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.
The terms of this Notice of Privacy Practices apply to the Kettering Health Network, our hospitals,
Kettering Medical Center, Grandview Medical Center, Southview Medical Center, Sycamore Medical
Center, and Greene Memorial Hospital, as well as our clinics and health centers, operating as a clinically
integrated health care arrangement and the physicians and other licensed professionals seeing and
treating patients at each service location. A complete listing of our service locations is available upon
request. The members of this clinically integrated health care arrangement work and practice at some or
all of the service locations. All of the entities and persons listed will share personal health information of
patients as necessary to carry out treatment, receive payment, and health care operations as permitted
by law. "Personal health information" is information about you, including demographic and genetic
information, that may identify you and that relates to your past, present or future physical or mental
health or condition and related health care services.
We are required by law to maintain the privacy of our patients' personal health information and to
provide patients with notice of our legal duties and privacy practices with respect to your personal health
information. We are required to abide by the terms of this Notice so long as it remains in effect. We
reserve the right to change the terms of the Notice of Privacy Practices as necessary and to make the
new Notice effective for all personal health information maintained by us. You may receive a copy of any
revised notices at any service location or a copy may be obtained on the web at www.khnetwork.org or by
mailing a request to the Privacy Officer.
USES AND DISCLOSURES OF YOUR PERSONAL HEALTH INFORMATION
Your Authorization. Except as outlined below, we will not use or disclose your personal health
information for any purpose unless you have signed a form authorizing the use or disclosure. You have
the right to revoke that authorization in writing unless we have taken any action in reliance on the
Uses and Disclosures for Treatment
We will make uses and disclosures of your personal health information as necessary for your treatment.
For instance, doctors and nurses and other professionals involved in your care will use information in
your medical record and information that you provide about your symptoms and reactions to plan a
course of treatment for you that may include procedures, medications, test, etc. We may also release your
personal health information to another health care facility or professional who is not affiliated with our
organization but who is or will be providing treatment to you. And if after you leave the hospital, you are
going to receive home health care, we may release your personal health information to that home health
care agency so that a plan of care can be prepared for you.
Uses and Disclosures for Payment
We will make uses and disclosures of your personal health information as necessary for the payment
purposes of those health professionals and facilities that have treated you or provided services to you.
For instance, we may forward information regarding your medical procedures and treatment to your
insurance company to arrange payment for the services provided to you or we may use your information
to prepare a bill to send to you or to the person responsible for your payment.
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Uses and Disclosures for Health Care Operations
We will use and disclose your personal health information as necessary, and as permitted by law, for
our health care operations which include clinical improvement, professional peer review, business
management, accreditation and licensing, etc. For instance, we may use and disclose your personal
health information for purposes of improving the clinical treatment and care of our patients. We may
also disclose your personal health information to another health care facility, health care professional,
or health plan for such things as quality assurance and case management, but only if that facility,
professional, or plan also has or had a patient relationship with you.
Our Facility Directory
We maintain a facility directory listing the name, room number, and, if you wish, your religious
affiliation. Unless you choose to have your information excluded from this directory, the information,
excluding your religious affiliation, will be disclosed to anyone who requests it by asking for you by name.
This information, including your religious affiliation, may also be provided to members of the clergy. You
have the right during registration to have your information excluded from this directory.
Family and Friends Involved In Your Care
With your approval, we may from time to time disclose your personal health information to designated
family, friends, and others who are involved in your care or in payment of your care in order to facilitate
that person's involvement in caring for you or paying for your care. If you are unavailable, incapacitated,
or facing an emergency medical situation, and we determine that a limited disclosure may be in your best
interest, we may share limited personal health information with such individual's without your approval.
We may also disclose limited personal health information to a public or private entity that is authorized
to assist in disaster relief efforts in order for that entity to locate a family member or other persons that
may be involved in some aspect of caring for you.
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Certain aspects and components of our services are performed through contracts with outside persons
or organizations, such as auditing, accreditation, legal services, etc. At times it may be necessary for
us to provide certain of your personal health information to one or more of these outside persons or
organizations who assist us with our health care operations. In all cases, we require these business
associates to appropriately safeguard the privacy of your information.
We may contact you to donate to a fundraising effort for or on our behalf. You have the right to "opt-out"
of receiving fundraising materials/communications and may do so by sending your name and address to
the Privacy Officer together with a statement that you do not wish to receive fundraising materials or
communications from us.
Appointments and Services
We may contact you to provide appointment reminders or test results. You have the right to request and
we will accommodate reasonable requests by you to receive communications regarding your personal
health information from us by alternative means or at alternative locations. You may request such
confidential communications in writing and may send your request to the Privacy Officer.
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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.
In limited circumstances, we may use and disclose your personal health information for research purposes.
For example, a researcher may wish to compare outcomes of all patients that received a particular drug
and will need to review a series of medical records. In all cases where your specific authorization is not
obtained, your privacy will be protected by strict confidentiality requirements applied by 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.
