your request. If we agree, we may only share your information if it is needed to provide emergency care to you or unless we notify you that we can no longer comply with your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
• You have the right to ask that we change the way we handle your confidential information. We will try to honor your request, but we may still ask you for information about how payment will be made or other information needed to care for you. Please make any request in writing to our Privacy Officer.
• You may have the right to ask us to make corrections to your information. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend this information. You have the right to request an amendment for as long as the information is kept by or for the hospital. Please talk with our Privacy Officer if you have questions about making corrections to your medical record.
  
  To request an amendment, your request must be made in writing and submitted to the Hospital’s Privacy Officer. In addition, you must provide a reason that supports your request. We may deny your request if you ask us to amend information that:
  • Was not created by us, unless 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 copy; or
  • Is accurate and complete.
• You have the right to receive a listing of certain disclosures we have made of your information. This right applies to disclosures for purposes other than treatment, payment or healthcare activities. You have the right to receive specific information regarding these disclosures. It will not include disclosures we may have made with your permission to you, to family members or friends involved in your care, or to notify you of an appointment. Your right to receive this information has certain exceptions, restrictions and limitations.
• You have the right to obtain a paper copy of this Notice from us. If you would like a paper copy of this Notice, please call HealthSource, (540) 433-4580, and request a copy of our Privacy Notice.

Complaints
Please let us know if you believe we have violated your privacy rights. Contact our Privacy Officer, who will be happy to assist you in filing a complaint. If you do file a complaint, we will not hold it against you. If you do not wish to file a complaint with us, you may contact the Secretary of Health and Human Services.