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Notice of Privacy Practices

Notice of Privacy Practices Geisinger Health System*

Notice of Privacy Practice (“Notice”)
Effective September 21, 2013

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.

We are required by law to maintain the privacy of Protected Health Information (“PHI”) and to provide Individuals with notice of the legal duties and privacy practices of the Covered Entities of the Geisinger Health System with respect to PHI, and to notify affected individuals following a breach of unsecured PHI.

If you have any questions about this Notice, you may ask a member of the staff where you receive health care services. You may also contact our Privacy Officer at (570) 271-7360.

You may obtain our most current Notice by visiting our website at, by calling or writing to our Privacy Officer to request that a copy be sent to you in the mail, or by asking for it when you come in for an appointment. The address for our Privacy Officer is provided on the last page of this Notice.

Uses and disclosures we are permitted or required to make

The following is a description of the types of Uses and Discloses of your PHI that we are permitted or required to make. Not every Use or Disclosure possible is listed, but all of the ways that we are permitted to Use and Disclose your PHI will fall within one of these general categories.

We will Use and Disclose your PHI to provide your health care and any related services. This includes Disclosure of your PHI to doctors, hospitals, pharmacies and other third parties who are involved in your care. For example, we will Disclose your PHI to another physician to whom you have been referred, the physician who referred you to us, or a home health agency that will be caring for you. We will Use your PHI during continuum of care rounds which may include, without limitation, physicians, nurses, care managers, social workers, pharmacists, physical therapists, spiritual care workers and nutrition staff who are involved in your care.

We will Use and Disclose your PHI so that we may bill and payment may be collected for the health care services you receive. This includes activities such as communicating your PHI to an insurance company.

Healthcare Operations
We will Use and Disclose your PHI as necessary for health care operations. For instance, we serve the region by participating in medical education programs. We may Disclose your PHI to the students and faculty of such programs. We may call your name in our waiting room when your doctor or other provider is ready to see you.

Other state and federal laws further limit our Uses and Disclosures even in the case of Treatment, Payment or Health Care Operations of those medical records of a sensitive nature, including HIV related records, records of alcohol or substance abuse treatment, and mental health records. We will Use and Disclose your PHI only in compliance with these more restrictive laws.

Appointment Reminders
We may call you on the telephone to remind you of an upcoming appointment. We may leave you a message that includes the date, time and general information about an upcoming appointment on your telephone answering device. We may send you an appointment reminder in the mail.

Patient Reunions
We may hold reunions for various patient groups to celebrate their success in treatment. If you are or were part of such a patient group, we may Use your PHI to invite you.

Treatment Alternatives/Other Health-Related Benefits and Services
We may Use or Disclose your PHI to contact you to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Fund Raising
We may use or disclose certain information for the purposes of fundraising for Geisinger Health System Foundation. The money raised will be used to expand and improve the services and programs we provide to the community. You are free to opt out of solicitation at any time and your decision will have no impact on your treatment or payment for services.

Hospital Directory
Unless you tell us not to, we will include certain information about you in the hospital directory if you are admitted to one of our hospitals. This information may include your name, location in the hospital, your general condition, your religious affiliation and whether you wish to have our Spiritual Care chaplains visit you.

This information may also be Disclosed to people who ask for you by name such as your relatives, friends and the media. Your religious affiliation may be given to community clergy even if they don't ask for you by name.

Spiritual Care Staff
Our doctors and other health care providers work with our Spiritual Care chaplains as part of the treatment team at our hospitals, unless you tell us that you do not want our Spiritual Care chaplains to be involved. Unless you tell us otherwise, Spiritual Care chaplains may call on you during your hospital stay.

Individuals Involved in Your Care
We may Disclose your PHI to those people who you tell us you would like to involve in your care, such as family members and friends.

As Required By Law or Legal Process
We will Disclose your PHI when we are required to do so by local, state or federal law or process of law.

