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Ohio Valley Notice of Privacy Practices


Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record:

  • You can ask to see or get an electronic or paper copy of your medical record and certain related health information we have about you or a summary of the information. You must make this request in writing. If you want us to provide your health information to another individual, you must sign the request and clearly identify the individual and specify the location where you would like us to send your information. We may contact you to clarify which information you want disclosed, the format you would like to receive it in, and other aspects of your request.
  • Under certain circumstances, we may not disclose certain portions or all of your medical record and related health information. If we do not provide you with access to your health information, you may, in some instances, request a review of our denial. Typically, in these circumstances, a licensed health care professional has determined that providing you, or your personal representative, with access to your medical record is reasonably likely to endanger the life or physical safety of you or another person. If we deny you access, we will provide you with an explanation for the denial and additional information explaining how to request a review of the denial and how to enforce your available rights. Your request for review of a denial will be reviewed by a licensed health care professional that is not directly involved in our original denial. They will review your request within a reasonable period of time. We will then promptly give you written notice of the reviewing professional’s determination. You may request a copy of your health information and, if applicable, request a review of the denial of access to your health information by calling the Compliance Hotline at 1-844-601-1873.

Ask us to correct your medical record:

You can ask us to change health information about you that is in our records. You must make these requests in writing, specify which information needs to be changed or amended, and an explanation to support the requested change or amendment. We may deny your request, or we may not be able to make the requested change. If we deny your request, we will explain why your request was denied and provide additional information regarding your options. Whether we make the requested change or deny the request, we will attempt to notify you within 60 days of your request, but no later than 90 days of your request. You may make a request to change information in your health records by calling 937- 521-3900 and ask for the Medical Records Department.

Request confidential communications

You can ask us to contact you in a specific way (for example, emails, phone, or fax) or at alternative addresses, phone numbers, or accounts. You may make these requests by calling 937-521-3900 and ask for the Medical Records Department. We will accommodate all reasonable requests

Ask us to limit what we use or share

  • You can ask us not to use or disclose certain health information for treatment, payment, or health care operations. We may agree to your request. If we do agree with your request, we may still use or disclose your health information to provide emergency care for you, to allow others to provide you with emergency care, or as otherwise required or permitted by law. You may make this request by calling 937- 521-3900 and ask for the Medical Records Department
  • If you pay for a service or health care item out-of-pocket and in full, you can ask us not to share information related to that particular item or service, for the purpose of payment or our communication with your health insurer. We will say “yes” unless a law requires us to share that information. You may make this request by calling 937-521-3900 and ask for the Accounts Payable Department.

Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) of the times we’ve shared your health information in the six years prior to the date you ask, who we shared it with, and why. You must make this request in a signed and dated writing. Your request must specify the time period of the disclosures requested and the facility maintaining your records. You may make this request by calling 937-521-3900 and ask for the Medical Records Department.
  • We will include all the disclosures within the specified time period except for those about treatment, payment, health care operations, and certain other disclosures exempted by law (such as any you asked us to make). We’ll provide one accounting for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

  • You can request a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a copy upon request. You may request a paper copy of this notice by calling 937-521-3900.

Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information, talk to us. Tell us what you want us to do. We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures:

Your health information may be used or shared for the following reasons:

To treat you

We can use your health information to provide care for you and disclose it to other health care professionals who are also providing care for you. We may disclose your health information to other doctors, nurses, technicians, medical or nursing students, or people outside of our organization who need the information to take care of you. This may include pharmacies, home health care providers, or drug and medical device experts. Example: A doctor treating you for an injury asks your primary care doctor about your overall health condition and history.

To run our organization

We can use and disclose your health information to run our practice and hospital, to improve the quality of care we deliver, or for other health care operations. We may use or disclose your health information to assess the quality of the care our staff provides to you, to assess the effectiveness of treatments, to determine what treatments are needed or missing in the community, or to assist with the training or education of our staff, residents, or students. We may remove information that identifies you and/or combine your health information with the information of others so that we can study the health of the community we serve or allow others (only if de-identified) to study the population health of our community. Example: We use health information about you to manage your treatment and services.

To bill for your services

We may use and disclose your health information so that the health care services you receive can be billed and paid for by you, your insurance, health plans, or others. We may also use or disclose your health information to your insurance provider, health plan, or others to obtain prior approval and coverage of a proposed treatment or to learn if the treatment will be covered. Example: We give information about you to your health insurance plan so it will pay for your services.

To contact you

We may use or disclose your health information to contact you about appointments, follow up care, and other matters. We may contact you by telephone, text, mail, email, or any other method that you authorize us to contact you. Example: We may text you an appointment reminder the morning of your scheduled appointment or leave a voicemail message at the telephone number you provide to us.

How else can we use or share your health information?

