HIPAA Notice of Privacy Practices*

Grant Memorial Hospital

HIPAA Notice of Privacy Practices*

Effective January 1, 2014



If you have any questions about this Notice, please contact our office at (304) 257-5812.

*In the event that West Virginia State Regulations pertaining to privacy are stricter than Federal Regulations, Grant Memorial Hospital will follow the West Virginia State Regulations.


This notice describes our privacy practices.

All of our sites and locations follow the terms of this notice.  In addition, these sites and locations may share health information with each other for treatment, payment, or healthcare operations described in this notice.


We are required by law to maintain the privacy of protected health information and to tell you of our legal duties.  Disclosures of your protected health information without authorization is strictly limited to defined situations that include  emergency care, quality assurance activities, public health , research, and law enforcement activities.  We use and disclose your information for the purposes of treatment, payment and healthcare operations and for other purposes that are permitted or required by law.  This Notice also describes your rights to access and control your protected health information.  “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.

Unless you give us an additional written authorization, we cannot use or disclose your health information for any reason except as described in this Notice.  You may request a copy of our Notice at any time.  We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law.  The new notice will be effective for all protected health information that we maintain at that time.  Upon your request, we will provide you with any revised Notice of Privacy Practices by accessing our website; or by calling the office and requesting that a revised copy be sent to you in the mail; or by asking for one at the time of your next appointment. 


The following categories describe different ways that we may use and disclose health information.  For each category of uses or disclosures we will explain what we mean.  Not every use or disclosure in a category will be listed.  However, all of the ways we are permitted to use and disclose information will fall within one of these categories.

For Treatment.  We may use health information about you to provide you with health care treatment or services.  We may disclose health information about you to doctors, nurses, technicians, health students, or other personnel who are involved in taking care of you.  They may work at our offices, at the hospital if you are hospitalized under our supervision, or at another doctor’s office, lab, pharmacy, or other health care provider to whom we may refer you for consultation, to take x-rays, to perform lab tests, to have prescriptions filled, or for other treatment purposes.  For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process.  In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals.  We also 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.
For Payment.  We may use and disclose health information about you so that the treatment and services you receive from us may be billed to and payment collected from you, an insurance company, or a third party.
For Healthcare Operations.  We may use and disclose your health information in connection with our healthcare operations.  Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing information with third party “business associates” that perform various activities (e.g. billing, transcription services) for the practice.  Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract (Business Associate Agreement) that contains terms that will protect the privacy of your protected health information.  Effective September 17, 2013, our Business Associate Agreements have been amended to provide that all of the HIPAA security administrative safeguards, physical safeguards, technical safeguards and security policies, procedures, and documentation requirements apply directly to the business associate. 

We may also disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.  We may also use and disclose your protected health information for other marketing activities.  For example, your name and address may be used to send you a newsletter about our practice and services we offer.  We may also send you information about products or services that we believe may be beneficial to you.  You may contact our Privacy Office to request that these materials not be sent to you. 

Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or Opportunity to Object 

We may use and disclose your protected health information in the following instances.  You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information.  If you are not present or able to agree or object to the use or disclosure of the protected health information, then your health care provider may, using professional judgment, determine whether the disclosure is in your best interest.  In this case, only the protected health information that is relevant to your health care will be disclosed. 

Your Authorization:  In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose.  If you give us authorization, you may revoke it in writing at any time. 
To your Family and Friends:  We must disclose your health information to you, as described in the Patient Rights section of this Notice.  We may disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare.
Persons Involved in Care: We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death.  If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures.  In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare.  We will also use our professional judgment and experiences with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays or other similar forms of health information.
Marketing Health-Related Services:  We will not use your health information for marketing communications to third parties without written authorization.
Required by Law:  We may use or disclose your health information when we are required to do so by law.
Abuse or Neglect:  We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes.  We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.
National Security:  We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances.  We may disclose, to authorized federal officials, health information required for lawful intelligences, counterintelligences, and other national security activities.  We may disclose to a correctional institution or a law enforcement official having lawful custody of protected health information of an inmate or patient under certain circumstances.
Appointment Reminders:  We may use or disclose your health information to provide you with appointment reminders such as voicemail, messages, postcards, or letters. 


