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Patient and Visitor Info

Patient Privacy, Rights and Responsibilities

Atrium Medical Center (Atrium) wants you to be aware of your privacy, rights and responsibilities as a patient.

Patient Rights and Responsibilities

Health care is a shared experience involving patients and their families and those who provide care. Premier Health facilities and employees recognize the personal worth and dignity of each patient. Your patient rights and responsibilities are offered as an expression of our philosophy and commitment to you.

Patient Rights

  1. You have the right to considerate, respectful, and responsive care. You have the right to medical treatment regardless of your age, race, color, national origin, religion, language, sex, gender identity or expression, sexual orientation, disability, socioeconomic status, or sources of payment for care.
  2. You have the right to receive the visitors whom you designate (or your support person designates, as appropriate) including, but not limited to, a spouse, a domestic partner, another family member, or a friend. You may also deny or withdraw consent of a visitor or visitors at any time. Premier Health hospitals do not restrict, limit, or otherwise deny visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability. Please note that Premier Health hospitals may limit visitors at times for clinical and safety reasons as appropriate.
  3. You have the right to respectful consideration of your psychosocial, spiritual, and cultural values, needs, and preferences. You have the right to request and receive pastoral/spiritual care services.
  4. You have the right to prepare a living will and/or appoint a surrogate to make decisions on your behalf in accordance with Ohio law. You have the right to present your advance directive (living will and/or health care power-of-attorney) at the time of admission and have hospital staff and practitioners comply with your directive to the extent permitted by law and hospital policy. Premier Health is opposed to and will not participate in assisted suicide and/or active euthanasia, nor will life-sustaining treatment be withheld or withdrawn in the presence of a viable fetus. Should you want to formulate your wishes through an advance directive during or after admission, you have the right to do so. To arrange for this, speak to your nurse or call the patient experience department (see phone numbers below).
  5. You have the right to have your physician promptly notified of your admission to the hospital.
  6. You have the right to have a family member or representative of your choice notified of your admission to the hospital upon request.
  7. You have the right as a competent adult to be involved in all aspects of your care. If you are unable to make decisions for yourself, we will involve your surrogate decision maker, next-of-kin, or a family member as appropriate and allowed by law.
  8. You have the right to and are encouraged to obtain timely, relevant, current, and understandable information concerning your diagnosis, treatment, and prognosis from your physicians and other direct caregivers.
  9. You have the right to be informed about any proposed treatment options so that you understand the potential risks, benefits, and possible side effects of those options, the likelihood of achieving your goals, problems that might occur during recuperation, and alternative courses of treatment and their associated risks, benefits, and side effects as well as the risks of not receiving treatment before making decisions about your medical care.
  10. You have the right to be informed about the outcomes of care, treatment, and services, including unanticipated outcomes, that you need to know about in order to participate in current and future health care decisions.
  11. You have the right to appropriate assessment and management of your pain consistent with accepted medical standards.
  12. You have the right to know the name of the physician who has primary responsibility for your care as well as the names of other professionals responsible for authorizing and performing treatments.
  13. You have the right to refuse treatment to the extent permitted by law and to be informed of the consequences of your refusal. This refusal includes, but is not limited to, experimental research.
  14. You have the right to a reasonable response to your requests for hospital services within the available resources of the hospital based upon priority of need and continuity of care. This includes discharge planning services such as facilitating transfers to another medical or extended care facility.
  15. You have the right to reasonable resources to facilitate effective communications, e.g., language interpreter, sign language interpreter, and devices to assist the hearing impaired.
  16. You and/or your next-of-kin, or an appointed surrogate speaking on your behalf, have the right to request and participate in appropriate discussion of ethical concerns and issues related to your care. To arrange such discussion, speak with the nursing personnel caring for you or your loved one or call the patient experience department (see phone numbers below).
  17. You have the right to confidentiality in regard to your medical record and care.
  18. You have the right to personal privacy and safety including access to protective services should they be required, e.g., guardianship and advocacy services. You have the right to receive care in a safe setting free from all forms of abuse, harassment, neglect, or exploitation.
  19. You have the right to be free from any form of restraint and/or seclusion that is not medically or behaviorally necessary. Restraint and/or seclusion may not be used as a means of discipline, coercion, convenience, or retaliation.
  20. You have the right to know the rules that apply to your conduct and that of your family and visitors while you are a patient at any Premier Health hospital.
  21. You have the right to access, request amendment to, and obtain information on disclosures of your health information in accordance with hospital policy and as allowed by law and regulation.
  22. You have the right to receive upon request a detailed explanation of your charges and bills for medical services and treatment. You have the right to ask and be informed about the existence of business relationships among hospitals, educational institutions, and other health care providers or payers that may influence your care.
  23. You have the right to receive a copy of the hospital’s nursing staffing plan on request.
  24. You have the right to express concerns about your care at any Premier Health hospital. Speak to your physician or the staff caring for you if you have any concerns about your care. If the issue is not resolved to your satisfaction, contact the patient experience department (see phone numbers below) to speak to a patient experience representative. Your concerns will be heard, investigated, and responded to in a timely manner. You also have the right to file a complaint with The Joint Commission which accredits all Premier Health hospitals or the Ohio Department of Health, regardless of whether or not you choose to first use the Premier Health hospital complaint process. Complaints may be forwarded to The Joint Commission and the Ohio Department of Health using the following contact information:

