Privacy & Legal Disclaimer

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Valley Health Systems including:

• Holyoke Medical Center
• Holyoke Bariatric Services
• Holyoke Cardiovascular Services
• Holyoke General Surgeons
• Holyoke Orthopedic Surgeons
• Holyoke Specialty Surgeons
• Holyoke Urology Services
• Endocrinology Services
• Rheumatology Services
• Neurology & Sleep
• Oncology
• Comprehensive Pain Management

 

NOTICE of PRIVACY PRACTICES

Effective 10/10/2018

THIS NOTICE 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 RESPONSIBILITIES
Patient-specific information is confidential and shall be made available only in conformity with all applicable state and federal laws and regulations regarding the confidentiality of patient records, including but not limited to, 42 CFR Part 2, and 45 CFR Parts 160 and 164 (HIPAA Privacy and Security Rules) if applicable. Holyoke Medical Center is required by law to maintain the privacy of your medical and health information (protected health information), to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of this notice and to make the new provisions effective for all protected health information we maintain. When changes are made to our privacy practices, a revised notice will be posted on our web site, in our admitting area, and available upon request as of its effective date.

YOUR RIGHTS

You have the right to:

• Request restrictions. You may request restrictions on our use and disclosure of your protected health information (1) for treatment, payment and health care operations, (2) to individuals such as a family member, close personal friend, or other person identified by you involved with your care or with payment related to your care, or (3) to notify or assist in the notification of such individuals regarding your location and general condition. While we consider all requests for restrictions carefully, we are not required to agree to a requested restriction. You may request restrictions at the time of registration, by contacting your care provider, or by contacting the Holyoke Medical Center Privacy Officer at (413) 534-2534. You may also request that we not inform your payer of services rendered that were paid in full out-of-pocket.
• Receive paper copy of notice. Upon request, you may obtain a paper copy of this notice, even if you have obtained such notice electronically. You may obtain this notice by contacting the Patient Registration Department at 413-534-2540 or via our website: www.holyokehealth.com
• Inspect and/or receive a copy of your health information. You may request access to your medical record file and billing records maintained by us in order to inspect and request copies of the records. All requests for access must be made in writing. Under limited circumstances, we may deny you access to your records. There is a reasonable cost-based charge for copies of medical records, plus the cost of postage if you request that we mail copies to you.
• Receive confidential communications. You may request, and we will accommodate, any reasonable written request for you to receive your protected health information by alternative means of communication or at alternative locations.
• Notification of a breach. Should there be a breach of your PHI, you will be notified by the Compliance Manager or Privacy Officer.
• Request to amend your records. You have the right to request that we amend pr otected health information maintained in your medical record file or billing records. We will comply with your written request unless we believe that the information that would be amended is accurate and complete or other special circumstances apply.
• Revoke your authorization. You may revoke your authorization to release your medical information except to the extent that we have taken action in reliance upon it.
• Receive an accounting of disclosures. Upon written request, you may obtain an accounting of certain disclosures of your protected health information made by us during any period of time prior to the date of your request, provided that such period does not exceed six years and does not apply to disclosures that occurred prior to April 14, 2003. If you request an accounting more than once during a twelve (12) month period, there will be a reasonable cost-based fee for the accounting statement.

To exercise the above rights, please send your request in writing to:

Correspondence Coordinator
Health Information Management Department
Holyoke Medical Center
575 Beech Street
Holyoke, MA 01040

USES AND DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS

Except where prohibited by Massachusetts state or federal laws (see section 4), Holyoke Medical Center may legally use and share your health information for treatment, payment, and health care operations. We do not need to ask for your specific permission to do these things, as explained below:

Treatment

Holyoke Medical Center health care providers will use and share your health information to provide and manage your health care and related services. For example, your primary care doctor may refer you to a specialist such as a radiologist or surgeon. The specialist may tell you that you need to be admitted to the hospital for treatment or surgery. All of the doctors in this example, whether they are in the Holyoke Medical Center system or not, will share medical information about you. This is to coordinate your care before, during, and after you go into the hospital. Holyoke Medical Center will share information with other third parties, such as home health agencies, visiting nurses, rehabilitation hospitals, and ambulance companies. We will also share information with those who treated you before you went into the hospital and with those who will treat you in the future. This helps to make sure that everyone caring for you has the information they need. We believe that sharing your information is critical in order to provide you with the best health care.
Dedicated Substance Abuse Facilities and/or providers will not share information with other Holyoke Medical Center entities and/or health care providers without an authorization signed by you to release information.

