PRIVACY NOTICE

Your Rights

Although the records we maintain about your healthcare are the property of Stonewall Jackson Memorial Hospital (SJMH), you do have certain rights concerning these records.

Receive a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.

Receive a copy of your medical record

You can ask to see or get an electronic or paper copy of your medical record.

We will provide a copy or a summary of your medical information, usually within 30 days of your request. We will charge a reasonable, cost-based fee.

Request correction(s) to your medical record

You can ask us to correct medical information about you that you believe is incorrect or incomplete.

We may say "no" to your request, but we'll tell you why, in writing, within 60 days.

Request confidential communications

You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address

We will say "yes" to all reasonable requests

If we are unable to contact you using your requested methods or locations, we may contact you using any information we have.

Ask us to limit what we use or share

You can ask us not to use or share certain medical information for treatment, payment, or our operations. We are not required to agree to your request, and we may say "no" if it would affect your care.

If you pay for a service or healthcare item out-of-pocket in full, you can ask us not to share that information. We will say "yes" unless a law requires us to share that information.

Retrieve a list of those with whom we've shared your information

You can ask for a list (accounting) of the times we've shared your information for six years prior to the date you asked, who we shared it with, and why.

We will include all the disclosures except for those about treatment, payment, and healthcare operations, and certain disclosures (such as any you asked us to make). We'll provide one accounting per year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

To act for you

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and/or make choices about your medical record and care, so long as we have received a copy of that document.

File a complaint if you feel your rights are violated

You can file a complaint if you feel we have violated your rights by contacting us using the information provided in this notice.

You can file a complaint with the US Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Ave, SW, Washington, DC 20201, calling 1-877-696-6775 or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

We will not retaliate against you for filing a complaint.

Your Choices

For certain medical information, you can tell us your choices about what we share. Please tell us if you have a clear preference for how we share your information in the situations described below. In these cases, you have both the right and choice to tell us to:

Share information with your family, close friends, or others involved in or paying for your care.

Share information in a disaster relief situation

Include your information in a hospital directory

If you are not able to tell us your preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In the following cases, we never share your information unless you give us written permission:

Marketing purposes

Sale of your information

Most sharing of psychotherapy notes

Sharing of genetic information

In the case of fundraising:

We may contact you for fundraising efforts, but you can tell us not to contact you again.

We may use or disclose your medical information without your authorization in the following ways:

Treatment
We may use or disclose your medical information to provide your care. For example, we may use your medical information to write a prescription, treat an injury, and/or coordinate x-rays, lab work, or prescriptions. We may also disclose medical information to non-SJMH healthcare providers

Bill for your services
We may use and disclose your medical information to bill and be paid for treatment. For example, we may give your health insurer information about your treatment so your insurer can pay for it. If a bill is overdue, we may give medical information to a collection agency to help collect payment. We may also provide medical information to other healthcare providers, such as ambulance companies, to assist in their billing efforts.

Run our organization
We can use and share your medical information to run our practice, improve your quality of care, provide it to students for education purposes, and to contact you when necessary.

How else can we use or share your medical information?
We are allowed or required to share your information in other ways - usually in ways that contribute to the public good. We have to meet many conditions before we can share your information for these purposes.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Lawsuits and Disputes
We will disclose your medical information when required to do so by international, federal, state, or local law. For example, if you are involved in a lawsuit or a dispute, we will disclose medical information in response to a court or administrative order. We will also disclose medical information in response to a subpoena or discovery request by someone else involved in the dispute. Law enforcement may need your medical information for the following types of disclosures:

To identify or locate a suspect, fugitive or missing person;

To report a victim of a crime under certain limited circumstances;

To report a death believed to be the result of criminal conduct; or

To report a crime committed on SJMH premises.

Workers' Compensation
We may disclose medical information for workers' compensation or similar programs.

Organ and Tissue Donation
If you are an organ or tissue donor, we may release medical information to organizations for organ procurement or organ, eye or tissues transplantation as necessary.

Assist Public Health and Safety Purposes
We may disclose medical information for public health purposes. Some examples of these are:

Reporting births and deaths;

Reporting adverse reactions to medication or safety problems with FDA-regulated products to the federal government;

Helping with and notifying patients of product recalls;

Reporting communicable diseases to health officials;

Reporting abuse, neglect; exploitation or domestic violence;

Preventing disease;

Preventing or reducing a serious threat to anyone's health or safety.

Business Associates
We may disclose medical information to third parties so that they can perform a job we have asked them to do.

Health Oversight Activities
We may disclose medical information to a health oversight agency for authorized government review of the healthcare system, civil rights and privacy laws, and compliance with government programs.

Research
In certain circumstances, we may use and disclose medical information for research purposes. All SJMH research is approved through a special review process to protect patient safety, welfare and confidentiality. This process evaluates a proposed research project and its use of medical information to balance the benefits of research with the need for privacy of medical information. Even without special approval, we may permit researchers to look at records to help them identify patients who may be included in their research project or for similar purposes, so long as they do not remove or take a copy of any medical information.

National Security and Intelligence Activities and Protective Services
We may disclose medical information to authorized federal officials for intelligence and other national security activities or so they may conduct special investigations and provide protection to the President of the United States and other persons.

Special Protections for HIV, Alcohol and Substance Abuse, Mental Health and Genetic Information
Special privacy protections apply to HIV-related information, alcohol and substance abuse and treatment information, mental health information, and genetic information. SJMH will only disclose that information as permitted by applicable state and federal laws.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected medical information.

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

We must follow the duties and privacy practices described in this notice and give you a copy of it.

Not every use or disclosure in a category will be listed. However, use of the ways that we are allowed to use or disclose your medical information should fall within one of the categories.

For more information see: www.hhs.gov/ocr/privacy/hippa/understanding/consumers/noticepp.html/

Changes to the Terms of this Notice

We can change the terms of this notice, and changes will apply to all information we have about you. The new notice will be available upon request, in our facility, and on our web site.

For further information about this Privacy Notice or to file a complaint, please contact our Corporate Compliance Officer at:

Stonewall Jackson Memorial Hospital
230 Hospital Plaza
Weston, WV 26452-8558
Phone: (304) 269-8501
Secure Line: (304) 517-1056

English: Stonewall Jackson Memorial Hospital, its clinics and affiliates, comply with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual preference or gender identity.

ATTENTION: If you speak another language, language assistance services, free of charge, are available to you. Call 1-304-269-8000, and ask to speak with the house supervisor.

Spanish: Stonewall Jackson Memorial Hospital, sus clínicas y afiliados, cumplen con las leyes federales de derechos civiles aplicables y no discriminan por raza, color, origen nacional, edad, discapacidad, sexo, preferencia sexual o identidad de género.
ATENCIÓN: Si usted habla español, servicios de asistencia lingüística, gratis, están a su disposición. Llame al 1-304-269-8000, y pida hablar con el supervisor de la casa.

Chinese: Stonewall Jackson Memorial Hospital, 其診所和分支機構，遵守適用的聯邦民權法律，不基於種族，膚色，國籍，年齡，殘疾，性別，性偏好或性別認同進行歧視。
注意：如果您使用中文，您可以免費獲得語言協助服務。 請致電1-304-269-8000, 並要求與房主監說話。