Notice of Privacy Practices
When this notice refers to “we” or “us,” it means Braxton County Memorial Hospital, Inc. (“BCMH”).
It also means the employees of BCMH, our clinic and home health services, the physicians who practice medicine in the hospital, and all of the other health care providers who join with BCMH in providing you with this notice.
Each time you are a patient at BCMH, a record of your visit is made. Although this record belongs to BCMH, you have certain rights in regard to the information that is collected about you. In addition, we have certain legal responsibilities to you in how we use and disclose your health information. We understand that health information is personal and that protecting your information is important. This notice will explain your rights and our responsibilities in regard to protected health information that is made, collected and maintained at BCMH. It will also tell you how we may use and disclose your protected health information. If you have any questions about this notice or our privacy practices, please contact our Privacy Office at (304) 364-1143.
Your health information rights
have the right to:
how your health information may be used or disclosed without your express
notice will describe those situations and provide you with examples.
a paper copy of this Notice of Privacy Practices upon request.
if you receive this notice electronically, you may ask for a written copy.
to inspect and copy our record of your health information.
may make a written request to inspect or copy your medical chart. We may deny
your request in certain circumstances; for example, if access to the information
would be harmful to you or someone else, or the law does not allow you to have
access to the information. If that happens, you can ask us to have the denial
reviewed. Unless the denial is based upon a law that does not allow you access
to the record, we will arrange to have the denial reviewed by a health care
professional who did not participate in the original decision. If you are given
a copy of your records, we will charge you our regular fee for making the copy
and sending it to you. For more information about inspecting or copying your
health care record, call our Privacy Office at (304) 364-1143.
a restriction on certain uses and disclosures of your information.
can use and disclose your health information without your authorization for
treatment and payment purposes and for health care operations. However, you may
make a written request that we limit our use or disclosure when carrying out
these activities. We are not required to comply with your request, but if we do
agree, we will restrict our use and disclosure unless the information is needed
to provide you with emergency care. For more information on how to request a
restriction, call our Privacy Office at (304) 364-1143.
an amendment to your health care record. You
may make a written request asking that we make changes to your health care
record. We are not required to make your requested amendments. For example, your
request may be denied if we did not create the record, if it is not part of our
records, if it is a record that you do not have a right to access, or if we
believe the record is accurate and complete. However, if we deny your request,
we will give you the reason for the denial in writing. If you disagree with the
denial, you may submit a written statement of your disagreement, which we will
file and distribute with future disclosures of the record you wanted to amend.
For more information about how to request amendments and the process we will
follow, call our Privacy Office at (304) 364-1143.
an accounting of disclosures of your health information that you have not
expressly authorized. The
law requires us to keep track of certain disclosures we make of your health
information, although we are not required to keep track of all of the
disclosures. For example, we do not have to keep track of disclosures we make to
you, or disclosures for treatment, payment or health care operations.
We also do not keep track of disclosures made for national security, for
the facility directory, or to family members or other people involved in your
care, to law enforcement officials or correctional institutions that have you in
custody, to health oversight agencies, incidental disclosures, disclosures in a
limited data set, or in response to an authorization you have signed. You may
make a written request for a list of the disclosures we have tracked. The list
will include the date of each tracked disclosure, the name of the party who
received your information, a brief description of what was disclosed, and the
purpose of the disclosure. Your request can ask for disclosures made as far back
as six years before the request, but cannot ask for disclosures made before
April 14, 2003. We will notify you of the cost involved, if any charges are
going to be made to you, so that you can choose to withdraw your request before
costs are incurred. For more information on what disclosures we track and how to
request a list, call our Privacy Office at (304) 364-1143.
confidential communications of your health information by receiving it in a
certain manner or at a certain location. You
may make a written request that we communicate with you about your medical
information in a certain way or at a certain location.
We will try to accommodate all reasonable requests.
If you would like more information about how to request confidential
communications, call our Privacy Office at (304) 364-1143.
Revoke an authorization to use or disclose health information except to the extent that action has already been taken. You may sign a written authorization requesting that we disclose your health information to someone else. If you later decide that you want to cancel your authorization, you should tell us in writing that you want to revoke the authorization. Except for disclosures that have already been made or mailed, we will comply with your request. For more information about signing an authorization or revoking one, call our Privacy Office at (304) 364-1143.
Our responsibilities to you
are required to:
the privacy of your health information.
you with notice of our legal duties and privacy practices.
by the terms of our Notice of Privacy Practices.
How we may use and disclose your health information without your written authorization
and state laws allow us to use and disclose your medical information without
your written authorization in the following ways.
HAVE PROVIDED YOU WITH SOME EXAMPLES FOR EACH CATEGORY OF USE OR DISCLOSURE, BUT
CANNOT LIST EVERY PERMITTED USE OR DISCLOSURE.
if you have any questions about specific uses or disclosures, please call our
Privacy Office at (304) 364-1143.
For treatment, payment, or health care operations
will use your health information for treatment purposes.
For example: Information obtained by a nurse, physician, or other member of your
health care team will be written in your medical record, and the record will be
shared by all the people who are caring for you. By sharing information, they
can plan your treatment, follow your progress, and arrange for your care after
you leave BCMH.
