Notice of Privacy Practices

This Notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

We have a legal duty to safeguard your protected health information. We will protect the privacy of the health information that we maintain that identifies you, whether it deals with the care, services, or treatment to you or for the payment for the care, service, or treatment. This notice must be provided to you, which will explain our privacy practices, including how, when, and why we may use and disclose your protected health information. With some exceptions, we will avoid using or disclosing any more of your health information than is necessary to accomplish the purpose of the use or disclosure. Glade Run is legally required to follow the privacy practices that are described in effective Notice of Privacy Practices.

Glade Run reserves the right to change the terms of our Notice of Privacy Practices at any time. Any changes will apply to any of your health information that we already have. Anytime a significant change is made to our privacy practices, you will be provided with a copy and the new version will be posted in the designated areas of our Main Campus and our offices in Butler and Pittsburgh. You may request a copy of our Notice of Privacy Practices that is in effect at any given time by calling our human resource department at (724) 452-4453, extension 1660.

Below are some common questions concerning our privacy practices:

What does Protected Health Information mean?
Protected Health Information is information about physical health, mental health, or drug and alcohol information that is identifiable and part of the designated record set.

How will Glade Run use and disclose my protected health information?
We use and disclose information for many different reasons. For some uses or disclosures we need your specific authorization, and in other cases, your authorization is not required. Below this is explained further.

Uses and Disclosures Relating to Treatment, Payment, or Agency Operations
Federal Law permits us to use and disclose your health information for the following reasons:

• For Treatment. Glade Run staff will use your protected health information in order to provide the health benefits in which you are involved. Glade Run may use your protected health information to administer your health benefits, such as to determine eligibility for services requested by your dentist.
• For Payment. Within all regulatory guidelines, we may use and disclose necessary health information in order to bill and collect payment for the care, service or treatment that has been provided. For example, we may provide or receive certain information from your insurance company to administer your health benefits including billing of premiums and payment of claims.
• For Health Care Operations. We may, at times, need to use and disclose your health information to run our Agency. For example, we may use your health information to monitor and/or evaluate the benefits provided to you. We may also need to provide some health information to our accountants, attorneys, and/or consultants in order to make sure that we are complying with the law. In some instances, we may need to first obtain from you a specific authorization. This will be done according to the specific laws or regulations.

Other Uses and Disclosures as Permitted by Federal Law
Glade Run may use and disclose your protected health information without your authorization for the following reasons:

• As required by Federal, State, or Local Law, in Judicial or Administrative Proceedings or by Law Enforcement. For example, we must comply with a court order or report serious threats to another person’s safety.
• Public Health Activities Under the Law. We need to report certain events or other related issues. One such example is the required reporting of certain communicable diseases. If by law a signed authorization would be necessary, you would be contacted.
• Health Oversight Activities. We need to provide information to government agencies that have the right to inspect our offices.
• Organ Donation. This is one of the other uses and disclosures specified in the regulations. This is not generally applicable to Glade Run, but if in the rare instance appropriate, we may disclose certain necessary health information to assist with the appropriate organ procurement agency.
• Research Purposes. In certain limited instances, as approved by an approved review board, we may be permitted to use or provide protected health information for research studies.
• To Avoid Harm. When Glade Run staff believe that it is necessary to protect you or another person, staff may provide health information to the police or others who may be able to prevent or lessen the possible harm.
• For Specific Government Functions. We may disclose the health information of military personnel or veterans where required by U.S. military authorities. Similarly, we may also disclose an employee’s health information for national security purposes, such as assisting in the investigation of suspected terrorists who may be a threat to our nation.
• For Workers’ Compensation. We may provide your health information as described under the workers’ compensation law, if your condition was the result of a workplace injury for which you are seeking workers’ compensation.
• Fundraising Activities. For example, if our Organization chose to raise funds to support one or more of our programs or facilities, or some other charitable cause or community health education program, we may use the information that we have about you to contact you. If you do not wish to be contacted as part of any fundraising activities, please contact our Resource Development Coordinator at (724) 452-4453, extension 1244.

Certain Uses and Disclosures Require You to Have the Opportunity to Object

• Disclosures to Family, Friends or Others Involved in Your Care. We may provide a limited amount of health information to a family member, friend or other person known to be involved in your care or in the payment for your care unless you tell us not to.
• Disclosures to Notify a Family Member, Friend or Other Selected Person. When you first began to receive health benefits at Glade Run you provided us with an emergency contact person in case something happened to you while at Glade Run or if there was an emergency need to reach you. Unless you tell us otherwise, we may disclose certain limited health information about you to your emergency contact person or another available family member in the event of an emergency.
• Facility Directory. This is not applicable at Glade Run. We don’t use a public directory.

