This Notice describes how medical information about you may be used and
disclosed and how you can get access to this information. Please review
While treating you, our employees, volunteers, students and health care
professionals affiliated with MLH follow this Notice. In addition, any
person involved in your care, entities, sites and locations may share
medical information about you with each other for treatment, payment or
health care operations as described in this notice.
We are required by law to maintain the privacy of your health
information and to provide you with this Notice.
II. Our Duties to Safeguard your Protected Health Information
Protected Health Information (PHI) is any information related to your
health care that is shared or maintained in any manner. It includes your
insurance information as well. This Notice applies to all of your PHI
generated by Main Line Health or any of its entities. Your personal
doctor may have different policies or notices regarding the doctor’s use
and disclosure of your medical information created in the doctor’s
This Notice will tell you about the ways in which we may use and
disclose your PHI. We also describe your rights and certain obligations
we have regarding the use and disclosure of your PHI.
We are required by law to:
make sure that your PHI is kept private;
give you this Notice of our legal duties and privacy
practices related to your PHI; and,
follow the terms of the Notice that is currently in
III. How Main Line Health May Use and Disclose Medical
Information About You – Treatment, Payment and Health Care Operations.
Except in an emergency or other special situations, we will ask you to
sign a general consent, as required by Pennsylvania law, so that we may
use and disclose your PHI for the following purposes:
Treatment. We may use and disclose PHI about you in
connection with your treatment, for example to diagnose you. In
addition, we may contact you to remind you about appointments, give you
instructions prior to tests or surgery, or inform you about treatment
alternatives or other health related benefits or services. We may also
disclose your PHI to other providers, doctors, nurses, technicians,
medical students, hospital personnel or other health care facilities
involved in your treatment. We may need to communicate this PHI to other
health care providers using phone, fax, two-way radio or electronic
Payment. We may use and disclose your PHI to obtain
payment for services we provide to you. For example, we may contact your
insurance company to pay for the services you receive, to verify that
your insurer will pay for the services, to coordinate benefits, or to
collect any outstanding accounts.
Health Care Operations. We may use and disclose your
PHI for health care operations which include: activities related to
evaluating treatment effectiveness, teaching and learning purposes,
evaluating the quality of our services, investigating complaints related
to service, fundraising activities and marketing activities.
Other Health Care Providers. We may also disclose your
PHI to other health care providers when such PHI is required for them to
treat you, receive payment for services you receive or conduct certain
health care operations. For example, we will share your PHI with an
ambulance company so the ambulance company can be reimbursed for
transporting you to the hospital.
Health Information Exchange. We participate in a health
information exchange (HIE) that allows us to electronically share
protected health information with local health care providers that are
participating in the HIE to coordinate your care. You may also access
your test results and other PHI electronically through the HIE. HIEs are
being developed at the hospital, regional, state and national levels so
that providers will have prompt access to your records for your care.
Currently we only share information with your providers through the HIE,
although in the future we may participate in HIEs with other providers,
plans and billing companies. More information on our HIE may be found
IV. Other Uses and Disclosures of Your PHI for which
Authorization is Not Required.
Hospital Directory. Inpatients are automatically listed
in our hospital directory. The directory includes your name, room
number, general health condition and religious affiliation. Unless you
disagree or object, information in the directory may be disclosed to
anyone who asks for you by name or to clergy members of your religious
Disclosure to Relatives and Close Friends. We may
disclose your PHI to a family member, other relative, a close personal
friend or any other person if we: 1) obtain your agreement; 2) provide
you with the opportunity to object to the disclosure; or, 3) we can
reasonably infer that you do not object to the disclosure.
Incapacity or Emergency Circumstances. If you are not
present, or the opportunity to agree or object to a use or disclosure
cannot practicably be provided because of your incapacity or an
emergency circumstance, we may exercise our professional judgment to
determine whether a disclosure to relatives and/or close friends is in
your best interest. If we disclose information to a family member, other
relative or a close personal friend, we would disclose only information
that is directly relevant to the person’s involvement with your health
Fundraising. We may contact you to request a
contribution to support important activities of Main Line Health or its
entities. In connection with any fundraising, we may use and disclose
your demographic information as well as the dates on which you received
health care services, the department where you received your services,
your treating physician and outcome information related to your care. If
you do not want to receive any fundraising requests, you may contact us
Development Office of Main Line Health
240 Radnor Chester Road
Radnor, PA 19087
Public Health Activities. We may disclose your PHI for
public health activities including the following:
Reporting births or deaths
To prevent or control disease, injury or disability
To report child abuse or neglect
To report reactions to medications or problems with
To notify individuals who may have been exposed to a
disease or may be at risk for contracting a disease or
Reporting PHI to your employer as required by laws
addressing work-related illnesses and injuries or
workplace medical surveillance
Victims of Abuse, Neglect or Domestic Violence. If we
reasonably believe you are a victim of abuse, neglect or domestic
violence, we may, in accordance with current Pennsylvania law, disclose
your PHI to a governmental authority, including a social service or
protective services agency, authorized by law to receive reports of such
abuse, neglect, or domestic violence.
Health Oversight Activities. We may disclose your PHI
to a health oversight agency that is responsible for ensuring compliance
with rules of government health programs such as Medicare and Medicaid.
These oversight activities include, for example, audits, investigations,
inspections and licensure.
Legal Proceedings and Law Enforcement. We may disclose
your PHI in response to a court order, subpoena, or other lawful
Deceased Persons. We may release PHI to a coroner or
medical examiner authorized by law to receive such information.
