Notice of Privacy

a. For Public Health Activities. For example, we may release your personal health information about births, deaths and various diseases to government officials in charge of collecting that information, and we give coroners, medical examiners and funeral directors necessary information relating to a death.

b. When Required by Federal, State or Local Law, Judicial or Administrative Proceedings or Law Enforcement. We may release your personal health information for any purpose required by law. For example, we may release your information when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect or domestic violence; when dealing with gunshot and other wounds; or when ordered by the court.

c. For Health Oversight Activities. For example, we will provide information to assist the government when it conducts an audit, investigation inspection or civil or criminal proceeding regarding a health care provider or organization.

d. For Purposes of Organ Donation. We may notify organ procurement organizations to assist them in organ, eye, or tissue donation and transplants.

e. To Avoid harm. In order to avoid a serious threat to the health or safety of a person or the public, we may give your information to law enforcement personnel or person able to prevent or lessen such harm.

f. For Employee Health and Workers Compensation Purposes. We may release your personal health information to your employer when we have provided health care at your employers request to determine workplace-related illness or injury. In most cases you will receive notice that the information is disclosed to your employer. We may release information in order to comply with workers compensation laws.

g. Legal Actions. We may release your personal health information if required to do so by subpoena or discovery request. In some cases, you will have notice of such release.

h. For Research Purposes. In limited circumstances, we may use and disclose your personal health information for research purposes. For example, a research organization may wish to compare outcomes of all patients that received a particular drug by a review of medical records. In cases where your specific authorization has not been obtained, review will be based upon an Institutional Review Board or privacy board, which oversees the research, or by representations of the researchers that limit their use and disclosure of patient information.

i. Business Associates. Certain aspects of our services are performed through contracts with outside people or organizations such as auditing, accreditation, legal services, satisfaction surveys, etc. At times it may be necessary for us to provide your information to one or more of these outside people or organizations who assist us with our health care operations.

j. Fundraising. We may contact you to raise funds for our organization. The money raised through these activities is used to expand and support the health care services and educational programs we provide to the community. If you do not wish to be contacted as part of our fundraising efforts please contact the person listed in Section VII. below.

k. Appointments and Services. We may contact you to provide appointment reminders.

l. Health Products and Services. We may from time to time use your personal health information to communicate with you about health products and services necessary for your treatment, to advise you of new products and services we offer, and to provide general health and wellness information.

B. YOU HAVE THE OPPORTUNITY TO OBJECT TO THESE DISCLOSURES

1. Patient Directories. We may include your name, location in the facility, general condition and religious affiliation, in our patient directory for use by clergy and visitors. If you do not want us to provide this information to clergy and others, you must tell us that you object and fill out the appropriate information.

2. Disclosures to family, friends or others. We may provide your information to a family member, friends, or other person that you indicate is involved in your care or the payment for your health care, unless you object and fill out the appropriate information.

A. The Right to Request Limits on How We Use and Disclose Your Health Information.
You have the right to ask that we limit certain of our uses and disclosures of your information for treatment, payment or health care operations. A restriction request form can be obtained from the Health Management Department. We will carefully consider your request. We are not required to agree to your restriction request, but will attempt to accommodate reasonable requests when appropriate. We retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. If we terminate, we will notify you. You have the right to terminate in writing or orally, any agreed-to restriction by contacting the Health Information Management Department at Fisher-Titus Medical Center, 272 Benedict Avenue, Norwalk, Ohio 44857.

B. The Right to Correct or Update Your Health Information.
You have the right to request in writing that personal health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments, but will carefully consider each. All amendment requests must be in writing, signed by you or your representative, and must state the reasons for the amendment. If an amendment you request is made by us, we may also notify others who work with us and have copies of the uncorrected record, if we believe that such notification is necessary. You may obtain an amendment request form from the Health Information Management Department at Fisher-Titus Medical Center, 272 Benedict Avenue, Norwalk, Ohio 44857.

C. The Right to Access Your Personal Health Information.
You have the right to copy and/or inspect much of the personal health information that we retain on your behalf. All requests for access must be made in writing and signed by you or your representative. We will charge $10.00 for the first ten pages, $.50 per page 11-50 and $.20 per page 51 and over. You may obtain an access request form from the Health Information Management Department at Fisher-Titus Medical Center, 272 Benedict Avenue, Norwalk, Ohio 44857.

D. The Right to Accounting for Disclosures of Your Health Information.
You have the right to receive an accounting of certain disclosures made by us of your personal health information after April 14, 2003. Requests must be made in writing and signed by you or your representative. Accounting request forms are available from the Health Information Management Department at Fisher-Titus Medical Center, 272 Benedict Avenue, Norwalk, Ohio 44857. The first accounting in any 12-month period is free; you will be charged a fee of $10.00 for each subsequent accounting you request within the same twelve-month period.

E. The Right to Choose How We Send Your Information to You.
You have the right to ask that we send information to you at an alternate address. For example, you may ask us to send information to your work address rather than your home address. You can also ask that it be sent by alternate means. For example, you can ask that we send information by fax instead of regular mail. We will agree to your request if we can easily provide it in the format you request.

F. The Right to Get This Notice.
You will be asked to acknowledge that you have received this Notice of Privacy Practices. You have the right to request a paper copy of this notice. You also have a right to get a copy of this notice by e-mail.