To Avert a Serious Threat to Health or Safety
We may Use or Disclose your PHI to prevent a serious threat to your health and safety, or the health and safety of others.

Organ and Tissue Donation
We may Disclose the PHI of organ donors to organizations that assist with such donations.

Military and Veterans
If you are or were a member of the military, we may Disclose your PHI subject to applicable law, rule, regulation and our policies.

Workers’ Compensation
We may Disclose your PHI for purposes of handling your workers compensation claims.

Public Health Activities
We may Disclose your PHI to public health entities as authorized by law. Such Disclosures include (but are not limited to) reports of births and deaths, and child or elder abuse and neglect.
A-770-127-F Rev. 9/13 ah

Health Oversight Activities
We may Disclose your PHI to agencies of the government for activities authorized by law. These activities include monitoring health care systems and participation in government programs.

Lawsuits and Disputes
If you are involved in a lawsuit or other dispute, we may Disclose your PHI in response to documents such as a court order or when certain other requirements are met.

Law Enforcement
We may Disclose your PHI if asked to do so by a law enforcement official for reasons including (but not limited to) identifying or locating a suspect, witness or missing person or investigating criminal activity.

Coroners, Medical Examiners and Funeral Directors
We may Disclose certain PHI to a coroner or medical examiner. We may also Disclose certain PHI about deceased patients to funeral directors so that they may carry out their duties.

If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may Disclose your PHI to the respective correctional institution or law enforcement official in accord with applicable law, rule, regulation and our policies.

Business Associates
Some of the services we provide are performed through contractual relationships with outside parties or business associates. These services may include (but are not limited to) financial, auditing and legal. We ask our business associates to sign an agreement in an effort to make sure that all PHI is appropriately safeguarded.

We may Use or Disclose your PHI for certain research purposes when such research is approved by an Institutional Research Review Board, as appropriate.

Receiving Payment for PHI
Unless allowed by law, we may not receive payment directly or indirectly for your PHI without your authorization.

You have rights regarding your PHI.

Your Right to Inspect and Copy
You have the right to inspect and receive a copy of your PHI that may be Used to make decisions about your care. To do so, you must complete the appropriate Authorization form and present it to Health Information Management Department. We have provided the address for the Health Information Management Department on the last page of this Notice. You will be charged a fee for photocopying.

You may also request a copy of your PHI in electronic format or to direct us to transmit it to another entity or individual.

We may deny your request to inspect and receive a copy of your PHI in very limited circumstances. If you are so denied, in some cases, you may request that such denial be reviewed. We will comply with the outcome of such review.

Your Right to Amend
If you feel that PHI that we have about you is incorrect or incomplete, you may ask us to amend or change such incorrect PHI. You have the right to request an amendment for so long as your PHI is kept by or for us. Please contact our Privacy Officer at
(570) 271-7360 to make such a request.

Your Right to an Accounting of Disclosures
You have the right to request an accounting of Disclosures. This is a list of Disclosures that we made of your PHI to entities outside of Geisinger Health System. Please contact our Privacy Officer at (570) 271-7360 to make such a request.

Your Right to Request Notification
We will notify you of certain unpermitted Uses or Disclosures that have occurred. This will be done by mail or other means if necessary.

Your Right to Request Restrictions
You have the right to request restrictions on the PHI we Use or Disclose about you for treatment, payment and health care operations. We are not required to agree to your request, and generally, we will not accept requests for such limitations.

As required by law, if you have paid out-of-pocket for a healthcare service or item, you have the right to ask us to not tell your insurance company about such service or item for purposes other than treatment. We will not share the PHI regarding such care with your insurer for purposes of payment or health care operations.

Your Right to Request Confidential Communications
You have the right to make a reasonable request that we communicate with you regarding your PHI in a certain way or at a certain location. Such reasonable requests may be limited to, when appropriate, how information as to payment for services we provide to you will be handled. We may require you to make this request in writing to the manager of your care site.

Your Right to a Paper Copy of this Notice
You have a right to obtain a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. You may obtain a paper copy of this Notice at the registration desk at your next appointment.