Organ and Tissue Donation. We may disclose your PHI to
organizations that obtain organs or tissues for banking and/or
Public Safety. We may use or disclose your PHI to
prevent or lessen a serious or imminent threat to the safety of a person
or the public.
Research. Usually, we will ask for your permission or
authorization before using your PHI for research purposes. However, we
may use and disclose your PHI without your authorization if Main Line
Hospital’s Institutional Review Board (IRB) has waived the authorization
requirement. An IRB is a committee that oversees and approves research
involving human subjects.
Disaster Relief Efforts. We may disclose your PHI about
you to an entity assisting in a disaster relief effort so that your
family can be notified about your condition, status and location.
Military, National Defense and Security. We may release
your PHI if required for military, national defense and security and
other special government functions.
Workers ’ Compensation. We may release your PHI about
you for workers’ compensation or similar programs. These programs
provide benefits for work-related injuries or illnesses.
Communications from Us. We may use or disclose your PHI
to identify health-related services and products that may be beneficial
to your health, such as notification of a new physician and/or
additional products and services, and then contact you about those
products and services. If you do not wish to receive information of this
type, please contact us at www.mainlinehealth.org/optout
Main Line Health Marketing Office
240 Radnor Chester Road
Radnor, PA 19087
As Required by Law. We may use and disclose your
PHI when required to do so by any other laws not already referenced
V. Uses and Disclosures Requiring Your Specific Authorization
Highly Confidential Information. Federal and State laws
require special privacy protections for certain highly confidential
information about you. This includes PHI that is: 1) maintained in
psychotherapy notes; 2) documentation related to mental health or
developmental disabilities services; 3) drug and alcohol abuse,
prevention, treatment and referral information; 4) information related
to HIV status, testing and treatment as well as any information related
to the treatment or diagnosis of sexually transmitted diseases; and 5)
PHI related to genetic testing. Generally, we must obtain your
authorization to release this type of PHI. However, there are limited
circumstances under the law when this type of PHI may be released
without your consent. For example, certain sexually transmitted diseases
must be reported to the Department of Health.
Other Uses or Disclosures Not Described in this Notice.
Other uses and disclosures of PHI not covered by this Notice or the laws
that apply to us will be made only with your written permission. Except
as permitted under this Notice or as permitted by law, we will seek your
written permission prior to using or sharing your information for
marketing purposes or selling your information. If you provide us
permission to use or disclose your PHI, you may revoke that permission,
in writing, at any time. If you revoke your permission, we will no
longer use or disclose your PHI for the reasons covered by your written
authorization. You understand that we are unable to take back any
disclosures we have already made with your permission, and that we are
required to retain a record of the care that we provided to you.
VI. Your Rights Regarding Medical Information About You.
You have the following rights regarding PHI we maintain about you:
Right to Inspect and Copy. You have the right to
inspect and copy PHI that may be used to make decisions about your care
excluding psychotherapy notes.
You may request an electronic copy of your PHI if we maintain the PHI in
an electronic format.
You must submit your request in writing to the appropriate Main Line
Health office or department. You may be charged a fee for the costs of
copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited
circumstances. You may request that the denial be reviewed. Another
licensed health care professional 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. You have the right to request that we
amend the PHI we keep about you in your medical and billing records.
Your request to amend your medical or billing records must be made in
writing and submitted to the appropriate Main Line Health office or
department. We may deny your request if we believe the information you
wish to amend is accurate, current and complete, if the PHI was not
created by Main Line Health or if other special circumstances apply.
We will ask your attending physician to review any amendments to the
Right to an Accounting of Disclosures. You have the
right to request a record of all disclosures of your PHI. We are not
required to give you an accounting of information we have used or
disclosed for treatment, payment or health care operations or
information you authorized us to disclose.
To request this list or accounting of disclosures, you must submit your
request in writing to the appropriate Main Line Health office or
department. Your request may cover any disclosures made in the six years
prior to the date of your request.
Right to Request Restrictions. You have the right to
request a restriction or limitation on the PHI we use or disclose about
you for treatment, payment or health care operations. We are not
required to agree to your request with one exception. We will honor your
request to not share your PHI with your medical insurer or other third
party payer, provided you pay in full for the health care item or
service. If we do agree, we will comply with your request unless the
information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing. In your
request, you must tell us (1) what information you want to limit; (2)
whether you want to limit our use, disclosure or both; and (3) to whom
you want the limits to apply, for example, disclosures to your spouse.
Right to Request Confidential Communications. You have
the right to request that we communicate with you about medical matters
in a certain way or at a certain location.
To request confidential communications, you must make your request in
writing to the appropriate Main Line Health office or department. We
will accommodate all reasonable requests. Your request must specify how
or where you wish to be contacted.
Right to Revoke Your Authorization. You may revoke your
authorization for us to use and disclose your PHI at any time by
submitting a request in writing to the appropriate office or department.
VII. Changes to This Notice
We reserve the right to change this Notice. Revised Notices will be
posted in on this page and other appropriate locations. We reserve the
right to 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. A copy of the current Notice is available upon
If you believe your privacy rights have been violated, you may file a
complaint, in writing, with the Main Line Health Privacy Officer at:
Privacy Officer, Main Line Health
Bryn Mawr Hospital
130 S. Bryn Mawr Ave. Bryn Mawr, PA 19010
You may also wish to file a complaint with the Director, Office of Civil
Rights of the U. S. Department of Health and Human Services. The Privacy
Officer can supply the correct address for the Director.
You will not be penalized for filing a complaint.
IX. Breach Notification
We will notify you in the event of a breach (as defined by HIPAA) of
For more information, call 1.866.CALL.MLH.