If you have any questions about this notice, please contact Christine Cook,
Corporate Compliance and Privacy Officer at 343-3130.

The West Branch Regional Medical Center and its medical staff, and the Medical Arts Center, all of whom are covered entities who jointly participate in the care of patients when they are receiving services on the premises of West Branch Regional Medical Center and the Medical Arts Center (hereinafter referred to as the Covered Entities), will comply with the terms of this notice. The Covered Entities may share your medical information for the treatment of patients, payment for services or operations as described in this notice.

The Covered Entities use health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of your provider.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

How the Covered Entities May Use or Disclose Your Health Information:
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give an example. 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 the categories.

For Treatment. We may use medical information about you to provide you with medical treatment or services. For example, information obtained by a health care provider, such as a physician, nurse, or other person providing health services to you, will record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions.

For Payment. We may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third party payor, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.

For Health Care Operations. We may use and disclose health information about you for operational purposes. For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and others to:

• Evaluate the performance of our staff;
• Assess the quality of care and outcomes in your case and similar cases;
• Learn how to improve our facilities and services; and
• Determine how to continually improve the quality and effectiveness of the health care we provide.

Medical Center Directory. We may include certain limited information about you in the medical center directory while you are a patient at the medical center. This information may include your name, location in the medical center, your general condition (e.g., fair, stable, etc.) and your religious affiliation. This is so your family, friends and clergy can visit you in the hospital and generally know how you are doing.

Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care.

Appointments. We may use your information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the individual.

Treatment Alternatives, Health Related Benefits and Services. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives, health related benefits or services that may be of interest to you.

As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law.

• For judicial and administrative proceedings pursuant to legal authority;
• To report information related to victims of abuse, neglect or domestic violence; and
• To assist law enforcement officials in their law enforcement duties;

To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Organ and Tissue Donation. Your health information may be used or disclosed for cadaver organ, eye or tissue donation purposes.

Government Functions. Specialized government functions such as protection of public officials or reporting to various branches of the armed services that may require use or disclosure of your health information.

Workers' Compensation. We may release medical information about you in order to comply with laws and regulations related to Workers' Compensation.

Public Health Risks. We may disclose medical information about you for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.

Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.

Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner to enable them to carry out their lawful duties.

Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official.

YOUR RIGHTS REGARDING HEALTH INFORMATION.

You have the following rights regarding health information we maintain about you:

• The right to request a restriction on certain uses and disclosures or your information as provided by 45 CFR 164.522; however, West Branch Regional Medical Center is not required to agree to a requested restriction;
• The right to obtain a paper copy of the notice of information practices upon request;
• The right to inspect and obtain a copy of your health record as provided for in 45 CFR 164.524;
• The right to amend your health record as provided in 45 CFR 164.526;
• The Right to request that communications of your health information be provided by alternative means or at alternative locations;
• The right to revoke your authorization to use or disclose health information except to the extent that action has already been taken; and
• The right to receive an accounting of disclosures made of your health information as provided by 45 CFR 164.528

COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the West Branch Regional Medical Center or with the Secretary of the Department of Health and Human Services. To file a complaint with the hospital, contact:
Christine Cook, Corporate Compliance and Privacy Officer at 343-3130.
All complaints must be submitted in writing.
You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION.
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written authorization. If you provide us authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care that we provided to you.

Obligations of West Branch Regional Medical Center and Physicians

We are required to:

• Maintain the privacy of protected health information;
• Provide you with this notice of its legal duties and privacy practices with respect to your health information;
• Abide by the terms of this notice;
• Notify you if we are unable to agree to a requested restriction on how your information is used or disclosed;
• Accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations; and
• Obtain your written authorization to use or disclose your health information for reasons other than those listed above and permitted under law.

We reserve the right to change our information practices and to make the provisions effective for all protected health information we maintain. We will make revised notices available to you by posting a copy of the current notice at West Branch Regional Medical Center. On the first page of the notice in the top right hand corner the notice will have the effective date. In addition, each time you register at or are admitted to the West Branch Medical Center for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice then in effect.