Other Uses and Disclosures Require Your Prior Written Authorization
In situations other than those categories of uses and disclosures mentioned above, or those disclosures permitted under federal law, we will ask for your written authorization before using or disclosing any of your protected health information.

If you choose to sign an authorization to disclose any of your health information, you can later revoke it to stop further uses and disclosures to the extent that we haven’t already taken action relying on the authorization. This request must be made in writing. You may request the form by calling (724) 452-4453, extension 1660.

What Rights do I have Concerning My Protected Health Information?

1. The Right to Request Limits on Uses and Disclosures of Your Health Information. You have the right to ask us to limit how we use and disclose your health information. We will certainly consider your request, but you should know that we are not required to agree to it. If we do agree to your request, we will put the limits in writing and will abide by them, except in the case of an emergency. Please note that you are not permitted to limit the uses and disclosures that we are required or allowed by law to make.

2. The Right to Choose How We Send Health Information to You or How We Contact You. You have the right to ask that we contact you at an alternate address or telephone number, for example, sending information to your work address instead of your home address or by alternate means, for example, by U.S. Mail instead of by telephone. We must agree to your request so long as we can easily do so.

3. The Right to See or to Get a Copy of Your Protected Health Information. In most cases, you have the right to look at or get a copy of your health information that we have, but you must make the request in writing. A request form is available by calling (724) 452-4453, extension 1660. We will respond to you within 30 days after receiving your written request. If we do not have the health information that you are requesting, but we know who does, we will tell you how to get it. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial. In certain circumstances, you may have a right to appeal the decision.

   If you request a copy of any portion of your protected health information, we will charge you for the copy on a per page basis, only as allowed under Pennsylvania state law. We need to require that payment be made in full before we will provide the copy to you. The fee is based on the number of pages that are to be copied. If you agree in advance, we may be able to provide you with a summary or an explanation of your records instead. There will be a charge for the preparation of the summary or explanation.

4. The Right to Receive a List of Certain Disclosures of Your Health Information That We Have Made. You have the right to get a list of certain types of disclosures that we have made of your health information. This list would not include uses or disclosures for treatment, payment or healthcare operations, disclosures to you or with your written authorization, or disclosures to your family for notification purposes or due to their involvement in your care. This list also would not include any disclosures made for national security purposes, disclosures to corrections or law enforcement authorities if you were in custody at the time, or disclosures made prior to April 14, 2003. You may not request an accounting for more than a six (6) year period.

   To make such a request, we require that you do so in writing; a request form is available by calling (724) 452-4453, extension 1660. We will respond to you within 60 days of receiving your request. The list that you may receive will include the date of the disclosure, the person or agency that received the information (with their address, if available), a brief description of the information disclosed, and a brief reason for the disclosure. We will provide such a list to you at no charge; but, if you make more than one request in the same calendar year, you will be charged $30.00 for each additional request that year.

5. The Right to Ask to Correct or Update Your Health Information. If you believe that there is a mistake in your health information or that a piece of important information is missing, you have a right to ask that we make an appropriate change to your information. You must make the request in writing, with the reason for your request, on a request form that is available in the human resource department or by calling (724) 452-4453, extension 1660. We will respond within 60 days of receiving your request. If we approve your request, we will make the change to your health information, tell you when we have done so, and will tell others that need to know about the change.

   We may deny your request if the protected health information: (1) is correct and complete; (2) was not created by us; (3) is not allowed to be disclosed to you; or (4) is not part of our records. Our written denial will state the reasons that your request was denied and explain your right to file a written statement of disagreement with the denial. If you do not wish to do so, you may ask that we include a copy of your request form, and our denial form, with all future disclosures of that health information.

6. The Right to Get A Paper Copy of This Notice. If you have agreed to receive this Notice via e-mail, you will always have the right to request a paper copy of this Notice, also.

How do I complain or ask questions about this agency’s privacy practices?
If you have any questions about anything discussed in this Notice or about any of our privacy practices, or if you have any concerns or suggestions, please contact our human resource department at 724-452-4453, extension 1660. You also have the right to file a written complaint with the Secretary of the U.S. Department of Health and Human Services. We may not take any retaliatory action against you if you lodge any type of complaint.

This notice is effective April 14, 2003.
Board Approved: March 24, 2003
Effective: April 14, 2003
Version: I
Revised: November 30, 2005