Payment

Holyoke Medical Center will use and share your health information to bill and collect payment for the health care services it gives to you. For example, if you have health insurance, your health care provider will share your medical information with the insurance company or government agency (for example, Medicare or Medicaid). The insurance company uses the information to tell if you are eligible for benefits or if the services you received were medically needed.

Health Care Operations

Holyoke Medical Center may use and share your health information for activities that are known as health care operations. These are activities that are needed to operate its facilities and carry out its mission. Some of the information is shared with outside parties who perform these health care operations or other services on behalf of Holyoke Medical Center (“business associates”). These business associates must also take steps to keep your health information private. Examples of activities that make up health care operations include:

• Monitoring the quality of care and making improvements where needed
• Making sure health care providers are qualified to do their jobs
• Reviewing medical records for completeness and accuracy
• Meeting standards set by regulating agencies
• Teaching health professionals
• Using outside business services; such as, transcription, storage, auditing, legal or other consulting services
• Storing your health information on computers
• Managing and analyzing medical information

Holyoke Medical Center may use your health information to contact you:

• At the address and telephone numbers you give to us (including leaving messages at the telephone numbers) about scheduled or cancelled appointments, registration/insurance updates, billing or payment matters, pre-procedure assessment, or test results
• With information about patient care issues, treatment choices, and follow up care instructions
• With information that may be of interest to you which describes a health-related product or service provided by Holyoke Medical Center
• At the e-mail address or other contact information you provide to assist us in activities described in this Notice, such as conducting patient satisfaction surveys
• For fundraising to support the Holyoke Medical Center system and its missions of excellence, provided that such information is limited to demographic or other information as allowed by law (such as name, address, telephone number or e-mail information, age, date of birth, gender, health insurance status, dates of service, department of service information, treating physician information, or outcome information). You have the right and regular opportunities to opt out of receiving such communications by contacting the Development Office at 413-534-2579. Your decision will have no impact on your treatment or payment for services.

USES AND DISCLOSURES REQUIRED OR PERMITTED BY LAW

Your protected health information may be used or disclosed without your authorization to the extent required or permitted by law. We will limit such use or disclosure of your protected health information to the relevant requirements of the law. Uses and disclosures which are required or permitted by law include:

• To a public health authority for the purpose of monitoring and controlling disease, injury or disability.
• To report child, elder or disabled persons abuse or neglect; or to report rape or sexual assault to public health or other government authorities authorized by law to receive such reports; and to protect victims of abuse, neglect or domestic violence.
• To report information about products and services under the jurisdiction of the U.S. Food and Drug Administration (FDA).
• To report information to your insurer and/or the Massachusetts Industrial Accident Board as required under laws addressing work-related illnesses or injuries or workplace medical surveillance.
• To report information related to the birth and subsequent health of an infant to state government agencies.
• To file a death certificate or to report a fetal death.
• To report an abortion performed after 24 weeks of pregnancy to state government agencies.
• To health oversight agencies that oversee the health care system, government programs and civil rights laws and for health oversight activities such as inspections, audits and investigations.
• For judicial or administrative proceedings, in response to a subpoena, legal order or other lawful process.
• To law enforcement officials in compliance with a court order or a grand jury or administrative subpoena.
• To coroners and medical examiners to perform duties authorized by law.
• To funeral directors in order to perform their duties with respect to a deceased individual or in reasonable anticipation of death.
• To organizations that facilitate organ, eye or tissue procurement, banking or transplantation.
• To prevent or lessen a serious or imminent threat to the health or safety of you or others.
• For research purposes if an Institutional Review Board/Privacy Board approves a waiver of authorization for such use or disclosure or if otherwise permitted by applicable law.
• To units of the government with special functions, such as the U.S. Military or the U.S. Department of State under certain circumstances, such as national security and intelligence activities.
• To a correctional institution if you are an inmate.
• When required to do so by any other law not already referred to in the preceding categories.

