Effective as of April 14, 2003
Revised July 24, 2008
Revised April 11, 2011
Revised May 29, 2013
Revised June 24, 2019

GOODWILL OF SOUTHWESTERN PENNSYLVANIA JOINT 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 following organization uses health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive.

Health Care Components of the Hybrid Entity Covered by Joint Notice

Departments providing service to individuals funded, directly or indirectly, by:

Pennsylvania Office of Developmental Programs
Pennsylvania Office of Mental Health and Substance Abuse Services
Pennsylvania Office of Vocational Rehabilitation
Pennsylvania Department of Human Services – Bureau of Employment and Training Programs
West Virginia Department of Education and the Arts, Division of Rehabilitation Services

All staff, supervisors and volunteers of covered Human Services’ Departments include:

Community Support Services
Core Services
Disability Services
Education Services
Employer Engagement
Reintegration Services
Supportive Housing
Transition Services
Workforce Development & Placement
Youth Services

All staff, supervisors, and volunteers of covered Goodwill Administrative Departments include:

Accounting Department
Human Resources Department
Information Technology Department
Marketing and Development
Risk Management Department
How We May Use or Disclose Your Health Information

For Treatment. We may use your health information to provide you with medical treatment or services. For example, information obtained by a health care provider, such as a physician, nurse, or other person providing health services to you, will record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions.

For Payment. We may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payer, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.

For Health Care Operations. We may use and disclose health information about you for operational purposes. For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and others to:

evaluate the performance of our staff:
assess the quality of care and outcomes in your cases and similar cases;
learn how to improve our facilities and services; and
determine how to continually improve the quality and effectiveness of the health care we provide.

Appointments. We may use your information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the individual.

Required by law. We may use and disclose information about you as required by law. For example, Goodwill of Southwestern Pennsylvania may disclose information for the following purposes:

for judicial and administrative proceedings pursuant to legal authority;
to report information related to victims of abuse, neglect or domestic violence; and
to assist law enforcement officials in their law enforcement duties;

Public Health. Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.

Descendants. Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.

Organ/Tissue Donation. Your health information may be used or disclosed for cadaver organ, eye or tissue donation purposes.

Research. We may use your health information for research purposes when an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information, has approved the research.

Health and Safety. Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.

Government Functions. Your health information may be disclosed for specialized government functions such as protection of public officials or reporting to various branches of the armed services.

Workers’ Compensation. Your health information may be used or disclosed in order to comply with laws and regulations related to Workers’ Compensation.

Other uses. Other uses and disclosures will be made only with your written authorization and you may revoke the authorization except to the extent Goodwill of Southwestern Pennsylvania has taken action in reliance on such.

Your Health Information Rights

You have the right to:

request a restriction on certain uses and disclosures of your information as provided by 45 C.F.R. §164.522; however, the organizations noted above are not required to agree to a requested restriction;
obtain a paper copy of the notice of information practices upon request;
inspect and obtain a copy of your health records as provided for in 45 C.F.R. §164.526
request communications of your health information by alternative means or at alternative locations;
receive an accounting of disclosures made of your health information as provided by 45 C.F.R. §164.528
opt out of receiving fundraising communications
pay out-of-pocket for a service and you may require that Goodwill SWPA not submit PHI to your health plan.

Complaints

You may complain to the organization’s privacy officer listed below and to the Department of Health and Human Services, if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.

Our Obligations Under This Joint Notice

We are required by law to:

maintain the privacy of protected health information;
provide you with a notice of our legal duties and privacy practices with respect to your health information;
abide by the terms of this notice;
notify you if we are unable to agree to a requested restriction on how your information is used or disclosed;
accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations; and
notify affected individuals following a breach of unsecured PHI.

We reserve the right to change our information practices and to make the new provisions effective for all protected health information we maintain. The revised notice will be made available to you in person via Goodwill staff or by mail.

Contact Information

If you have any questions or complaints, please contact:

Ella Holsinger, Privacy Officer
Goodwill of Southwestern Pennsylvania
Robert S. Foltz Building
118 52^nd Street
Pittsburgh, PA 15201
412-632-1925

Individuals may file written complaints with the Office for Civil Rights, HHS by mail, fax, or email at the address listed below.

Barbara Holland, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
801 Market Street, Suite 9300
Philadelphia, PA 19107-3134
Customer Response Center: (800) 368-1019
Fax: (202) 619-3818
TDD: (800) 537-7697
Email: ocrmail@hhs.gov

Or mail:

Roger Severino, Director
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201

Toll-free: (800) 368-1019
TDD toll-free: (800) 537-7697