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.
Foothills Medical Group is affiliated with Bradford Regional Medical Center and Olean General Hospital, member hospitals of Upper Allegheny Health System. As such, Foothills Medical Group is required by law to maintain the privacy of patients' Protected Health Information (PHI) and to provide individuals with the following Notice of the legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice.
Who will follow this Notice?
- All health care professionals, employees, students, volunteers and other personnel from any department authorized to access your medical record.
- Health care providers not employed by Foothills Medical Group, Bradford Regional Medical Center or Olean General Hospital who are involved in your care (such as physicians).
- Other entities that provide health care services to you in a way that is integrated with our services at one of our affiliated hospitals or medical offices, and their health care professionals, employees, students, volunteers and other personnel.
How We May Use and Disclose Your Protected Health Information About You
Treatment: We will use health information about you to provide you with medical treatment or services. We will disclose PHI about you to doctors, nurses, technicians, or other personnel who are involved in taking care of you. Different departments of Foothills Medical Group, Bradford Regional Medical Center and Olean General Hospital may share health information about you in order to coordinate the services you need, such as prescriptions, lab work and x-rays.
Payment: We may use and disclose medical information so that services can be billed. For example, we may need to give information to your health plan about services you received so your health plan can pay us. We may also inform your health plan about a planned treatment to determine whether your plan will cover the treatment.
Health Care Operations: We may use and disclose PHI about you for the purpose of our business operations. 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 disclose your health information to contractors, agents and other associates who need information to assist us in carrying out our business operations. Our contracts with them require that they protect the privacy of your health information.
Incidental Disclosures: Disclosures of your information may occur during or as an unavoidable result of otherwise permissible uses or disclosures of your health information. For example, during the course of your treatment, other patients in the area may see or overhear discussion of your health information despite using reasonable safeguards.
Patient Directory: While you are a hospital patient, your name, location, general condition (e.g., satisfactory) and your religious affiliation will be included in a patient information directory. Directory information, except for your religious affiliation, may be released to people who ask for you by name. Your religious affiliation may also be provided to members of the clergy of your congregation, even if they don't ask for you by name. We will give you the opportunity to opt out of the directory, unless an emergency situation prevents us from asking you.
Disclosure to Family, Friends or Other: If you do not object, or we reasonably infer that there is no objection, we may disclose PHI about you to a family member, relative, partner, 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.
Appointment reminders: We may use and disclose PHI to contact you as a reminder that you have an appointment with us. We may also use and disclose protected health information to give you information about treatment alternatives, or other health care services or benefits we offer.
Fundraising Activities: We may use and disclose your information to raise funds or solicit support for various programs. You have the right to opt out of receiving fundraising communication. If you do not want to be contacted for fundraising efforts, you must opt out by notifying us. For Foothills Medical Group of Bradford Regional Medical Center send inquiries to: Bradford Regional Medical Center Foundation, 116 Interstate Parkway, Bradford, PA 16701 in writing. For Foothills Medical Group of Olean General Hospital send inquiries to: Olean General Hospital Foundation, 515 Main Street, Olean, NY 14760. All reasonable efforts will be made to ensure those patients who do not want to receive fundraising materials will be removed from the fundraising mailing list.
Research: In certain circumstances, we may use and disclose protected health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects are subject to a special approval process by an Institutional Review Board or similar.
As Required by Law: We will disclose protected health information about you when required to do so by federal, state, or local law. For example, we make disclosures when a law requires that we report information to a government agency and law enforcement personnel about victims of abuse, neglect, or domestic violence; when dealing with gunshot and other wounds, or when ordered in a judicial or administrative proceeding.
To Avert a Serious Threat to Health or Safety: We may use and disclose protected health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Under these circumstances, disclosures would only be made to someone who is able to prevent or lessen such harm.
Public health activities: We may disclose medical information about you for public health activities related to prevention or control of disease, injury or disability. For example, we report certain communicable diseases to the Department of Health.
Health Oversight Activities: We may disclose your medical information to health oversight organizations authorized to conduct audits, investigations, and inspections of our facilities.
Organ and Tissue Donation: We may release medical information to organizations that handle organ, eye or tissue donation and transplantation.
Workers Compensation: We may release protected health information about you for workers compensation or similar programs if these programs provide benefits for work-related injuries and illness.
Specific Government Functions: As a member of the armed forces, we may release protected health information about you as required by military command authorities. We may disclose PHI for national security purposes, such as protecting the president of the United States or conducting intelligence operations.
Inmates: If you are an inmate of a correctional facility, or under the custody of a law enforcement official, we may disclose to the institution or agents of the institution health information necessary for your health and the health and safety of other individuals.
Coroners, Medical Examiners, and Funeral Directors: We may release protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.
Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose protected health information about you in response to a court or administrative order, subpoena or other lawful process.
Law Enforcement: We may release health information in response to a court order, subpoena, warrant, summons or similar process, to identify or locate a suspect, fugitive, material witness, or missing person, about the victim of a crime, about a death we believe may be the result of criminal conduct, about criminal conduct at the hospital, and in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
Disclosures to Schools: Student immunization information may be disclosed to a school without written authorization if state law requires the school to have immunization records and the patient or personal representative's written or oral agreement is documented.