We also may give your family physician, referring physician, or other health care providers copies of records they need to treat you once you are discharged from BCMH.
will use your health information for payment.
For example: A bill, or portions of your hospital chart, may be sent to your health insurance company to help it process payment for your visit. These records usually include information about your diagnosis, procedures you had and supplies that were used to treat you.
will use your health information for regular health care operations.
of the medical staff, risk and safety managers, hospital lawyers and members of
quality improvement teams may use information in your medical record to assess
the quality of care given to you and to do claims reviews. We may use your
health information, along with the information of other patients, to create data
that does not identify any of you in order to compare outcomes of care.
information may be used to improve the quality and effectiveness of care, to
respond to concerns you have raised, and to address safety issues.
also may give your health information to business associates that provide a
service to the hospital. Examples include pharmacy and equipment vendors,
outside laboratories, BCMH-affiliated research teams, copy services, collection
agencies and financial consultants. In these cases, we will only give our
business associates the pieces of your health information that they need to do
the job we have asked them to do. We will also require our business associates
to have appropriate safeguards to protect the privacy of your information.
For public health activities
may disclose your health information to public health agencies.
example: Records of the birth or death of patients will be reported to the state
agency that keeps a vital statistics registry. We will also provide information
to other public health agencies that are authorized by law to collect medical
information for public health investigations or to control disease or prevent
will disclose your health information to appropriate authorities in cases of
suspected abuse or neglect.
health care providers at BCMH suspect that you have been the victim of child or
elder abuse or neglect, we will provide your health information to the proper
state agency or agencies authorized to conduct an investigation.
will disclose your health information to the Food and Drug Administration (FDA)
For example: If
you get hurt by or have an unexpected reaction to an FDA-regulated product, we
will report the event to the FDA, so that it can investigate, monitor or track
the safety of the product.
will report cases of communicable disease to the proper government agencies.
will follow the West Virginia law that requires us to notify the Health
Department when a patient is diagnosed with a serious disease that can be spread
to others, such as HIV or tuberculosis.
may disclose health information to an employer when required by law.
an employer sends its employee to BCMH to evaluate whether the employee has a
work-related injury that the employer must report, we may provide the results of
the evaluation to the employer.
For health oversight activities, judicial and administrative procedures, and law
will disclose your health information to health oversight agencies as required
may disclose your health information to a government benefit program so that it
can determine your eligibility. We also may disclose your health information to
a government agency that is auditing the hospital or inspecting it to determine
if the hospital is complying with program standards.
may disclose your health information in response to a court order, subpoena, or
in the course of a judicial or administrative proceeding.
we receive a valid order from a court requiring us to disclose your health
information, we will comply with the order, but will only disclose the
information specifically required by the order.
we receive a subpoena or other lawful process, we will not disclose your health
information until we receive satisfactory assurance that you have been sent
notice of the request, and have not filed objections, or that other steps have
been taken to protect the health information from being used improperly.
may disclose your health information to law enforcement officials under certain
you are the victim of a gunshot or other type of injury that must be reported to
law enforcement, we will disclose your health information as required by law. In
the case of a medical emergency, we may disclose your health information to law
enforcement officials if disclosure appears necessary to alert law enforcement
to the commission or location of a crime, or the identity of the perpetrator.
you are the suspected victim of a crime that does not have to be reported, we
may disclose your health information to a law enforcement official who requests
the information, but (1) only if you agree, or (2) if you are unavailable or
incapacitated at the time, only if the law enforcement official tells us that
the information is needed quickly for law enforcement activity and is not
intended to be used against you.
will disclose your information under these
circumstances only if we believe at the time that disclosure is in your best
may also disclose your health information to a law enforcement official for the
purpose of identifying or locating a suspect, fugitive, material witness, or
missing person, although we will only disclosure limited information and will
not disclosure information related to your DNA or blood-typing.
we receive a grand jury subpoena, court order, or a warrant for your health
information, we may disclose it if the information requested is limited in scope
and is material to a legitimate law enforcement investigation.
may disclosure your health information if we believe it is relevant to or
constitutes evidence of criminal activity on BCMH’s premises.
In cases of death, organ or tissue donation, and research
disclose health information to coroners, medical examiners, and funeral
directors as required by law.
If the Medical Examiner requests health information to help determine the
cause of a patient's death, we will provide the requested information.
Likewise, if a patient has died with a blood-borne disease, such as HIV,
we will inform the funeral director who is handling the body, so that
precautions may be taken to avoid the spread of the disease.
disclose health information necessary to carry out organ or tissue donation.
We will follow federal and state laws that require us to contact an organ
procurement agency whenever a patient is dying or has died and to share relevant
information with the agency so that it can determine if the patient is a
candidate for organ or tissue donation.
disclose health information for certain types of research.
We may disclose health information to a researcher, whose project has met
the safeguards and requirements of a research approval board after it has
considered the patient's need for privacy, as long as the information will be
protected and will not be used for any other purpose.
