Patient Privacy and Information Release
Mercy Health Partners is committed to providing you with the highest quality of care and to following all of the various rules, regulations and standards designed to protect you and your rights as a patient. In that regard, we are committed to protecting your rights under the Health Insurance Portability and Accountability Act (HIPAA). This act guarantees your right to maintain health insurance upon changing jobs, your right to have your health information protected from unnecessary use or disclosure without your authorization, your right to access your records and your right to have your health information kept in a safe and secure manner while being maintained in our system or while being used or transmitted electronically from one location to another. Please refer to our "Notice of Privacy Practices" for more detailed information on your rights and MHP's responsibilities under the HIPAA Privacy Regulations.
Do you need a HIPAA Approved Authorization Form to obtain release of a Mercy Health Partners patient's Protected Health Information? If so, print the following form, fill it out completely and have the patient sign. Authorization Form for Release of Patient Information (download times may vary)
How We May Use and Disclose Medical Information About You
We may use and disclose medical information about you for treatment (such as sending medical information about you to a specialist as part of a referral); to obtain payment for treatment (such as sending billing information to your insurance company or Medicare); and to support our healthcare operations (such as comparing patient data to improve treatment methods).
We may use or disclose medical information about you without your prior authorization for several other reasons. Subject to certain requirements, we may give out medical information about you without prior authorization for public health purposes, birth, death, domestic violence, abuse or neglect reporting, health oversight audits or inspections, qualified research studies, funeral arrangements and organ donation, workers compensation purposes or to prevent or lessen serious and imminent health or safety threats or other emergencies. We also disclose medical information when required by law, such as in response to a request from law enforcement in specific circumstances, or in response to valid judicial or administrative orders.
We also may contact you for appointment reminders, or to tell you about or recommend possible treatment options, alternatives, health-related benefits or services that may be of interest to you, or to support fundraising efforts.
If admitted as a patient, unless you tell us otherwise, we will list in the patient directory your name, location in the hospital, your general condition (good, fair, etc.) and your religious affiliation, and will release all but your religious affiliation to anyone who asks about you by name. Your religious affiliation may be disclosed only to a clergy member, even if they do not ask for you by name.
We may disclose medical information about you to a friend or family member who is involved in your medical care or to disaster relief authorities so that your family can be notified of your location and condition.
Other Uses of Medical Information In any other situation not covered by this notice, we will ask for your written authorization before using or disclosing medical information about you. If you chose to authorize use or disclosure, you can later revoke that authorization by notifying us in writing of your decision.
Your Rights Regarding Your Medical Information
In most cases, you have the right to look at or get a copy of medical information that we use to make decisions about your care, when you submit a written request. If you request copies, we may charge a fee for the cost of copying, mailing or other related supplies. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision.
If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we correct the records, by submitting a request in writing that provides your reason for requesting the amendment. We could deny your request to amend a record if the information was not created by us; if it is not part of the medical information maintained by us; or if we determine that the record is accurate. You may appeal, in writing, a decision by us not to amend a record.
You have the right to a list of those instances where we have disclosed medical information about you, other than for treatment, payment, healthcare operations or where you specifically authorized a disclosure, when you submit a written request. The request must state the time period desired for the accounting, which must be less than a 6-year period and starting after April 14, 2003. The first disclosure list request in a 12-month period is free; other requests will be charged according to our cost of producing the list. We will inform you of the cost before you incur any costs. If this notice was sent to you electronically, you have the right to a paper copy of this notice.
You have the right to request that medical information about you be communicated to you in a confidential manner, such as sending mail to an address other than your home, by notifying us in writing of the specific way or location for us to use to communicate with you.
You may request, in writing, that we not use or disclose medical information about you for treatment, payment or healthcare operations or to persons involved in your care except when specifically authorized by you, when required by law or in an emergency. We will consider your request but we are not legally required to accept it. We will inform you of our decision on your request.
All written requests or appeals should be submitted to our Privacy Officer listed at the bottom of this notice.
Registering a Complaint
If you are concerned that your privacy rights may have been violated, or you disagree with a decision we made about access to your records, you may contact our Privacy Officer (listed below). You may also contact the Catholic Healthcare Partners ReportLine, a 24-hour hotline, at 1-888-302-9224.
Finally, you may send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights. Our Privacy Office can provide you the address.
Under no circumstance will you be penalized or retaliated against for filing a complaint.
Privacy Officer:
Mercy Health Partners of NEPA
746 Jefferson Avenue
Scranton, PA 18510
Phone 570-348-7100
Fax 570-340-4880