Confidentiality of Alcohol and Drug Abuse Patient Records
The confidentiality of alcohol and drug abuse patient records maintained by this facility is protected
by federal law and regulations. Generally, the facility may not say to a person outside the program
that you attend a drug or alcohol program, or disclose any information identifying you as an alcohol or
drug abuser unless: (1) you consent in writing: (2) the disclosure is allowed by a court order; or (3) the
disclosure is made to medical personnel in a medical emergency or to qualified personnel for research,
audit, or program evaluation. Federal law and regulations do not protect any information about a crime
committed by you either at our facility or against any person who works for the facility or about any
threat to commit such a crime. Federal laws and regulations do not protect any information about
suspected child abuse or neglect from being reported under State law to appropriate State or local
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Other Uses and Disclosures
We are permitted or required by law to make certain other uses and disclosures of your personal health
information without your authorization. We may release your personal health information as follows:
- For any purpose required by law; including suspected child abuse or neglect; or if we believe you to
be a victim of abuse, neglect, or domestic violence; if required to do so by a court or administrative
ordered subpoena or discovery request; if required by law to a government oversight agency
conducting audits, investigations, or civil or criminal proceedings; as required by law to report
wounds, injuries, and crimes;
- For public health activities, such as required reporting of disease, injury, birth, death, and for required
public health investigations; or if in limited instances if we suspect a serious threat to health or safety;
- To the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in
- To your employer when we have provided health care to you at the request of your employer to determine workplace
related illness or injury;
- To coroners and/or funeral directors consistent with the law;
- If necessary to arrange an organ or tissue donation from you to a transplant recipient for you;
- If you are a member of the military as required by armed force services; we may also release your personal health
information if necessary for national security or intelligence activities; and
- To workers' compensation agencies if necessary for your workers' compensation benefit determination.
Ohio law requires that we obtain an authorization from you in many instances before disclosing the
performance or results of an HIV test or diagnoses of AIDS or an AIDS-related condition; before
disclosing information about drug or alcohol treatment you have received in a drug or alcohol treatment
program; before disclosing information about mental health services you may have received; and before
disclosing certain information to the State Long-Term Care Ombudsman.
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RIGHTS THAT YOU HAVE
Access to Your Personal Health Information
You have the right to obtain a copy and/or inspect much of the personal health information that we retain on your behalf.
You have a right to obtain an electronic copy of your health information that exists in an electronic format and you may
direct that the copy be transmitted directly to the entity or person designated by you provided that any such delegation is
clear, conspicuous, and specific with complete name and mailing address or other identifying information.
Amendments to Your Personal Health Information
You have the right to request in writing that personal health information we maintain about you be
amended. We are not obligated to make all requested amendments but will give each request careful
consideration. All amendment requests must be in writing, signed by you or your representative, and must
state the reasons for the amendment/correction requests.
Accounting for Disclosures of Your Personal Health Information
You have the right to receive an accounting of disclosures made by us of your personal health information up to six years prior
to the date of your request. Requests must be made in writing and signed by you or your representative. You may be charged a
fee if you request more than one accounting within the same 12-month period.
When you request an accounting of disclosures of your electronic health record, the accounting will be for three years prior
to the date of the request for the accounting and will include, in addition to all types of disclosures listed in the general
policy, disclosures for treatment, payment, and healthcare operations. These requirements apply to those disclosures made by
the Kettering Health Network from such a record on or after the later of January 1, 2011 or the date that an electronic health
record is acquired.
Restrictions on Use and Disclosure of Your Personal Health Information
You have the right to request in writing, restrictions on certain Kettering Health Network uses and disclosures of your personal
health information for treatment, payment, or health care operations. With the exception of restriction requests for disclosures
to health plans for purposes of carrying out payment or health care operations when the information pertains solely to a health
care service for which we have been paid in full by you, we are not required to agree to your requested restriction. We retain
the right to terminate an agreed-to restriction if we believe such termination is appropriate.
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If you believe your privacy rights have been violated, you may file a complaint to us in writing. You may
also file a complaint with the Secretary of the US Department of Health and Human Services at Office
for Civil Rights, US Department of Health and Human Services, 233 N. Michigan Ave., Suite 240,
Chicago, IL 60601, in writing within 180 days of a violation of your rights. There will be no retaliation
for filing a complaint.
Acknowledgment of Receipt of Notice
You will be asked to sign an acknowledgment form that you received this Notice of Privacy Practices.
FOR FURTHER INFORMATION AND REQUESTS
If you have questions or need further assistance regarding this Notice, or wish to exercise any of
the rights stated in this Notice, you may contact the Information Security and Privacy Office of the
Kettering Health Network in writing at 3535 Southern Boulevard, Kettering, Ohio 45429 or by phone at
937-395-3963 / 937-395-3964 or send an email to the privacy officer
As a patient you retain the right to obtain a paper copy of this Notice of Privacy Practices, even if you
have requested such copy by e-mail or other electronic means.
This Notice of Privacy Practices is effective February 1, 2010.
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