    Email:complaint@jointcommission.org
    Fax: 630-792-5636
    Mail:Office of Quality Monitoring
    The Joint Commission
    One Renaissance Boulevard
    Oakbrook Terrace, IL 60181

    Email:HCComplaints@odh.ohio.gov
    Phone:1 (800) 342-05531 (800) 342-0553
    Fax: 614-564-2422
    Mail: Ohio Department of Health
    Complaint Unit
    246 North High Street
    Columbus, OH 43215

    Patient Experience Department Phone Numbers

    Atrium Medical Center:(513) 420-5072(513) 420-5072
    Good Samaritan Hospital:(937) 734-1000(937) 734-1000
    Miami Valley Hospital:(937) 208-2666(937) 208-2666
    Upper Valley Medical Center:(937) 440-4714(937) 440-4714

Patient Responsibilities

  1. You have the responsibility to make informed decisions about your health care. This includes seeking and considering the information provided by your physician and other caregivers.
  2. You have the responsibility to provide accurate and complete information about all matters relating to your health.
  3. You have the responsibility to inform the hospital staff and your health care providers about the existence of any living will and/or health care power-of- attorney that you have prepared and to present these documents so that they are readily available and can be included in your medical record.
  4. You have the responsibility to report any changes in your condition to your physician and/or the nurse caring for you.
  5. You have the responsibility to follow treatment plans and instructions recommended by your physician. This includes your responsibility to ask questions when you do not understand the plan of care or instructions given to you. If you choose not to follow instructions, you are responsible for the outcome.
  6. You have the responsibility to cooperate with the hospital staff caring for you and to ask questions when you do not understand instructions, need clarification, or have concerns about your plan of care.
  7. You have the responsibility to express any concerns that you have about your hospital care. Speak to your physician, the staff caring for you, or call the patient experience department (see phone numbers below) to express and discuss concerns about your care.
  8. You have the responsibility to abide by the rules that apply to your conduct and that of your family and visitors while you are a patient at any Premier Health hospital. You also have the responsibility to be considerate of the hospital’s staff and property as well as other patients and their property, privacy, and confidentiality.
  9. You have the responsibility to ensure payment of your bill(s) for care and treatment received. This includes the responsibility to cooperate with appropriate hospital staff to provide accurate information for processing insurance forms and other payment processes.
  10. You have the responsibility to send valuables home with your family/friends or to secure them in the hospital safe by notifying your nurse while you are a patient at any Premier Health hospital.

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Patient Privacy

Atrium Medical Center Notice of Privacy Practices

This notice describes how your protected health information may be used and disclosed and how you can get access to this information.  Please review it carefully.

