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This notice applies to:  Univeristy Hospitals Elyria Medical Center and its Entities

Effective Date:  September 23, 2013


University Hospitals Elyria Medical Center and its entities at all locations will follow this notice, including our workforce: all healthcare professionals, doctors’ offices, volunteers and students, foundation, home care programs, other services, and affiliated facilities follow the terms of this notice.   In addition, these entities, sites and locations may share medical information with each other for treatment, payment or hospital operations purposes described in this notice. Doctors and others not employed by UH Elyria Medical Center may exchange information with UH Elyria Medical Center employees.  These health care practitioners may also give you other Notice of Privacy practices which describe their office practices.


We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the hospital. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the hospital, whether made by hospital personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your medical information created in the doctors’ office or clinic.

This notice will tell you about the ways in which we may use and disclose medical information about you.  We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to:

  • Make sure that medical information that identifies you is kept private,
  • Give you this notice of our legal duties and privacy practices with respect to medical information about you, and
  • Follow the terms of the notice that is currently in effect.


Except as outlined below, we will not use or disclose your protected health information (PHI) 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 & Disclosures For Treatment:  We will use and disclosure your PHI as necessary to provide you with medical treatment or services. For instance, doctors, nurses, technicians, students in health care training programs or other professionals who are involved in your care will use information in your medical record and information that you provide about yourself to plan a course of treatment for you that may include procedures, medications, tests, etc. We may also release your PHI to another health care facility or professional who is not affiliated with our organization but may be providing treatment to you presently or in the future, for example, nursing homes, rehab centers, home health care, etc.
  • Uses & Disclosures For Payment: We will use and disclosure your information as necessary to assist in the payment of your bills and collect payment from you, your insurance company, or other payers, such as Medicare, for the care, treatment and other related services you receive.  We may tell your health insurer about a treatment your doctor has recommended to obtain prior approval to determine whether your plan will cover the cost of the treatment.    
  • Uses & Disclosures For Health Care Operations: We may use and disclose your PHI as necessary, and as permitted by law, for our health care operations. These business uses and disclosures are necessary to make sure that our patients receive quality care and cost effective services. For example, we may use PHI to review the quality of our treatment and services, and to evaluate the performance of our staff, contracted employees and students in caring for you.
  • Business Associates:  We may use or disclose your PHI to an outside company that assists us in operating our health system.  They perform various services for us.  This includes, but is not limited to, auditing, accreditation, legal services, and consulting services.  These outside companies are called “business associates” and they contract with us to keep any PHI received from us confidential in the same way we do.  These companies may create or receive PHI on our behalf.
  • Appointment Reminders: We may use and disclose PHI to contact you for appointment reminders and to communicate necessary information about your appointment.
  • Health-Related Benefits 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.
  • Fundraising Activities:  We may use PHI, such as your name, address, phone number, the dates you received service, your treating physician, outcome information, and health insurance status to contact you to raise money for EMH Healthcare interests.  We may share this information with a foundation associated with EMH Healthcare to work on our behalf.  If you do not want us or our affiliates to contact you, in the event of any fundraising activities, with each communication we may send, we will provide you with instructions to exercise your right to opt out of future communications and your right to opt back in.
  • Our Facility Directory:  We maintain a facility directory listing the name, location, a general description of your condition that does not communicate specific medical information, and 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 be also provided to members of the clergy. You have the right to have your information excluded from this directory. To restrict use of your information in the directory, please inform the admitting staff or your nurse.  In emergency circumstances, if you are unable to communicate your preference, you will be listed in the directory.
  • Friends and Family Involved in Your Care: If you agree, do not object, or we reasonably infer that there is no objection, we may disclose PHI about you to a family member, relative, or another person identified by you who is involved in your health care or payment for your health care.  If you are not present or are incapacitated or it is an emergency or disaster relief situation, we will use our professional judgment to determine whether disclosing limited PHI is in your best interest under the circumstances.  We may disclose PHI to a family member, relative, or another person who was involved in the health care or payment for health care of a deceased individual if not inconsistent with the prior expressed preferences of the individual that are known to EMH Healthcare.  But you also have the right to request a restriction on our disclosure of your PHI to someone who is involved in your care.
  • Research:  In limited circumstances, we may use and disclose your protected health information for research purposes. For example, a research organization may wish to compare outcomes of all patients that received a particular medication to those who received another, for the same condition.  In some instances, the law allows us to do some research using your PHI without your approval. In all cases where your specific authorization has not been obtained, your privacy will be protected by strict confidentiality requirements applied by the Institutional Review Board which oversees the research or by representations of the researchers that limit their use and disclosure of protected information.
  • Shared Medical Record/Health Information Exchange (HIE): We may maintain PHI about our patients in shared electronic medical records that allow EMH Healthcare associates to share PHI.  We may also participate in various electronic health information exchanges HIE’s that facilitate access to PHI by other health care providers who provide you care.  For example, if you are admitted on an emergency basis to another hospital that participates in the electronic HIE, the exchange will allow us to make your PHI available electronically to those who need it to treat you.
  • 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;
    • for public health activities, such as required reporting of disease, injury, birth, death, and for required public health investigations;
    • as required by law if we suspect child abuse or neglect;
    • if we believe you to be a victim of abuse, neglect, or domestic violence;
    • to the Food and Drug Administration as required by law to report adverse events, product defects, or to participate in product recalls;
    • for employer sponsored health and wellness services we provide our patients, included services provided at their employment site, to provide you medical treatment or services, we will disclose the information about you to others who provide you medical care;
    • 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;
    • to a government oversight agency as required by law to conduct audits, investigations, or civil or criminal proceedings;
    • if required to respond to a court ordered subpoena or discovery request; in most cases you will have notice of such release;
    • to law enforcement officials as required by law to report wounds and injuries and crimes;
    • to coroners and/or funeral directors consistent with law;
    • to arrange an organ or tissue donation from you or a transplant for you;
    • to the armed forces services if you are a member of the military as required by law;
    • to federal agencies for national security or intelligence activities;
    • to workers' compensation agencies if necessary for your workers' compensation benefit determination; and
    • to respond to a serious threat to health or safety of yourself or others as permitted by law;
    • to your legal representative, such as a legal guardian or an executor or administrator of your estate, upon presentation of appropriate court-issued documentation of authority, or to your personal representative whom you have authorized to represent you and to receive your protected health information, upon presentation of a valid written authorization from you;
    • Most uses and disclosures of psychotherapy notes, uses and disclosures of PHI for marketing and disclosures that constitute the sale of PHI, require your written authorization.

