Notice of Privacy Practices (HIPAA)

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. Three Rivers Behavioral Health will be referred to in this Notice of Privacy Practices ("Notice") as "Three Rivers". This Notice is given to you by a Three Rivers Facility to describe the ways in which Three Rivers may use and disclose your medical information (called "protected health information" or "PHI") and to notify you of your rights with respect to PHI in the possession of Three Rivers. Three Rivers protects the privacy of PHI, which also is protected from disclosure by state and federal law. In certain circumstances, pursuant to this Notice, patient authorization or applicable laws and regulations, PHI can be used by Three Rivers or disclosed to other parties. Below are categories describing these uses and disclosures, along with some examples to help you better understand each category.

USES AND DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS: Three Rivers may use or disclose your PHI for the purposes of treatment, payment and health care operations, described in more detail below, without obtaining written authorization from you.

FOR TREATMENT: Three Rivers may use and disclose PHI in the course of providing, coordinating, or managing your medical treatment, including the disclosure of PHI for treatment activities at another healthcare facility. These types of uses and disclosures may take place between physicians, nurses, technicians, students, and other health care professionals who provide your health care services or are otherwise involved in your care. For example, if you are being treated by a primary care physician, that physician may need to use/disclose PHI to a specialist physician whom he or she consults regarding your condition, or to a nurse who is assisting in your care.

FOR PAYMENT: Three Rivers may use and disclose PHI to collect payment for the health care services provided to you. For example, Three Rivers may need to give PHI to your health plan to be reimbursed for the services provided to you. Three Rivers may also disclose PHI to their business associates, such as billing companies, claims processing companies, and others that assist in processing health claims. Three Rivers may also disclose PHI to other health care providers and health plans for the payment activities of such providers or health plans.

FOR HEALTH CARE OPERATIONS: Three Rivers may use and disclose PHI as part of their operations, including for quality assessment and improvement, such as evaluating the treatment and services you receive and the performance of our staff in caring for you. Other activities include hospital training, underwriting activities, compliance and risk management activities, planning and development, and management and administration. Three Rivers may disclose PHI to doctors, nurses, technicians, students, attorneys, consultants, accountants, and others for review and learning purposes. These disclosures help make sure that Three Rivers is complying with all applicable laws and are continuing to provide health care to patients at a high level of quality. Three Rivers may also disclose PHI to other health care facilities plans for certain of their operations, including their quality assessment and improvement activities, credentialing and peer review activities, and health care fraud and abuse detection or compliance, provided that those other facilities and plans have, or have had in the past, a relationship with the patient who is the subject of the information.

FOR SHARING PHI AMONG THREE RIVERSAND PROFESSIONAL STAFF: Three Rivers works together with physicians and other care providers on their professional staff to provide medical services to you when you are a patient at a Three Rivers Facility. Three Rivers and members of their respective professional staff will share PHI with each other as needed to perform their treatment, payment and health care operations activities.

OTHER USES AND DISCLOSURES FOR WHICH AUTHORIZATION IS NOT REQUIRED: In addition to using or disclosing PHI for treatment, payment and health care operations, Three Rivers may use and disclose PHI without your written authorization under the following circumstances:

AS REQUIRED BY LAW AND LAW ENFORCEMENT: Three Rivers may use or disclose PHI when required by law, Three Rivers also may disclose PHI when ordered to in a judicial or administrative proceeding, in response to subpoenas or discovery requests, to identify or locate a suspect, fugitive, material witness, or missing person, when dealing with gunshot and other wounds, about criminal conduct, to report a crime, its location or victims, or the identify, description or location of a person who committed a crime, or for other law enforcement purposes.

FOR PUBLIC HEALTH ACTIVITIES AND PUBLIC HEALTH RISKS: Three Rivers may disclose PHI to government officials in charge of collecting information about births and deaths, preventing and controlling disease, reports of child abuse or neglect and of other victims of abuse, neglect, or domestic violence, reactions to medications or product defects or problems, or to notify a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading a disease or condition.

FOR HEALTH OVERSIGHT ACTIVITIES: Three Rivers may disclose PHI to the government for oversight activities authorized by law, such as audits, investigations, inspections, licensure or disciplinary actions, and other proceedings, actions or activities necessary for monitoring the health care system, government programs, and compliance with civil rights laws.

CORONERS, MEDICAL EXAMINERS, AND FUNERAL DIRECTORS: Three Rivers may disclose PHI to coroners, medical examiners, and funeral directors for the purpose of identifying a decedent, determining a cause of death, or otherwise as necessary to enable these parties to carry out their duties consistent with applicable law.

ORGAN, EYE, AND TISSUE DONATION: Three Rivers may release PHI to organ procurement organizations to facilitate organ, eye, and tissue donation and transplantation.

RESEARCH: Under certain circumstances, Three Rivers may use and disclose PHI for medical research purposes.

TO AVOID A SERIOUS THREAT TO HEALTH OR SAFETY: Three Rivers may use and disclose PHI to law enforcement personnel or other appropriate persons, to prevent or lessen a serious threat to the health or safety of a person or the public.

SPECIALIZED GOVERNMENT FUNCTIONS: Three Rivers may use and disclose PHI of military personnel and veterans under certain circumstances, and may also disclose PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities, and for the provision of protective services to the President or other authorized persons or foreign heads of state or to conduct special investigations.

WORKERS' COMPENSATION: Three Rivers may disclose PHI to comply with workers' compensation or other similar laws that provide benefits for work-related injuries or illnesses.

HEALTH-RELATED BENEFITS AND SERVICES; LIMITED MARKETING ACTIVITES: Three Rivers may use and disclose PHI to inform you of treatment alternatives or other health-related benefits and services that may be of interest to you, such as disease management programs.

