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 this information carefully.

At Susquehanna Health, we are committed to protecting your health information. This Notice of Privacy Practices describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective April 14, 2003, and applies to all protected health information as defined by federal regulations.

This Notice describes the practices of Susquehanna Health and all related entities as may exist from time to time, including specifically Williamsport Hospital and Medical Center, Divine Providence Hospital, Muncy Valley Hospital, Muncy Valley Skilled Nursing Unit, Susquehanna Regional Home Health Services, Susquehanna Infusion Services, Providence Cancer Treatment Services, Inc., Susquehanna Valley Cancer Treatment Center, Susquehanna Regional EMS, The Meadows of Divine Providence, Health Services Pharmacy, Susquehanna MRI, Soldiers & Sailors Memorial Hospital, The Green Home, Susquehanna Health Medical Group, Tioga Health Care Providers and all physicians and practitioners employed by Susquehanna Health Medical Group or Tioga Health Care Providers or having staff privileges at any Susquehanna Health hospital. (collectively referred to in this Notice as "SH").

Understanding Your Health Record/Information
Each time you visit SH, a record of your visit is made. Typically, this record will contain your symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

  • Basis for planning your care and treatment;
  • Means of communication among the many health professionals who contribute to your care;
  • Legal document describing the care you received;
  • Means by which you or a third-party payer can verify that services billed were actually provided;
  • Tool in educating health professionals;
  • Source of information for medical research;
  • Source of information for public health officials charged with improving the health of this state and the nation;
  • Source of information for our planning, fundraising and marketing;
  • Tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

Understanding what is in your record and how your health information is used helps you to:

  • Ensure its accuracy;
  • Better understand who, what, when, where and why others may access your health information;
  • Make more informed decisions when you allow SH to share your health information with others.

Your Health Information Rights
Although your health record is the physical property of SH, the information belongs to you. You have the right to:

  • Obtain a paper or electronic copy of this Notice of Privacy Practices upon request;
  • Inspect and obtain a copy of your health record as permitted by law;
  • Amend your health record as permitted by law;
  • Obtain an accounting of disclosures of your health information as permitted by law, although an accounting will not contain disclosures that were made for treatment, payment or health care operations purposes, or disclosures that were made with your authorization;
  • Request communications of your health information by alternative means or at alternative locations;
  • Request a restriction on certain uses and disclosures of your information as permitted by law, although SH is not required to agree on a requested restriction;
  • Revoke your authorization to use or disclose health information except to the extent that action has already been taken.
  • Receive notice of breaches of your health information
  • Request to restrict disclosure to your health plan of your health information for services that you paid for, in full

Please contact the Privacy Officer at (570) 321-1000, for more information if you would like to exercise any of the rights listed above.

Our Responsibilities
SH is required to:

  • Maintain the privacy of your health information;
  • Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you;
  • Abide by the terms of this notice;
  • Notify you if we are unable to agree to a requested restriction;
  • Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations;
  • Follow all applicable federal, state and local requirements for notification if your information is lost or stolen.

We reserve the right to change our privacy practices and to make the new provisions effective for all protected health information we maintain. Should our privacy practices change, you may obtain the revised Notice of Privacy Practices by accessing our website at, by calling SH and requesting that the revised Notice be sent to you by mail, or by asking for the revised Notice at the time of your next visit to SH.

Individuals who are admitted as inpatients at any SH hospital will be given the opportunity to select a privacy password that the patient can share with their family and friends to use to call in to the hospital and receive medical status updates from the nursing staff about the patient.  Anyone who calls but does not know the password will not receive any information about the patient.

We will not use or disclose your health information without your authorization, except as described in this notice. We will also stop using or disclosing your health information after we have received a written termination of authorization, according to the procedures included in the authorization.

SH understands your medical care may be managed by both SH and non-SH medical providers. Your doctor having a complete picture of your healthcare, especially in an emergency situation, is important to your receiving quality medical care. SH participates in multiple regional Health Information Exchanges (HIE). With your signed authorization, we are able to share, either your electronic or paper, health record with medical providers involved in your care for the purposes of medical evaluation or treatment.

Examples Of Disclosures For Treatment, Payment And Health Operations


We will use your health information for treatment.
For example: Information obtained by a nurse, doctor or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your doctor will document in your record his or her expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way, the doctor will know how you are responding to treatment. We will also provide your doctor or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you.

We will use your health information for payment.
For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures and supplies used.

We will use your health information for regular health operations.
For example: Members of the medical staff, the risk or quality improvement manager or members of the quality improvement team at SH may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.

Other Uses or Disclosures That May Be Made Without Authorization

Business Associates: There are some services provided in our organization through contracts with business associates. Examples of business associates include certain healthcare quality improvement services, certain laboratory tests and a copy service we use when making copies of your health record. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Workforce Members: SH employees, volunteers, trainees and other persons who work at SH.

Hospital Directory: Unless you notify us that you object, we will use your name, location in the facility, general condition and religious affiliation for hospital directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.

Notification: Unless you object, we may use or disclose information to notify or assist in notifying a family member, personal representative or another person responsible for your care, your location and general condition.

Communication With Family: Unless you object, health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care.

As Required by Law: We will disclose medical information about you when required to do so by federal, state or local law.

Military and Veterans: If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release information to components of the Department of Veterans Affairs to determine whether you are eligible for certain benefits.

Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes: We may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in a lawsuit or dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement: We may release medical information if asked to do so by a law enforcement official:

  • 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 if, under certain limited circumstances, we are unable to obtain the person's agreement;
  • 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.

National Security and Intelligence Activities: We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

To Avert a Serious Threat to Health or Safety: We may use and disclose medical information about you when we determine it is necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

Research: We may disclose information to researchers when their research proposal, reviewed by an institutional review board, has been approved. Protocols are established to ensure the privacy of your health information.

Funeral Directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.

Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs for the purpose of tissue donation and transplant.

Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. We will not use your personal information, without your permission, to market services or products which are sponsored or paid for by third party vendors.

Fundraising: We may use certain information (name, address, telephone number, dates of service, age and gender) to contact you in the future to raise money for Susquehanna Health. We may also provide this information to our institutionally related foundations only, for the same purpose. The money raised will be used to expand and improve the services and programs we provide for the communities we serve. If you do not wish to be contacted for fundraising efforts please notify the SH Development Office, 1001 Grampian Blvd., Williamsport PA 17701 or call our toll free number at 888-322-0945.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects or post-marketing surveillance information to enable product recalls, repairs or replacement.

Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.

Correctional Institution: Should you be an inmate of a correctional institution, we may disclose to the institution, or agents thereof, health information necessary for your health and the health and safety of other individuals.

Media Inquiries: Unless you notify us that you object, we may provide your one-word condition to requesting media if the reason for your visit to one of our facilities is a matter of public record; for example, if you were involved in a car accident.

Federal law makes provisions for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a workforce member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

For More Information Or To Report A Problem

If have questions and would like additional information, you may call (570) 321-1000 and request to speak to the Privacy Officer at SH.

If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer at SH, or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights.

In accordance with The Health Information Technology for Economic and Clinical health (HITECH) Act of 2009, and its regulations, if a breach of PHI is determined, SH will notify you and the Secretary of the U.S. Department of Health and Human Services and their Office of Civil Rights (OCR) of the breach.