Access:  You have the right to look at or get copies of your health information with limited exceptions.  You may request that we provide copies in a format other than photocopies.  We will use the format you request unless we cannot practically do so.  You must make a request in writing to obtain access to your health information.  You may obtain a form to request access by using the contact information listed at the end of this Notice.  We will charge you a reasonable cost-based fee for expenses such as copies and staff time.  You may also request access by sending us a letter to the address at the end of this Notice.  We may charge you a fee for each page and fee for staff time to locate and copy your health information and postage if you want the copies mailed to you.  If you request an alternative format, we will charge a cost-based fee for providing your health information in that format.  If you prefer, we will prepare a summary of an explanation of your health information for a fee.  Contact us using the information listed at the end of this Notice for a full explanation of our fee structure. 

Disclosure Accounting:  You have the right to receive an accounting of certain disclosures.  This right applies to disclosures of purposes other than treatment, payment or healthcare operations as described in the Notice of Privacy Practices.  It excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes.  You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003.  If you request this accounting more than once in a 12 month period, we may charge a reasonable fee for responding to these additional request.  Restriction:  You have the right to request that we place additional restrictions on our use or disclosure of health information.  We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement except in an emergency.
You have the right to restrict information given to your third party payer if you fully pay for the services out of your pocket.
Alternative Communication:  You have the right to request that we communicate with you about your health information by alternative means or to alternative locations.  (You must make your request in writing.)  Your request must specify the alternative means or location, and provide satisfactory explanation how payments will be handled under the alternative means or location you request. 
Amendment:  You have the right to request that we amend your health information.  (Your request must be in writing), and it must explain why the information should be amended.  We may deny your request under certain circumstances. 
Security Breach:  You have the right to be notified in the event that we (or one of our Business Associates) discover a breach of unsecured protected health information involving your medical information.  The notice will contain the following information:  (1) a brief description of what happened, including the date of the breach and the date of the discovery of the breach; (2) the steps you should take to protect yourself from potential harm resulting from the breach; and (3) a brief description of what we are doing to investigate the breach, mitigate losses, and to protect against further breaches.

Electronic Notice:  If you receive this Notice on our website or by electronic mail (e-mail), you are entitled to receive this Notice in written form.

COMPLAINTS – If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of this Notice.  You may also submit a written complain to the U.S. Department of Health and Human Services.  We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.  We support your right to the privacy of your health information. 

We will not retaliate in any way if you choose to file a complaint with the U.S. Department of Health and Human Services.  Contact:  Privacy Officer, Telephone:  304-257-5812, Fax 304-257-1520, Address: Grant Memorial Hospital, PO Box 1019, Petersburg, WV 

Attention:  If you have limited English proficiency, language assistance services, free of charge, are available to you. 
Call 1-304-257-1026 (TTY: 1-304-257-4009).

ATENCIÓN:  si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.  Llame al 1-304-257-1026 (TTY: 1-304-257-4009).Spanish
注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-304-257-1026(TTY:1-304-257-4009)。Chinese
ATTENTION :  Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement.  Appelez le 1-304-257-1026 (ATS : 1-304-257-4009).French
ACHTUNG:  Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.  Rufnummer: 1-304-257-1026 (TTY: 1-304-257-4009).German
رقم  x304-257-1026-ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم 1.(304-257-4009-1 ھاتف الصم والبكم:Arabic
CHÚ Ý:  Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.  Gọi số 1-304-257-1026 (TTY: 1-304-257-4009).Vietnamese
주의:  한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.  1-304-257-1026 (TTY: 1-304-257-4009)번으로 전화해 주십시오.Korean
 注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。1-304-257-1026) TTY:1-304-257-4009)まで、お電話にてご連絡ください。Japanese
PAUNAWA:  Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.  Tumawag sa 1-304-257-1026 (TTY: 1-304-257-4009). Tagalog
ATTENZIONE:  In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti.  Chiamare il numero 1-304-257-1026 (TTY: 1-304-257-4009).Italian
  เรียน:  ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี  โทร 1-304-257-1026 (TTY: 1-304-257-4009).Thai
ध्यान दिनुहोस्: तपार्इंले नेपाली बोल्नुहुन्छ भने तपार्इंको निम्ति भाषा सहायता सेवाहरू निःशुल्क रूपमा उपलब्ध छ । फोन गर्नुहोस् 1-304-257-1026 (टिटिवाइ: 1-304-257-4009) ।Nepali
توجھ: اگر بھ زبان فارسی گفتگو می کنید، تسھیلات زبانی بصورت رایگان برای شما.تماس بگیرید. (1026-257-304-1 TTY: 1-304-257-4009) فراھم می باشد. با . Persian (Farsi)
ВНИМАНИЕ:  Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.  Звоните 1-304-257-1026 (телетайп: 1-304-257-4009). Russian
خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال1-304-257-1026  (TTY: 1-304-257-4009).کریںUrdu

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