Privacy

PRIVACY PRACTICES

To download a PDF of this information, click here.

NOTICE OF PRIVACY PRACTICES

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 Genesis HealthCare System, Zanesville Surgery Center, and Zanesville Imaging (dba Diagnostic Imaging Center) operating as a clinically integrated health care arrangement composed of:

GENESIS BETHESDA HOSPITAL
2951 Maple Avenue, Zanesville, Ohio 43701

GENESIS GOOD SAMARITAN HOSPITAL
800 Forest Avenue, Zanesville, Ohio 43701

ALTERNACARE
2951 Maple Avenue, Zanesville, Ohio 43701

COMMUNITY AMBULANCE SERVICE
952 Linden Avenue, Zanesville, Ohio 43701

DIAGNOSTIC IMAGING CENTER
2800 Maple Avenue, Zanesville, Ohio 43701

GENESIS C.O.O.R. 740 Adair Avenue, Zanesville, Ohio 43701

GENESIS CAREGIVERS
2529 Maple Avenue, Zanesville, Ohio 43701

GENESIS EXTENDED CARE AND REHAB CENTER
2991 Maple Avenue, Zanesville, Ohio 43701

GENESIS HEALTH AND REHAB – MCCONNELLSVILLE
4114 State Route 376 N.W., McConnellsville, Ohio 43756

GENESIS HEALTHCARE CENTER CAMBRIDGE
61353 Southgate Parkway, Cambridge, Ohio 43725

GENESIS HEALTHCARE CENTER NEW CONCORD
1 East Main Street, New Concord, Ohio 43762

GENESIS HEALTHSOURCE
2800 Maple Avenue, Zanesville, Ohio 43701

GENESIS HOMECARE – MUSKINGUM COUNTY
2503 Maple Avenue, Zanesville, Ohio 43701

GENESIS HOMECARE – PERRY COUNTY
445 West Broadway, New Lexington, Ohio 43764

GENESIS HOSPICE AND PALLIATIVE CARE
713 Forest Avenue, Zanesville, Ohio 43701

GENESIS OCCUPATIONAL/EMPLOYEE HEALTH SERVICES
2800 Maple Avenue, Zanesville, Ohio 43701
2951 Maple Avenue, Zanesville, Ohio 43701
800 Forest Avenue, Zanesville, Ohio 43701

GENESIS RADIATION ONCOLOGY
800 Forest Avenue, Zanesville, Ohio 43701

GENESIS RECOVERY CENTER
800 Forest Avenue, Zanesville, Ohio 43701

GENESIS URGENT CARE
2800 Maple Avenue, Zanesville, Ohio 43701

GENESIS WOUND MANAGEMENT CENTER
860 Bethesda Drive – Building 2, Zanesville, Ohio 43701

HEALTHY GENERATION CLINICS
800 Forest Avenue, Zanesville, Ohio 43701

NORTHSIDE GOOD SAMARITAN PHARMACY
751 Forest Avenue – Suite 204, Zanesville, Ohio 43701

NORTHSIDE HOME INFUSION
21 Maysville Avenue, Zanesville, Ohio 43701

NORTHSIDE MAYSVILLE PHARMACY
15 Maysville Avenue, Zanesville, Ohio 43701

NORTHSIDE OXYGEN AND MEDICAL EQUIPMENT
702 Wabash Avenue, Zanesville, Ohio 43701

NORTHSIDE OXYGEN AND MEDICAL EQUIPMENT CAMBRIDGE
61353 Southgate Parkway, Cambridge, Ohio 43725

NORTHSIDE OXYGEN AND MEDICAL EQUIPMENT SOMERSET
301 Dr. Mike Clouse Drive, Somerset, Ohio 43783

NORTHSIDE PAVILION PHARMACY
945 Bethesda Drive, Zanesville, Ohio 43701

NORTHSIDE PHARMACY
2899 Bell Street, Zanesville, Ohio 43701

NORTHSIDE PHARMACY NURSING HOME DIVISION
19 Maysville Avenue, Zanesville, Ohio 43701

NORTHSIDE ROSEVILLE PHARMACY
157 South Main Street, Roseville, Ohio 43777

NORTHSIDE SOMERSET PHARMACY
117 West Main Street, Somerset, Ohio 43783

THERAPY POOL
800 Forest Avenue, Zanesville, Ohio 43701

WOMEN’S CENTER
2800 Maple Avenue, Zanesville, Ohio 43701

ZANESVILLE SURGERY CENTER
2907 Bell Street, Zanesville, Ohio 43701

AND THE PHYSICIANS AND OTHER LICENSED PROFESSIONALS SEEING AND TREATING PATIENTS AT EACH FACILITY
The members of this clinically integrated health care arrangement work and practice in Muskingum and surrounding counties in southeastern Ohio. All of the entities and persons listed will share protected health information of patients as necessary to carry out treatment, payment, and health care operations as permitted by law and according to Genesis HealthCare System policy.

We are required by law to maintain the privacy of our patients' protected health information and to provide patients with notice of our legal duties and privacy practices with respect to your protected 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 this Notice of Privacy Practices as necessary and to make the new Notice effective for all protected health information maintained by us. You may receive a copy of any revised notices at Genesis - Good Samaritan and Bethesda Hospitals’ Admitting Offices, at any of the affiliate locations listed on this notice, or a copy may be obtained by mailing a request to our Customer Relations Department at Genesis - Good Samaritan Hospital. The Notice of Privacy Practices is also available on the Genesis HealthCare System website at www.genesishcs.org.

USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION

Your Authorization. Except as outlined below, we will not use or disclose your protected 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 authorization.

