How Your Medical Information May Be Used and Disclosed &

How You Can Get Access To This Information

Please review this notice carefully and if you have any questions about this notice, please contact the Executive Director. Effective date of this Notice of Privacy Practices is May 2005. Revised September 2013

WHO WILL FOLLOW THIS NOTICE:  All Health Care Access staff, volunteers, contracted consultants, Board Members, agents, will follow the terms of this notice. They also may share medical information with each other for treatment, payment and health care operations purposes.

OUR PLEDGE REGARDING MEDICAL INFORMATION:  We understand that Protected Health Information (PHI) and your healthcare are personal. We are committed to protecting medical information about you. A record is created of the care and services you receive from this agency. This record is needed to provide the necessary care and to comply with legal requirements. This notice applies to all of the records of your care generated by HCA. This notice will tell about the ways in which HCA may use and disclose your PHI. HCA will not sell or use your PHI for marketing purposes. Also described are your rights and certain obligations we have regarding the use and disclosure of your PHI.

The law requires HCA to:

  • Make sure that your PHI that identifies you is kept private.
  • Inform you of our legal duties and privacy practices with respect to PHI about you; and
  • Follow the terms of the notice that is currently in effect.


The following categories describe different ways HCA uses and discloses PHI. Each category will be explained. Not every possible use or disclosure will be listed. However, all the different ways HCA is permitted to use and disclose information will fall within one of these categories.

Treatment.  We may use and disclose your PHI to provide health care treatment. We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This may include communicating with other health care providers regarding your treatment and coordinating and managing your health care with others. For example:  HCA needs to inform dental providers if you are on blood thinners, as dental procedures can cause bleeding.

Payment.  Since HCA does not bill for any services, your PHI is not used for collection of payment. HCA may use your PHI in payment to providers for services and treatment provided to you. For example:  HCA may verify services you are receiving to a family member who may be helping you with co-pays toward the cost of your care.

Health Care Operations.  We may use and disclose PHI for our health care operations. We may use or disclose your PHI in order to support the business activities of our agency which we call “health care operations”. These health care operations allow us to improve the quality of care we provide and reduce health care costs. For example:  Examples of the way we may use or disclose PHI about you for “health care operations” include, but are not limited to, reviewing the quality of services we provide to you, evaluating our staff, having students train in our office, and conducting or arranging for other business activities.

Your PHI may be used to contact you as a reminder of an appointment you have for treatment at HCA or a provider office.

Your PHI may be used to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Health-Related Benefits and Services.  Your PHI may be used to tell you about health-related benefits or services that may be of interest to you.

Private Accreditation Organizations.  Your PHI may be used to fulfill HCA’s requirements to meet the standards of accreditation organizations such as PANO.

Individuals Involved In Your Care.  With your permission, your PHI may be released to a family member, guardian or other individuals involved in your care. They may also be told about your condition unless you have requested additional restrictions.

As Required By Law.   Your PHI will be disclosed when required to do so by federal, state, or local authorities, laws, rules and/or regulations.

  • If you are involved in a lawsuit or a dispute, your PHI will be disclosed in response to a court or administration order, subpoena, discovery request, or other lawful process by someone else involved in the dispute when we are legally required to respond.

Your PHI will be released if requested by a law enforcement official:

    • In response to a court order, subpoena, warrant, summons or similar process;
    • To identify or locate a suspect, fugitive, material witness, or missing person;
    • About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
    • About a death we believe may be the result of criminal conduct;
    • In emergency circumstances to report a crime; the location of the crime or victims; or the identification, description or location of the person who committed the crime.
  • Your PHI will be released to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
  • Your PHI may be disclosed to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
  • Your PHI may be used and disclosed when necessary to prevent a serious threat to your health and safety and that of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
  • We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, civil, administrative or criminal investigations, inspections, and licensing activities.

Military and Veterans.  If you are a member of the armed forces, your PHI may be released as required by military command authorities. If you are a member of the foreign military personnel, your PHI may be released to the appropriate foreign military authority.

Workers’ Compensation.  If you seek treatment for a work-related illness or injury, we must provide full information in accordance with state-specific laws regarding workers’ compensation claims. Once state-specific requirements are met and an appropriate written request is received, only the records pertaining to the work-related illness or injury may be disclosed.

