Effective Date of This Notice: May 5th, 2005

• How Valley Forge Medical Center & Hospital may Use or Disclose Your Health Information:

Valley Forge Medical Center & Hospital (VFMC) collects health information from you and stores it within VFMC as your medical record. This medical record is the property of VFMC, but the information in the medical record belongs to you. VFMC protects the privacy of your health information. The law permits VFMC to use or disclose your health information for the following purposes:

• Treatment. If another treatment provider has previously been involved in your treatment, or is going to be involved in the future, we may want to discuss your case in order to coordinate care between us, however, this will only be done with written authorization/consent from you, or in an emergency situation. The kinds of health care information we may disclose about you in such circumstances could include your diagnosis, physician assessments, lab results, progress in treatment, etc. During your treatment at VFMC, you may also be involved in group therapy. This technique may involve discussions of a personal nature within a small group setting. Group therapy is a widely accepted and often-beneficial therapeutic tool. Follow-up phone calls may also be done after treatment, however only with authorization/consent from you or in situations where we must follow–up regarding health concerns, such as test results that came back after your discharge.
• Payment. If you are covered by health insurance, we may disclose diagnostic and treatment details to your insurance provider in order to obtain payment for services rendered. If we are assisting you in applying for health coverage, such as Medical Assistance, we may need to disclose pertinent information, such as work history, in order to meet eligibility requirements.
• Regular Health Care Operations. Your medical record may be randomly inspected by agencies who conduct quality assurance reviews to ensure that high standards of care are being maintained.
• Notification and communication with family. Only with authorization/consent, or in an emergency, may we disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. In an emergency situation, including if you are transferred to another facility for medical or psychiatric reasons, we will give you the opportunity to object to notification of your family or personal representative. However, if you are unavailable or unable to agree or object due to medical or psychiatric reasons, our health professionals will use their best judgment in communication with your family and others.
• Required by law.. As required by law, we may use and disclose your health information.
• Public health. As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure, such as HIV, AIDS, hepatitis, and tuberculosis. These disclosures are done in a confidential manner with only the minimum necessary information provided to required public health authorities.
• Health oversight activities. We may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.
• Judicial and administrative proceedings. We may disclose your health information in the course of any administrative or judicial proceeding.
• Law enforcement. We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.
• Deceased person information. We may disclose your health information to coroners, medical examiners and funeral directors.
• Organ donation. We may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues.
• Public safety. We may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
• Worker’s compensation. With your authorization/consent we may disclose your health information as necessary to comply with worker’s compensation laws.
• Marketing. We may contact you to provide appointment reminders or to give you information about other treatments or health-related benefits and services that may be of interest to you.
• Change of Ownership. In the event that VFMC is sold or merged with another organization, your health information/record will become the property of the new owner.
• Business Associates. There are some services that we need to contract with business associates for, such as consultant and attorney services. When these services are contracted, we may disclose your health information so that they may perform the job we’ve asked them to do. To protect your health information, we require these business associates to appropriately safeguard your information.
• When VFMC May Not Use or Disclose Your Health Information

Except as described in this Notice of Privacy Practices, VFMC will not use or disclose your health information without your written authorization. If you do authorize VFMC to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.

• Your Health Information Rights
• You have the right to request restrictions on certain uses and disclosures of your health information. VFMC is not required to agree to the restriction that you requested.
• You have the right to receive your health information through a reasonable alternative means or at an alternative location. It is the policy of VFMC, however, that all such requests be put in writing. A reasonable fee will be charged for copying your health information.
• You have the right to inspect and copy your health information. However, it is the policy of VFMC that each discipline sits down and reviews their notes with you.
• You have a right to request that VFMC amend your health information that is incorrect or incomplete. VFMC is not required to change your health information and will provide you with information about VFMC’s denial and how you can disagree with the denial.
• You may request that we provide you with a written accounting of all disclosures made by us during the time period for which you request (not to exceed 6 years or for any date prior to April 14th, 2003). We ask that such requests be made in writing on a form provided by our facility. Please note that an accounting will not apply to any of the following types of disclosures: disclosures made for reasons of treatment, payment or health care operations; disclosures made to you or your legal representative, or any other individual involved with your care; disclosures to correctional institutions or law enforcement officials; disclosures for national security purposes, and disclosures made with written authorization/consent. You will not be charged for your first accounting request in any 12-month period. However, for any requests that you make thereafter, you will be charged a reasonable, cost-based fee. For more information about this right, see 45 C.F.R.; 164.528.
• You have a right to a paper copy of this Notice of Privacy Practices.

If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact

The Director of Planning
Valley Forge Medical Center & Hospital
610-539-8500 ext. 339

• Changes to this Notice of Privacy Practices

VFMC reserves the right to amend this Notice of Privacy Practices at any time in the future, and to make the new provisions effective for all information that it maintains, including information that was created or received prior to the date of such amendment. Until such amendment is made, VFMC is required by law to comply with this Notice.

Should our privacy practices change, we will provide all current and future patients with a copy of the revised Notice of Privacy Practices.

• Complaints

Complaints about this Notice of Privacy Practices or how VFMC handles your health information should be directed to:

The Director of Planning
Valley Forge Medical Center & Hospital
610-539-8500 ext. 339

If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:

Department of Health and Human Services
Office of Civil Rights

You may also address your compliant to one of the regional Offices for Civil Rights. A list of these offices can be found online at http://www.hhs.gov/ocr/regmail.html.