In addition to using or disclosing your health information to provide your treatment, securing your health care coverage, and maintain our operations, we may use or disclose your health information in other ways. Typically, in ways that contribute to the public good, such as public health and research. These uses or disclosures of your health information typically occur in limited circumstances, involve limited information, or are required by law. In each case, there are additional requirements we enforce to ensure the confidentiality and privacy of your health information. For more information see:

Public health and safety

We will disclose your health information when required to do so by federal, state, or local law. We may also disclose your health information for public health or safety reasons, such as births, deaths, abuse, neglect, to assist with product recalls, or to report adverse or unanticipated reactions to drugs or medical products. We may disclose health information to notify people whose health or safety may be endangered. We may disclose your health information for health oversight activities to governmental, regulatory, or to entities designated by authorized agencies for activities authorized by law, such as investigations, compliance reviews, inspections, assessment of workers’ compensation claims, or audits. We may disclose your health information in response to judicial or administrative proceedings. We may also disclose your health information, when authorized by law, for law enforcement purposes, in the event of an emergency, or for disaster relief purposes.

Patient information directories

We may use or disclose limited information about you in our patient directory maintained at our hospital, such as your name, location or room number, and a description of your general condition. We typically provide this information to people who ask about you by name. We may also include your religious affiliation and provide this information to clergy providing religious support at our hospital. We include this limited information about you in our directory so that family members, friends, and loved ones may contact us for information about your condition or to visit you in our hospital. If you prefer to keep this information confidential or to be removed from the hospital directory, you may request this from the hospital admissions department.

Organ and tissue donation

We may use or disclose health information about organ, eye, or tissue donors and transplant recipients to third parties that manage or operate organ, eye, or tissue donations or transplants. We may also disclose health information about decedents to third parties to assist with their duties, such as identifying a deceased person or determining a cause of death or to permit funeral directors to carry out their duties.


We may use or disclose your health information for medical research purposes. Our researchers may review your health information as part of your current care or to prepare or perform research. Any individual health information used for research purposes will be screened through a specialized institutional process to review the protections for patients involved in the research. We will not disclose your health information outside of our organization for research purposes unless we obtain your prior written approval or our institutional process for review of patient protections determines that your privacy is protected.

Health related services

We may use or disclose your health information to contact or provide you with information about health-related products and services available at our hospital or practice.

Health information exchanges

We may participate in health information exchanges and disclose your health information to other health care providers or entities for treatment. We may participate in these health information exchanges to ensure your other health care providers have timely access to a centralized repository of your health information. You have the right to submit a written request to place restrictions on disclosures of your health information. You have the right to limit or request that we do not disclose any of your health information to a health information exchange.

Authorizations for Other Uses or Disclosures:

We understand the sensitivity of the information we collect and our responsibility to maintain its confidentiality. We take our obligation to protect your privacy seriously and will strive to make every effort to ensure it is maintained. As such, when we use or disclose your health information we will limit the use or disclosure to only the information that is minimally necessary to accomplish the purpose. We will not use or disclose your health information for any reason other than those described in this notice without your written authorization unless otherwise permitted by law. For example, we will not use your health information for certain marketing purposes (other than if the communication is made directly to you in person, is simply a promotional gift of nominal value, is a prescription refill reminder, general health or wellness information, or a communication about health-related products or services that we offer or that are directly related to your treatment), use or disclose psychotherapy notes that may be in your health information, or sell your health information without your written authorization. If you do provide authorization for us to use or disclose your health information other than as described in this notice, you may limit or revoke that authorization in writing at any time. However, we cannot take back any use or disclosure of your health information that was made prior to the revocation of your authorization.

In our effort to ensure that only the minimally necessary amount of your health information is used or disclosed, we recognize that there are certain types of health information that are more sensitive than others. With that in mind, we will obtain your consent for certain disclosures, consistent with applicable state and federal law, that has information related to: (i) the performance or results of an HIV test or diagnosis or an AIDS-related condition; (ii) genetic test results; (iii) substance use disorder or drug and alcohol treatment received as part of a drug or alcohol treatment program; or (iv) mental health treatment

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information, to provide you with notice of our legal duties and privacy practices with respect to your health information, and to notify you in the event you are affected by a breach of our security systems and your protected health information.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all health information we maintain. The new notice will be available upon request, in our office, and on our web site. You may request new versions of this notice in the same manner that you may request a copy of this notice as described above.

File a Complaint

  • If you believe we have violated your privacy rights, please contact our Compliance Officer using the information provided.
  • If you believe any health care provider, including us, has violated your privacy rights, you can file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or by visiting
  • We will not retaliate against anyone that files a complaint.

Questions about this Notice

If you have any questions or would like additional information about this notice, please contact:

Compliance Officer

Ohio Valley Surgical Hospital

100 W. Main St. Springfield, Ohio 45502 Phone: 937-521-3900 or 1-844-601-1873