When you complete an authorization form that complies with the law, we will Disclose your PHI as you have directed.  For example, if you choose to participate in a health information exchange and sign an authorization, we will take steps to allow Disclosure of your PHI to the health information exchange.

Changes to this notice

We may change this Notice at any time. We may make the revised or changed Notice effective for PHI we already have as well as any PHI we receive in the future. We will post a current copy of this Notice in our hospitals and clinics. On the first page of the Notice, in the top right corner, you will find the effective date of that Notice.

If we make a material change to Uses and Disclosures, your rights, our legal duties or other privacy practices stated in this Notice, we will promptly revise and distribute our changed Notice. Except when required by law, a material change to any term of this Notice may not be implemented prior to the effective date of the revised Notice.


If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or the United States Secretary of Health and Human Services. We have provided both addresses on the last page of this Notice. To file a complaint with our Privacy Officer, please call (570) 271-7360.


Other uses for your PHI

Other Uses and Disclosures of your PHI not covered by the categories included in this Notice or applicable laws, rules or regulations will be made only with your written permission or authorization.

If you provide us with such written permission, you may revoke it at any time.

We are not able to take back any Uses or Disclosures that we already made with your authorization.

We are required to retain your PHI regarding the care and treatment that we provided to you.

We are required to abide by the terms of this Notice.


The address for our Privacy Officer is:
System Privacy Office
MC 43-14 100
North Academy Avenue Danville, PA 17822

The address for Health Information Management Department is:
Health Information Management Department
Medical Reports MC 13-11
100 North Academy Avenue Danville, PA 17822

The address for the Department of Health and Human Services is:
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201


* Throughout this Notice, the acronym "GHS" or the terms "System," "Geisinger" or "Geisinger Health System" shall refer to those corporate affiliates within the System which are involved in the provisions of health care services and related support services. The Geisinger Health System is comprised of Geisinger Health System Foundation ("Foundation") as parent and all subsidiary corporate entities comprising the System.
Although Geisinger Health System Foundation does not provide medical care of any type or employ physicians, it is the corporate parent of Geisinger Medical Center, Geisinger Clinic and Geisinger Wyoming Valley Medical Center, each of which is an individual corporate entity legally separate and distinct from Geisinger Health System Foundation. The below listed separate corporate entities are among those that are participating in an organized health care arrangement. The legally separate corporate parent, Geisinger Health System Foundation, is also participating in such organized health care arrangement. These separate legal entities may share protected health information with each other as necessary to carry out treatment, payment or health care operations relating to the organized health care arrangement unless otherwise limited by law, rule or regulation.

Geisinger Clinic (all sites)Mountain View Care Center
Geisinger Medical Center (including Geisinger-Shamokin Area Community Hospital Campus)Community Medical Care, Inc.
Geisinger Wyoming Valley Medical CenterGeisinger System Services
Geisinger Community Health ServicesGeisinger Assurance Company, Ltd
MarworthGeisinger Medical Management Corporation
Geisinger-Bloomsburg Health Care CenterGeisinger Health Plan
Columbia-Montour Home Health Services/Visiting Nurses Association, Inc. d/b/a Geisinger-Bloomsburg Physicians ServicesGeisinger Indemnity Insurance Company
Community Medical CenterGeisinger Insurance Corporation - Risk Retention Group
Community Medical Center Healthcare SystemGeisinger Quality Options, Inc.

This Notice of Privacy Practices applies to all entities except Marworth, Geisinger Health Plan, Geisinger Indemnity Insurance Company, and Geisinger Quality Options, Inc. To request the Notice of Privacy Practices for Marworth, Geisinger Health Plan, or Geisinger Indemnity Insurance Company, please contact our Privacy Officer at (570) 271-7360.

Unless we provide you with a different Notice and except as provided above, this Notice will apply to all entities that we may purchase or affiliate with in the future.

© Geisinger Health System