To our patients,

This notice describes how health information about you (as a patient of this facility) may be used and disclosed, and how you can gain access to your health information. This is required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Our Commitment To Your Privacy

Our hospital is dedicated to maintaining the privacy of your health information. We are required by law to maintain the confidentiality of your health information.

We realize that these laws are complicated, but we must provide you with the following information:

Use and Disclosure of your Health Information in certain Special Circumstances

The following circumstances may require us to use or disclose your health information:

1. To public health authorities and health oversite agencies that are authorized by law to collect information.
2. For lawsuits and similar proceedings in response to a court or administrative order.
3. If required to do so by a law enforcement official.
4. When necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public.
5. If you are a member of the U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
6. To federal officials for intelligence and national security activities authorized by law.
7. To correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.
8. For Workers Compensation and similar programs.

Your Rights Regarding your Health Information

1. You can request that our hospital communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. We will accommodate reasonable requests.
2. You can request a restriction in our use or disclosure of your health information for treatment, payment, or health care operations. Additionally, you have the right to request that we restrict our disclosure of your health information to only certain individuals involved in your care or the payment of your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.
3. You have the right to inspect and obtain a copy of the health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to: Edgewood Surgical Hospital, 239 Edgewood Drive Extension, Transfer, PA 16154.
4. You may ask us to amend your health information if you believe it is incorrect or incomplete, and as long as the information is kept by or for our facility. To request an amendment, your request must be made in writing and submitted to: Edgewood Surgical Hospital, 239 Edgewood Drive Extension, Transfer, PA 16154. You must provide us with a reason that supports your request for amendment.
5. Right to copy of this notice. You are entitled to receive a copy of this Notice of Privacy Practices. You may ask us to give you a copy of this Notice at any time. To obtain a copy of this Notice, contact our registration receptionist.
6. Right to file a complaint. If you believe your privacy rights have been violated, you may file a complaint with our facility or with the Secretary of the Department of Health and Human Services. To file a complaint with our facility, contact Edgewood Surgical Hospital, Attention: HIPAA Officer, 239 Edgewood Drive Extension, Transfer, PA 16154 or call (724) 646-0400.
7. Right to provide authorization for other uses and disclosures. Our facility will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.

If you have questions regarding this notice or our health information privacy policies, please contact Edgewood Surgical Hospital, 239 Edgewood Drive Extension, Transfer, PA 16154 or call (724) 646-0400.