Ohio law requires that we obtain an authorization from you before disclosing the performance or results of an HIV test or diagnosis of AIDS or an AIDS-related condition.

Other uses and disclosures of your PHI that are not described above will be made only with your written authorization.  If you provide EMH Healthcare with an authorization, you may revoke this authorization in writing, and this revocation will be effective for future uses and disclosures of PHI.  However, the revocation will not be effective for information that we have used or disclosed in reliance on the authorization.


You have the following rights regarding medical information we maintain about you:

  • The Right to Access and obtain a copy your Own Health Information:  You have the right to inspect and receive a copy of most of your protected health information for as long as we maintain it, as required by law. All requests for access must be made in writing.  We may charge you a nominal fee for each page copied and postage, if applicable. You have the right to ask for a summary of this information.  If you request a summary, we may charge you a nominal fee.  Please contact EMH Healthcare Health Information (HIS) office with any questions or requests.
  • The Right to Request Restrictions: You have the right to request restrictions on certain of our use and disclosure of your PHI. A restriction request form can be obtained from the HIS Office. 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 restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed to restriction by sending such termination notice to the HIS office.

UH Elyria Medical Center will agree to restrict disclosure of PHI about an individual to a health plan if the purpose of the disclosure is to carry out payment or health care operations and the PHI pertains soley to a service for which the individual, or a person other than the health plan, has paid to UH Elyria Medical Center in full. For example, if a patient pays for a service completely out of pocket and asks UH Elyria Medical Center not to tell his/her insurance company about it, we will abide by this request.  A request for restriction should be made in writing.  To request a restriction you must contact the HIS office.  We reserve the right to terminate any previously agreed-to restrictions (other than a restriction we are required to agree to by law.)  We will inform you of the termination of the agreed-to restriction and such termination will only be effective with the respect to PHI created after we inform you of the termination.

  • Right to Inspect and Copy: You have the right to inspect and request a copy of medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. While an inpatient, a request to inspect your records may be made to your nurse or doctor. If you are an outpatient, requests may be made to the HIS office.  For all other requests to inspect and request a copy of your medical information submit your request in writing to the Health Information Services (HIS) Release of Information Department, 630 E. River St., Elyria, Ohio 44035. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. A fee schedule is available on request.

We may deny your request to inspect and obtain a copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another professional chosen by the hospital will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

  • Right to Amend: If you feel that medical information we have about you is incorrect or incomplete; you may ask us to amend the information. An amendment does not mean information can be removed.

You have the right to request an amendment for as long as the information is kept by or for the hospital. You may obtain an amendment request form from the HIS Department Release of Information Office.  Return your completed form including the reason which supports your request to the HIS Release of Information Department.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  • Is not part of the medical information kept by or for the hospital;
  • Is not part of the information which you would be permitted to inspect and obtain a copy; or
  • Is accurate and complete.
  • Right to an Accounting: With some exceptions, you have the right to receive an accounting of disclosures made by us of your protected health information. Requests must be made in writing and signed by you or your representative. Accounting request forms are available from the HIS Office.  A nominal fee will be charged for the record search.
  • Right to Request Confidential Communications: If you believe that a disclosure of all or part of your protected health information may endanger you, you may request in writing that we communicate with you in an alternative manner or at an alternative location.  For example, you may ask that all communications be sent to an alternate address.  Your request must specify the alternative means or location for communication with you.  It also must state that the disclosure of all or part of the PHI in a manner inconsistent with your instructions would put you in danger.  We will accommodate a request for confidential communications that is reasonable and that states that the disclosure of all or part of your PHI could endanger you.
  • Right to be Notified of a Breach: You have the right to be notified in the event that we (or one of our Business Associates) discovers a breach of unsecured protected health information involving your medical information.
    • Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

You may obtain a copy of this notice at our website, www.emh-healthcare.org


If we make a material change to this Notice, we will post a copy of the current notice in the hospital and on our website at www.emh-healthcare.org. The notice will contain on the first page, in the top right-hand corner, the effective date.


Unless otherwise specified, to exercise any of the rights described in this Notice or if you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with the hospital, please submit your complaint in writing to the Compliance & Privacy Office at UH Elyria Medical Center, 630 E. River St., Elyria, Ohio 44035 or you may call (440) 329-4949.

You will not be penalized for filing a complaint.

ACKNOWLEDGMENT OF RECEIPT OF NOTICE: You will be asked to sign an acknowledgement form that you received this Notice of Privacy Practices.

University Hospitals Elyria Medical Center
630 East River Street
Elyria, Ohio 44035
(440) 329-7500 
Revised 9/2013, Ver. 2.0
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