1. We Have a Legal Duty to Safeguard Your Medical Information
2. How We May Use and Disclose Your Medical Information
3. Your Rights Regarding Your Medical Information
4. How to Complain About Our Privacy Practices
5. Effective Date of This Notice

1. For treatment. We may disclose your medical information to physicians, nurses, medical students, and other health care personnel who provide you with health care services or are involved in your care. For example, if you are being treated for a knee injury, we may disclose your medical information to a physical rehabilitation department in order to coordinate your care.
2. For payment. We may use and disclose your medical information in order to bill and collect payment for the treatment and services provided to you. For example, we may provide portions of your medical information to our billing department and your health plan to get paid for health care services we provided to you. We may also provide your medical information to our business associates, such as billing companies, claims processing companies, and others that process our health care claims.
3. For health care operations. We may disclose your medical information in order to operate the Health Services practice plan. For example, we may use your medical information in order to evaluate the quality of health care services, to evaluate the performance of the health care professionals, and for the teaching and training of health care personnel. We may also provide your medical information to our accountants, attorneys, consultants, and others in order to make sure we're complying with the laws that affect us.
4. When a disclosure is required by federal, state or local law, judicial or administrative proceedings, or law enforcement. For example, we make disclosures when a law requires that we report information to specific government agencies 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.
5. For public health activities. For example, we report information about births, deaths and various diseases to government officials in charge of collecting that information. We provide coroners, medical examiners, and funeral directors necessary information relating to an individual's death. We are also required to report any situations where we cannot eliminate the possibility of child abuse or elder abuse.
6. For health oversight activities. For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization.
7. For purposes of organ donation. We may notify organ procurement organizations to assist them in organ, eye, or tissue donation and transplants.
8. For specific government functions. We may disclose your medical information to military personnel in certain situations. We may also disclose medical information for national security purposes, such as conducting intelligence operations.
9. For worker's compensation purposes. We may provide your medical information in order to comply with worker's compensation laws.
10. To avoid harm. We may provide your medical information to law enforcement or persons able to prevent or lessen harm in order to avoid serious threat to the health or safety of a person or the public.
11. Appointment reminders and health-related benefits or services. We may use your medical information to provide appointment reminders or give you information about treatment alternatives, or other heath care services or benefits we offer.
12. For research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who receive one type of medication to those who receive another medication, for the same condition. All research projects are subject to a special approval process. This approval process entails trying to balance the research needs with the patient's need for privacy of their medical information. We may disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave Eastern Virginia Medical School facilities. We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at Eastern Virginia Medical School.
13. Fundraising activities. We may use your medical information to raise funds for our organization. The money raised through these activities is used to expand and support the health care services and educational programs we offer the community. We only would release contact information, such as your name, address and phone number and dates you received treatment or services at Eastern Virginia Medical School. If you do not want us to contact you for fundraising efforts, you must notify our Privacy Office in writing.
    
    Eastern Virginia Medical School
    Privacy Office, Fairfax Hall
    721 Fairfax Avenue
    Norfolk, VA 23507

1. Two uses and disclosures which require you to have the opportunity to object.
   • Fundraising. We may use information about you (such as your name, address, and phone number) in order to contact you to raise money. If you do not wish to be contacted as a part of our fundraising efforts, you may "opt out" in writing, or complete an "opt out" form available in each clinical unit.
   • Disclosures to family, friends or others. We may provide your medical information to a family member, friend or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part in writing.
2. Uses and disclosures which require your prior specific permission.
   • In any other situation not described above, we will ask for your written authorization before using or disclosing any of your medical information. Authorization forms are available at each clinical department. If you choose to sign an authorization to disclose your medical information, you can later revoke that authorization in writing to stop any future uses and disclosures.

1. The right to request restrictions.
   
   You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you may request in writing that we not disclose information about a surgery you had in the past.
   
   We are not required to agree to your request. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make.
   
   To request restrictions, you must make your request in writing and include:
   1. what information you want to limit
   2. whether you want to limit the use, disclosure or both; and
   3. to whom you want the limits to apply; for example, disclosures to your spouse.
       
2. The right to choose how we provide medical information to you.
   
   You have the right to ask that we send information to you to an alternative address or by alternate means. For example, you may request that we contact you at work or by mail.
   
   We will not ask the reason for your request. We will accommodate all reasonable requests so long as we can easily provide it in the format that you request.
    
3. The right to see and obtain a copy of your medical information.
   
   You have the right to inspect and obtain a copy of the 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.
   
   If you want to request a copy of your medical information, you must submit your request in writing to the site where medical service or treatment was provided. We may charge a fee for the cost of copying, mailing or other supplies associated with your request. If we don't have your medical information but we know who does, we will tell you how to get it. We will respond to you in 15 days after receiving your written request for a copy. We will respond to you in 30 days if you want to inspect your medical record.
   
   In certain situations, we may deny your request to inspect and receive a copy your medical information. If we deny your request, we will tell in you in writing our reasons for the denial and explain your right to have the denial reviewed.
    
4. The right to get a list of the disclosures we have made.
   
   You have the right to get a list of instances in which we have disclosed your medical information. This list will not include uses or disclosures made for treatment, payment, or health care operations, or for reasons involving national security, to corrections or law enforcement personnel or those released as a result of your written authorization.
   
   We will respond within 60 days of receiving your request. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The list will include the date of the disclosure, to whom the medical information was disclosed, a description of the information disclosed and the reason for the disclosure. The first list you request within a twelve month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
    
5. The right to correct or update your medical information.
   
   If you feel that medical information we have about you is incorrect, you may ask us to change the information. You have the right to request a correction for as long as the information is kept by or for Eastern Virginia Medical School.
   
   To request a change to your medical information, your request and reason for the request must be in writing. We may deny your request for a change if it is not in writing or does not include a reason to support the request. We will respond within 60 days of receiving your request. We may deny your request in writing if you ask us to change information that:
   1. Is accurate and complete.
   2. Was not created by us, unless the person that created the information is no longer available to make the change.
   3. Is not a part of the information which you would be permitted to receive; or
   4. Is not a part of the medical information kept by or for us.
      
      Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. You have the right to request that your request and our denial be attached to all future disclosures of the medical information in question. If we approve your request, we will make the change to your medical information, tell you we have done it, and tell others that need to know about the change to your medical information.
       
6. The right to get this notice.
   
   You have the right to a paper copy of this notice. You may ask for a copy of this notice at any time.

Eastern Virginia Medical School
Privacy Office, Fairfax Hall
721 Fairfax Avenue
Norfolk, VA 23507