OTHER USES AND DISCLOSURES

Uses and Disclosures You May Agree or Object to:

• Patient Directory. Unless you object, we may disclose your location and general condition to persons who ask for you by name without obtaining your authorization. If you object, we will not acknowledge that you are in the hospital to anyone who asks for you, nor will we be allowed to accept flowers or mail for you. Clergy: Unless you object, we may provide your name, location, general condition and religious affiliation to the clergy.
• Persons Involved in Your Care. Unless you object, we may disclose to a member of your family, a close friend or another person you identify, your health information as it relates to that person’s involvement in your health care or to notify them of your general condition, location or death.
• Disaster Relief. Unless you object, we may disclose your health information to a public or private entity authorized to assist in disaster relief efforts.
• Fundraising: Holyoke Medical Center may use patient demographic, health status data and dates of health service for fundraising purposes including your Name, General Department of service, Address and other contact information, Treating physician information, Email address, Age, Gender, Dates of health care services, Health insurance status, Outcome information (to screen out only). You may refuse receiving fundraising communications by contacting the Development Office at 413-534-2579.

If you are unable to agree or to object, we will use our professional judgment for what is in your best interests or to respond to an emergency.

Uses and Disclosures That Require Your Written Permission (Authorization):

Other uses and disclosures will be made only with your written authorization.

Your permission must be obtained prior to disclosing any protected health information for “marketing” communications, as it is defined by federal law. Your permission is not required for communications made to describe a health-related product or service (or payment for such product or service) provided by HMC or communications for the purpose of treatment, case management or coordination of care.

Federal and state law require special privacy protections for certain information about you. The following information may not be disclosed unless specifically authorized by you or as otherwise required by law:

• HIV testing and test results
• Certain types of Genetic testing and test results
• Confidential communications with a psychotherapist, psychologist, social worker, sexual assault counselor, domestic violence counselor, or other allied mental health professional, or human services professional.
• Substance abuse (alcohol or drug) treatment or rehabilitation.
• Sexually transmitted disease test results

To obtain an authorization form to release your health information, please contact the Correspondence Coordinator in the Health Information Management Department at 413-534-2528.

RETENTION

Holyoke Medical Center maintains medical records for at least 20 years after the patient’s discharge or after the final treatment as required by state law. A copy of the hospital’s record retention policy is available upon request.

HOW TO COMPLAIN IF YOU BELIEVE YOUR PRIVACY RIGHTS HAVE BEEN VIOLATED

If you think that we may have violated your privacy rights or you disagree with any action we have taken with regard to your health information, we want you, your family, or your guardian to speak with us. If you present a complaint, your care will not be affected in any way. It is the goal of Holyoke Medical Center to give you the best care while respecting your privacy.

You may file a complaint by contacting the HMC Patient Relations line at 413-534-2727 or the Privacy Officer at 413-534-2534. You may also send a written complaint to the U.S. Department of Health and Human Services, J.F.K. Federal Building – Room 1875, Boston, MA 02203, Voice phone 617-565-1340, or email to OCRComplaint@hhs.gov. We will take no retaliatory action against you if you file a complaint about our privacy practices.

FOR MORE INFORMATION

If you need clarification or more information on any portion of this notice, or if you feel your privacy rights have been violated, you may contact the Privacy Officer at 413-534-2534 or write to the following address:

Privacy Officer
Health Information Management Department
Holyoke Medical Center, Inc.
575 Beech Street, Holyoke, MA 01040-2296
www.holyokehealth.com
413-534-2500