Public Health Risk.  Your medical information may be used and disclosed for public health activities. These activities generally include the following:

  • To prevent or control disease, injury or disability;
  • To report births and deaths;
  • To report child abuse or neglect;
  • To report reactions to medications or problems with products;
  • To notify people of recalls of products they may be using;
  • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
  • To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

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. This release would be necessary for the following reasons:

  • For the institution to provide you with health care;
  • To protect the health and safety of you and others;
  • For the safety and security of the correctional institution.

Certain Stricter Requirements That We Follow.  Several state laws may apply to your PHI that set a stricter standard than the protections offered under the Federal health privacy regulations. Stricter state law in Pennsylvania will for example, limit us from disclosing medical records containing HIV related information; medical records containing psychiatric and psychological treatment. State law dictates to whom and under what circumstances disclosure is appropriate. Generally, release of this information is contingent upon your specific consent, or pursuant to court order.

Other Uses of Medical Information.  Other uses and disclosures of PHI not covered by this notice or the laws that apply to this facility will be made only with your written permission. If you provide HCA permission to use or disclose your PHI, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose your PHI for the reasons covered in your written authorization. You understand that we are unable to take back any disclosures already made with your permission, and that we are required to retain our records of the care that the facility provided to you.

CHANGES TO THIS NOTICE: We reserve the right to change this notice and make the revised or changed notice effective for PHI we already have about you as well as any information we receive in the future. HCA will post a current copy of the notice with the effective date, in office and on the HCA website. In addition, each time you apply for services with HCA, we will offer you a copy of the current notice in effect.

COMPLAINTS: You will not be penalized for filing a complaint. Please refer to our Grievance Policy.

YOUR RIGHTS: Following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights.

Right to Inspect and Copy.  You have the right to inspect and copy PHI that may be used to make decisions about your care. Except where individual state laws are more stringent, HCA has a minimum of 30 days to act on your request. To inspect and copy PHI that may be used to make decisions about you, you must submit a written request. If you request a copy of the information, we may charge a fee for the cost of copying, mailing or other supplies associated with your request.

We may deny your request to inspect and copy in some limited circumstances. If you are denied access to PHI, you may request that the denial be reviewed. Another licensed health care professional, other than the person who denied your request, will be chosen by HCA to review your request and the denial. The facility will comply with the outcome of the review.

  • A licensed health care professional has determined, in the exercise of professional judgment, that the access requested is reasonably likely to endanger the life or physical safety of the individual or another person.
  • The protected health information makes reference to another person (unless such other person is a health care provider) and a licensed health care professional has determined, in the exercise of professional judgment, that the access requested is reasonably likely to cause substantial harm to such other person.
  • The request for access is made by the individual’s personal representative, and a licensed health care professional has determined, in the exercise of professional judgment, that the provision of access to such personal representative is reasonably likely to cause substantial harm to the individual or another person.

Right to Amend.  If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment to information kept by HCA. Except where individual state laws are more stringent, HCA has a minimum of 60 days to act on your request. To request an amendment, you must submit a written request. You must also provide a reason that supports your request.

Your request for an amendment may be denied if:

  • Your request is not in writing or does not include a reason to support the request;
  • The PHI was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  • The PHI is not part of the PHI kept by or for HCA;
  • The PHI is not part of the information you would be permitted to inspect and copy; or
  • The PHI is accurate and complete.

Right to an Accounting of Disclosures.  You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of your PHI for purposes other than treatment, payment and health care operations. Except where individual state laws are more stringent, HCA has a minimum of 60 days to act on your request.

To request this list or accounting of disclosures:

  • You must submit your request in writing.
  • Your request must state a time period, which may not be longer than six years and may not include dates before May 2005.
  • Your request should indicate in what form you want the list (for example, on paper, electronically).

The first list you request within a 12-month period will be free. For additional lists, we may charge you for the cost of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions.  You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care, like a family member. For example:  You could ask that we not use or disclose information about a surgery you had. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you must make your request in writing. In your request, you must tell us:

  • What information you want to limit;
  • Whether you want to limit our use, disclosure or both;
  • To whom you want the limits to apply, for example, disclosures to your spouse.

Right to Request Confidential Communication. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example:  You can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice. You have the right to a copy of this notice. You may ask us to give you a copy at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

Right to Notification of a Breach of Your PHI. You have the right to and will be notified following a breach of your unsecured PHI or if a security breach occurs involving your PHI.