The terms of this Notice of Privacy Practices apply to Premier Health operating as a clinically integrated health care arrangement composed of Miami Valley Hospital, Good Samaritan Hospital, Atrium Medical Center, and Upper Valley Medical Center, as well as outpatient sites, physicians, and other licensed professionals seeing and treating patients at these sites. A complete listing of our service locations is available upon request.  The members of this clinically integrated health care arrangement will share protected health information of our patients as necessary to carry out treatment, payment, and health care operations as permitted by law.

We are required by law to maintain the privacy of our patients’ protected health information and to provide patients with notice of our legal duties and privacy practices with respect to protected health information.  We are required to abide by the terms of this Notice so long as it remains in effect.  We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make the new Notice effective for all protected health information maintained by us.  You may receive a copy of any revised notices at the Registration Desk.

Uses and Disclosures of Your Protected Health Information

Your Authorization: Except as outlined below, we will not use or disclose your protected health information for any purpose unless you have signed a form authorizing the use or disclosure.  You have the right to revoke that authorization in writing unless we have taken any action in reliance on the authorization.  There are certain uses and disclosures of your protected health information for which we will always obtain a prior authorization, and these include:

  • Marketing communications, unless the communication is made directly to you in person, is simply a promotional gift of nominal value, is a prescription refill reminder, general health or wellness information, or a communication about health related products or services that we offer or that are directly related to your treatment;
  • Most sales of your protected health information unless for treatment or payment purposes or as required by law; and
  • Psychotherapy notes unless otherwise permitted or required by law.

Uses and Disclosures for Treatment: We will use and disclose your protected health information as necessary for your treatment. For instance, doctors and nurses and other professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to plan a course of treatment for you that may include procedures, medications, test, etc.  We may also release your protected health information to another health care facility or professional who is not affiliated with our organization but who is or will be providing treatment to you.  For instance if, after you leave the hospital, you are going to receive home health care, we may release your protected health information to that home health care agency so that a plan of care can be prepared for you.

Uses and Disclosures for Payment: We will use and disclose your protected health information as necessary for the payment of those health professionals and facilities that have treated you or provided services to you.  For instance, we may forward information regarding your medical procedures and treatment to your insurance company to arrange a payment for the services provided to you or we may use your information to prepare a bill to send to you or to the person responsible for payment of your bill.

Uses and Disclosures for Health Care Operations: We will use and disclose your protected health information as necessary, and as permitted by law, for our healthcare operations which include clinical improvement, professional peer review, business management, accreditation and licensing, etc.  For instance, we may use and disclose your protected health information for purposes of improving the clinical treatment and care of our patients.  We may also disclose your protected health information to another health care facility, health care professional, or health plan for such things as quality assurance and case management but only if that facility, professional, or plan also has or had a patient relationship with you.

Health Information Exchange: We may participate in health information exchanges (HIEs) to facilitate the secure exchange of your electronic health information between and among other health care providers, health plans, and health care clearinghouses that participate in the HIE.  In order to provide better treatment and coordination of your health care, we may share and receive your health information for treatment, payment, or other health care operations.  Your participation in the HIE is voluntary, and your ability to obtain treatment will not be affected if you choose not to participate.  You may opt-out at any time by notifying the Health Information Management/Medical Records Department.  However, your choice to opt-out does not affect health information that was disclosed through an HIE prior to the time that you opted out.

Our Facility Directory: We maintain a facility directory listing the name, room, and general condition of our patients.  Unless you choose to have your information excluded from this directory, your information will be disclosed to anyone who requests it by asking for you by name.  You have the right during registration, or at any time during your hospitalization, to request that your information be excluded from this directory and also to restrict what information is provided and/or to whom.

Family and Friends Involved in Your Care: With your approval, from time to time we may disclose your protected health information to designated family, friends, and others who are involved in your care, or are involved in payment for your care, in order to facilitate that person’s involvement in caring for you or in paying for your care.  If you are unavailable, incapacitated, or facing an emergency medical situation, and we determine that a limited disclosure may be in your best interest, we may share limited protected health information with such individuals without your approval.  We may also disclose limited protected health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.