Uses and Disclosures for Treatment. We will make uses and disclosures of your protected health information as necessary for your treatment. For instance, doctors, nurses, students 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, tests, etc. We may disclose protected health information to employers relating to the medical surveillance of the workplace, work-related illnesses and injuries. We may also release your protected 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. For instance, if, after you leave the hospital, you are going to receive home health care, we may release your protected 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 protected 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. Some insurance companies use third party auditors to review claims and medical records.

Uses and Disclosures for Health Care Operations. We will use and disclose your protected 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 protected health information for purposes of improving the clinical treatment and care of our patients, including satisfaction surveys. We may also disclose your protected 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 of patients that we admit to the hospital listing the name, room number, general condition 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. The patients admitted for services provided by our Behavioral Health Services Department will be excluded from the facility directory listing consistent with other federal and state laws.

Family and Friends Involved In Your Care. With your approval, we may from time to time disclose your protected 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 protected health information with such individuals without your approval. We may also disclose limited protected 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.

Business Associates. 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 parts of your protected 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.

Fundraising. 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 Genesis Corporate Communications, 2529 Maple Avenue, Zanesville, Ohio 43701 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. We also provide, as a service to the community, the Genesis NurseLine which requires callers to share their health information, and after receiving calls, the Genesis NurseLine sends related medical information to the callers. You have the right to request and we will accommodate reasonable requests by you to receive communications regarding your protected health information from us by alternative means or at alternative locations. For instance, if you wish appointment reminders to not be left on voice mail or sent to a particular address, we will accommodate reasonable requests. You may request such confidential communication in writing and may send your request to our Corporate Integrity Department at Genesis HealthCare System, Zanesville Surgery Center’s Business Office, or to the affiliate location providing the service.

Health Products and Services. We may from time to time use your protected 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.

Research. In limited circumstances, we may use and disclose your protected 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 a patient attends a drug or alcohol program, or disclose any information identifying a patient as an alcohol or drug abuser unless: (1) the patient consents 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 a patient 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 authorities.

Other Uses and Disclosures. We are permitted or required by law to make certain other uses and disclosures of your protected health information without your consent or authorization.
We may release your protected health information for any purpose required by law;
We may release your protected health information for public health activities, such as required reporting of disease, injury, and birth and death, and for required public health investigations;
We may release your protected health information as required by law if we suspect child abuse or neglect;
We may also release your protected health information as required by law if we believe you to be a victim of abuse, neglect, or domestic violence;
We may release your protected health information to the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in product recalls;
We may release your protected health information to your employer when we have provided health care to you at the request of your employer to determine workplace-related illness or injury; in most cases you will receive notice that information is disclosed to your employer;
We may release your protected health information if required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings;
We may release your protected health information if required to do so by subpoena or discovery request; in some cases you will have notice of such release;
We may release your protected health information to law enforcement officials as required by law to report wounds and injuries and crimes;
We may release your protected health information to coroners and/or funeral directors consistent with law;
We may release your protected health information if in limited instances if we suspect a serious threat to health or safety;
We may release your protected health information if necessary to arrange an organ or tissue donation from you or a transplant for you;
We may release your protected health information for certain research purposes when such research is approved by an institutional review board with established rules to ensure privacy;
We may release your protected health information if you are a member of the military as required by armed forces services; we may also release your protected health information if necessary for national security or intelligence activities; and
We may release your protected health information to workers' compensation agencies if necessary for your workers' compensation benefit determination.

Ohio law requires that we obtain a consent 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. For full information on when such consents may be necessary, you can contact the Director of the Corporate Integrity Program.

RIGHTS THAT YOU HAVE

Access to Your Protected health information. You have the right to copy and/or inspect much of the protected 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 you a fee that is consistent with state law if you request a copy of the information. We will also charge for postage if you request a mailed copy. You may obtain an access request form and the charges for copying from our Health Information Management Department at Genesis - Good Samaritan Hospital, Zanesville Surgery Center’s Business Office, or at the affiliate location that maintains the protected health information.

Amendments to Your Protected health information. You have the right to request in writing that protected health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. All amendment requests, in order to be considered by us, must be in writing, signed by you or your representative, and must state the reasons for the amendment/correction request. If an amendment or correction 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 our Quality Management Department at Genesis - Good Samaritan Hospital, Zanesville Surgery Center’s Business Office, or at the affiliate location that maintains the protected health information.

Accounting for Disclosures of Your Protected health information. You have the right to receive an accounting of certain disclosures made by us of your protected health information after April 14, 2003. Requests must be made in writing and signed by you or your representative. Accounting request forms are available in our Health Information Management Department at Genesis - Good Samaritan Hospital, Zanesville Surgery Center’s Business Office, or at the affiliate location that maintains the protected health information.

Restrictions on Use and Disclosure of Your Protected health information. You have the right to request restrictions on certain uses and disclosures of your protected health information for treatment, payment, or health care operations. We are not required to agree to your restriction request but will attempt to accommodate reasonable requests when appropriate and we retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. You also have the right to terminate, in writing, any agreed-to restriction by sending such termination notice to our Health Information Management Department at Genesis - Good Samaritan Hospital, Zanesville Surgery Center’s Business Office, or at the affiliate location that maintains the protected health information.

Complaints. If you believe your privacy rights have been violated, you can file a complaint with our Customer Relations Department at Genesis - Good Samaritan Hospital if the violation occurred at either hospital, Zanesville Surgery Center’s Privacy Officer if the violation occurred at Zanesville Surgery Center, or at the affiliate location where the violation occurred. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. 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 that you received this Notice of Privacy Practices.

FOR FURTHER INFORMATION
If you have questions or need further assistance regarding this Notice, you may contact the Corporate Integrity Department at Genesis HealthCare System. Telephone: (740) 586-6712. 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.

EFFECTIVE DATE
This Notice of Privacy Practices is effective April 14, 2003.

Last revised on: October 14, 2005