Shared Health Information System: Foothills Medical Group, Bradford Regional Medical Center and Olean General Hospital are affiliated entities. We maintain PHI about our patients in an electronic medical record that allow, and when required, access to PHI for treatment, payment and healthcare operations.
Other Uses and Disclosures of PHI: Most uses and disclosures of psychotherapy notes, uses and disclosures of PHI for marketing purposes and disclosures that constitute the sale of PHI require your written authorization.
Other uses and disclosures of PHI that are not described above will be made only with your written authorization. If you provide Foothills Medical Group with an authorization, you have the right to revoke the authorization in writing at any time. If you revoke the authorization, we will not further use or disclose your health information for the purposes documented on the authorization.
Your Rights Regarding Your PHI
Access, Inspect or Copy: You have the right to review and obtain a copy of your protected health information that may be used to make decisions about your care, including your medical and billing records. To inspect or receive copies of your medical information, submit your request in writing to the Practice Manager. We may charge a fee for the costs of copying, mailing or other supplies associated with your request for copies. You may not be denied a copy if you are unable to pay. You may request an electronic copy of your record and it will be provided in an electronic format if it is readily producible; otherwise you will be provided with a printed copy.
In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed.
Restrictions: You have the right to request restrictions on how we use or disclose your health information to treat your condition, collect payment for your treatment or for our health care operations. We are not required to agree to your request. If we do agree, we will fulfill your request unless the information is needed to provide you emergency treatment. You may direct your written request to the Practice Manager. You have the right to restrict disclosure of your medical information to your health plan for payment when you make a written request and pay for the service out-of-pocket in full prior to or at the time of the service, or if you make payment arrangements at the time of the service subject to approval of Foothills Medical Group that are complied with in a timely manner. We will comply with this restriction unless the disclosure is required by law.
Confidential Communications: You have the right to request that we send information to you at an alternate address or by alternate means (for example, you may wish to be contacted at work rather than at home). This request must be in writing, and should be directed to the area that would handle the communication. You do not need to provide a reason for your request. Reasonable requests will be accommodated.
Accounting of Disclosures: With some exceptions, you have the right to request an accounting of certain disclosures of your PHI. The request should state the time period for which you wish to receive an accounting. This time period should not be longer than six years. If you request this accounting more than once in a 12-month period, we may charge you a reasonable fee for responding to these additional requests.
Amendments: If you believe that PHI we have about you is incorrect or incomplete, you may ask us to amend the information, for as long as Foothills Medical Group maintains the information. You must provide the request and your reason for the request in writing; requests can be made through the Practice Manager. We will respond within 60 days of receiving your request. We may deny your request in writing if the PHI is (a) correct and complete, (b) not created by us, (c) not allowed to be disclosed, or (d) not part of our records. Our written denial will state the reason for the denial and explain your right to file a written statement of disagreement with the denial. You may respond with a statement of disagreement to be appended to the information you wanted amended. If we accept your request to amend the information, we will make reasonable efforts to inform others, including people and entities you name.
Electronic Notice: You have the right to get a copy of this notice by e-mail. Even if you have agreed to receive notice via e-mail, you also have the right to request a paper copy of this notice.
Changes to this Notice: We reserve the right to change this Notice. We may make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. The current Notice will be displayed and is available to you on our website at www.myfmg.org.
Breach Notification: You have the right to be notified of a breach of your unsecured protected health information, with a few limited exceptions. A breach is defined as unauthorized acquisition, access, use or disclosure of protected health information in a manner not permitted, unless there is a low probability that the privacy or security of your protected health information has been compromised.
Complaints: If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a privacy-related complaint with us send to:
Privacy Officer, Foothills Medical Group
Corporate Office - Upper Allegheny Health System
130 South Union Street, Suite 300
Olean, NY 14760
All complaints must be submitted in writing. You will not be penalized for filing a complaint.
The persons shown in photographs on this website are stock photography models (Models) and are not actual patients of, nor are they affiliated with, Foothills Medical Group, Foothills Medical Group's direct and indirect parent companies, subsidiaries, or subsidiaries of its parent companies ("Affiliates"). Foothills Medical Group or Foothills Medical Group's Affiliates, have obtained the rights to use the photographs via license agreements with certain third party stock photography companies, and Foothills Medical Group or Foothills Medical Group's Affiliates use of the photographs is in compliance with the terms of those license agreements.
The photographs showing the Models are used on this website for illustrative purposes only. The Models do not personally endorse Foothills Medical Group, or any products, services, causes, or endeavors associated with, or provided by, Foothills Medical Group or any of Foothills Medical Group's Affiliates. The context in which the photographs are used on this website is not intended to reflect personally on any of the Models shown in the photographs. Foothills Medical Group, Foothills Medical Group's Affiliates, their respective officers, directors, employees, agents and/or independent contractors assume no liability for any consequence relating directly or indirectly to the use of the photographs showing the Models on this website.