To avert a threat to health or safety
may use or disclose your health information if we believe, in good faith, that
the use or disclosure will prevent or lessen a serious and imminent threat of
harm to the health and safety of a person or the public.
you have suffered a head injury that makes you unable to safely drive a motor
vehicle, we may disclose your relevant health information to the Department of
For specialized government functions
may disclose your health information, when appropriate, to assure the proper
execution of a military mission, for national security and intelligence, and for
the protection of the president of the United States or heads of state.
the president of the United States visits Charleston and requires care at BCMH,
we may disclose your health information if it is deemed to be necessary to
protect the safety of the president during his visit.
may disclose your health information to a correctional institution if you are an
inmate of that institution.
will provide your health information to the correctional institution in which
you are an inmate if the institution represents that the information is
necessary for your health, safety or treatment, or for the health and safety of
other inmates and correctional officers.
For fundraising activities, marketing and informational purposes
may use or disclose information about you for fundraising.
For example: We may disclose limited information about you to our fundraising
affiliate, the BCMH Foundation, so that it can contact you when events are
planned to help raise money for the hospital. If you do not want to be
contacted, please write to our Privacy Office at 100 Hoylman Drive, Gassaway
WV 26624 and ask to be removed from any fundraising list.
may use or disclose information about you for limited marketing purposes.
may disclose limited information about you to our marketing department to
provide you with a nominal promotional gift, such as a newsletter describing
special services we offer.
We may use or disclose information about you for additional health information and scheduling.
may disclose limited information about you to arrange for the scheduling of
treatment, to remind you of an appointment, to recommend possible treatments to
you, or to provide information about health services that might be of interest
As required by law
will use or disclose your health information to the extent that the law requires
For example: If you were in an accident that was caused by someone else’s negligence and your medical bills were paid by Medicaid, the law may require us to provide your health information to Medicaid so that it can collect reimbursement from the person who caused the accident. We also may have to disclose information to Workers’ Compensation if you have made a claim for benefits.
Uses and disclosures of health information to which you may object
law allows us to use your health care information in some instances, unless you
object in advance.
instances include the following:
you are in the hospital, religious affiliation information about you may be
collected and stored electronically and shared with clergy members.
While you are in the hospital, information such as your name, room number, and general condition may be put in a hospital directory and released to people who ask for you by name.
about your condition may be given to family members, relatives or close
personal friends who are involved in your care, or to notify them of your
location and general condition, when you are in an emergency condition, or
when you are incapacitated.
Information may be given to disaster relief organizations.
and disclosures of health information that require your authorization
All other uses and disclosures of your health information will be made only with
your valid written authorization. You may revoke an authorization at any time by
writing down your revocation and sending it to our Privacy Office at 100 Hoylman
Drive, Gassaway, WV 26624. The revocation will be valid
upon our receipt of it, except to the extent that we have already relied upon it
and taken action on it.
law specially protects certain types of health information. This information
will only be used and/or disclosed with a valid written authorization if
all requirements of the law are met. This information includes:
related to the Human Immunodeficiency Virus (HIV)
of drug and/or alcohol abuse testing, diagnosis or treatment
Uses and disclosures of health information when you are incapacitated, incompetent or deceased
you become incapacitated or incompetent, your health information will be treated
the same way it was treated when you were capable and competent.
Your health information will remain protected even after your death. If an authorization is required for the release of your health information after your death, the executor or administrator of your estate must sign the authorization.
Uses and disclosures of health information involving minors
health information of minors will be treated like any other health information
except for the following special rules:
1. As provided in West Virginia law, both parents of a child will have equal access to the child's records, except as limited by court order of other West Virginia law. The parent objecting to a release of records to the other parent has the duty to provide us with a court order prohibiting the release.
2. As provided in West Virginia law, records of the diagnosis, treatment or counseling of a minor fro drug or alcohol abuse or addiction will not be release to parents or guardians without the consent of the minor.
3. As provided in West Virginia law, records of the diagnosis, testing or treatment of a minor for a sexually transmitted disease will not be released to parents or guardians without the consent of the minor.
4. As provided in West Virginia law, records involving the use of birth control by a minor, or of prenatal care rendered to a minor, will not be released to parents or guardians without the consent of the minor.
more information, to make a written request, to report a problem or to file a
notice is required by the Health Insurance Portability and Accountability Act of
1996 (HIPAA). Standards have been developed to implement the requirements of the
act and provide more detail about the rights and responsibilities described in
this notice. If you would like additional information regarding HIPAA, you may
access it electronically at the following website:
you have questions and would like additional information about our notice and
privacy practices, or if you want to make a written request under this notice,
you may call our Privacy Office at (304)
If you believe your privacy rights have been violated, you can file a complaint
with us during regular business hours by calling the our Privacy Office at (304) 364-1143. The contact
person will tell you what additional steps to take. You can also file a
complaint by contacting the Secretary, United States Department of Health and
There will be no retaliation for filing a complaint.
Effective date and practice changes
This Notice of Privacy Practices is effective April 14, 2003. We reserve the right to change our privacy practices and to make the new provisions effective for all protected health information we maintain at BCMH. Should our privacy practices change, you will receive a revised notice on your next visit to BCMH or upon your request.