DISCLOSURES TO YOU OR FOR HIPAA COMPLIANCE INVESTIGATIONS: Three Rivers may disclose your PHI to you or to your personal representative, and are required to do so in certain circumstances described below in connection with your rights of access to your PHI and to an accounting of certain disclosures of your PHI Three Rivers must disclose your PHI to the Secretary of the U.S. Department of Health and Human Services (the "Secretary") when requested by the Secretary in order to investigate compliance with privacy regulations issued under the federal Health Insurance Portability and Accountability Act of 1996 ("HIPAA")

CONFIDENTIALITY OF ALCOHOL & DRUG ABUSE RECORDS: Three Rivers may not say to a person outside of the program that a patients attends our program or disclose and information identifying a patient as an alcohol or drug user unless: 1) you have signed a consent 2) disclosure is allowed by a court order, 3) disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation.

USES AND DISCLOSURES TO WHICH YOU MAY OBJECT: You may object to the following uses and disclosures of PHI that Three Rivers may make:

PATIENT DIRECTORIES: Your information may be included in a patient directory that is available only to those individuals whom you have identified as contacts during your hospital stay. You will receive a unique patient code that can be provided to these contacts.

OTHER USES AND DISCLOSURES OF PHI FOR WHICH AUTHORIZATION IS REQUIRED: Other types of uses and disclosures of your PHI not described above will be made only with your written authorization, which you have the limited right to revoke in writing.

REGULATORY REQUIREMENTS: Three Rivers is required by law to maintain the privacy of your PHI, to provide individuals with notice of their legal duties and privacy practices with respect to PHI, and to abide by the terms described in this Notice. Three Rivers reserves the right to change the terms of this Notice and of its privacy policies, and to make the new terms applicable to all of the PHI it maintains. Before Three Rivers makes an important change to its privacy policies, they will promptly revise this Notice and post a new Notice in registration and admitting areas. You have the following rights regarding your PHI:

You may request that Three Rivers restrict the use and disclosure of your PHI. Three Rivers is not required to agree to any restrictions you request, but if the entity does so it will be bound by the restrictions to which it agrees except in emergency situations.

You have the right to request that communications of PHI to you from Three Rivers be made by particular means or at particular locations. For instance, you might request that communications be made at your work address, or by e-mail rather than regular mail. Your requests must be in writing and sent to the Privacy Officer. Three Rivers will accommodate your reasonable requests without requiring you to provide a reason.

Generally, you have the right to inspect and copy your PHI in the possession of Three Rivers if you make a request in writing to the applicable Three Rivers Hospital's Medical Records Department within thirty (30) days of receiving your request (unless extended by an additional thirty (30) days), Three Rivers will inform you of the extent to which your request has or has not been granted. In some cases, Three Rivers may provide you a summary of the PHI you request if you agree in advance to such a summary and any associated fees. If you request copies of your PHI or agree to a summary of your PHI, Three Rivers may impose a reasonable fee to cover copying, postage, and related costs. If Three Rivers denies access to your PHI, it will explain the basis for denial and your opportunity to have the denial reviewed by a licensed health care professional (not involved in the initial denial decision) designated as a reviewing official. If Three Rivers does not maintain the PHI you request, if it knows where that PHI is located it will tell you how to redirect your request.

If you believe that your PHI maintained by Three Rivers contains an error or needs to be updated, you have the right to request that the entity correct or supplement your PHI. Your request must be made in writing to the local Medical Records Department and it must explain why you are requesting an amendment to your PHI. Within sixty (60) days of receiving your request (unless extended by an additional thirty (30) days), Three Rivers will inform you of the extent to which your request has or has not been granted. Three Rivers generally can deny your request if your request relates to PHI: (i) not created by Three Rivers; (ii) that is not part of the records Three Rivers maintains; (iii) that is not subject to being inspected by you; or (iv) that is accurate and complete. If your request is denied, Three Rivers will give you a written denial that explains the reason for the denial and your rights to: (i) file a statement disagreeing with the denial; (ii) submit a request that any future disclosures of the relevant PHI be made with a copy of your request and Three River's denial attached, if you do not file a statement of disagreement; and (iii) complain about the denial.

You generally have the right to request and receive a list of disclosures of your PHI Three Rivers has made during the six (6) years prior to your request (but not before April 14, 2003). The list will not include disclosures (i) for which you have provided a written authorization; (ii) for treatment, payment, and health care operations; (iii) made to you; (iv) for an Three Rivers patient directory or to persons involved in your health care; (v) for national security or intelligence purposes; (vi) to correctional institutions or law enforcement officials; or (vii) of a limited data set You should submit any such request to the Privacy Officer, and within sixty (60) days of receiving your request (unless extended by an additional thirty (30) days), Three Rivers will respond to you regarding the status of your request The entity will provide the list to you at no charge, but if you make more than one request in a year you will be charged $25.00 for each additional request.

You have the right to receive a paper copy of this notice upon request even if you have agreed to receive this notice electronically. To obtain a paper copy of this notice, please contact the Privacy Officer.

You may complain to Three Rivers if you believe your privacy rights with respect to your PHI have been violated by contacting Three Rivers’ Privacy Officer and submitting a written complaint. Three Rivers will not penalize you or retaliate against you for filing a complaint regarding their privacy practices.

You also have the right to file a complaint with the Secretary of the Department of Health and Human Services at 200 Independence Avenue, S.E., Washington, DC 20201.

If you have any questions about this notice, please contact Three Rivers Health Administrator, or write to: 4043 Irene St, West Mifflin, PA 15122