Business Associates: Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, legal services, etc.  At times, it may be necessary for us to provide certain protected health information to one or more of these outside persons or organizations who assist us with our health care operations.  In all cases, we require these business associates to appropriately safeguard the privacy of your information.

Fundraising: We may contact you to donate to a fundraising effort on our behalf.  You have the right to “opt-out” of receiving fundraising materials/communications and may do so by calling the Atrium Medical Center Foundation at (513)420-5144 or toll free (800)338-4057, ext. 5144 or by sending an email message to foundation@AtriumMedCenter.org identifying yourself and stating that you do not wish to receive future fundraising requests.  You may also write to us at Foundation, One Medical Center Drive, Middletown, Ohio 45005.  We will honor your request after the date we receive your direction.

Appointments and Services: We may contact you to provide appointment reminders or test results.  You have the right to request, and we will accommodate reasonable requests, to receive communications regarding your protected health information from us by alternative means or at alternative locations.  For instance, if you would prefer that appointment reminders not be left on voice mail or sent to a particular address, we will accommodate all reasonable requests.  You may request such confidential communication in writing by sending your request to the outpatient center where you receive care.

Health Products and Services: We may use your protected health information from time to time to communicate with you about health products and services necessary for your treatment, to advise you of new products and services we offer, and to provide general health and wellness information.

Research: In limited circumstances, we may use and disclose your protected health information for research purposes.  For example, a research organization may wish to compare outcomes of all patients that received a particular drug and will need to review a series of medical records.  In all cases where your specific authorization is not obtained, your privacy will be protected by strict confidentiality requirements applied by an Institutional Review Board which oversees the research or by representations of the researchers that limit their use and disclosure of patient information.

Confidentiality of Alcohol and Drug Abuse Patient Records: The confidentiality of alcohol and drug abuse patient records maintained by this facility is protected by federal law and regulations.  Generally, the facility may not say to a person outside the program that you attend a drug or alcohol program or disclose any information identifying you as an alcohol or drug abuser unless: (1) you consent in writing; (2) the disclosure is allowed by a court order; or (3) the disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation.  Federal law and regulations do not protect information about a crime committed by you either at our facility or against any person who works for the facility or about any threat to commit such a crime.  Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities. 

Other Uses and Disclosures: We are permitted or required by law to make certain other uses and disclosures of your protected health information without your consent or authorization.  We may release your protected health information:

  • For any purposes required by law;
  • For public health activities, such as required reporting of disease, injury, and birth and death, and for required public health investigations;
  • As required by law if we suspect child abuse or neglect; we may also release your protected health information as required by law if we believe you to be a victim of abuse, neglect, or domestic violence;
  • To a student’s school, but only if parents or guardians (or the student if not a minor) agree either orally or in writing;
  • To the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in product recalls;
  • To your employer when we have provided health care to you at the request of your employer to determine workplace-related illness or injury; in most cases you will receive notice that information is disclosed to your employer;
  • If required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings;
  • If required to do so by subpoena or discovery request; in most cases you will have notice of such release;
  • To law enforcement officials as required by law to report wounds, injuries, and crimes;
  • To coroners and/or funeral directors consistent with law;
  • If necessary to arrange for an organ or tissue donation from you or a transplant for you;
  • If, in limited instances, we suspect a serious threat to health and safety;
  • As required by armed forces services if you are a member of the military; we may also release your protected health information if necessary for national security or intelligence activities; and
  • To workers’ compensation agencies if necessary for your workers’ compensation benefit determination.

Ohio law requires that we obtain a consent from you in many instances before disclosing the performance or results of an HIV test or diagnoses of AIDS or an AIDS-related condition, before disclosing information about drug or alcohol treatment you have received in a drug or alcohol treatment program, and before disclosing information about mental health services you may have received.  For full information on when such consents may be necessary, you can contact the Privacy Officer, 110 N. Main Street, Suite 930, Dayton, Ohio 45402.

Rights That You Have

Access to Your Protected Health Information: You have the right to copy and/or inspect much of the protected health information that we retain on your behalf.  All requests for access must be made in writing and signed by you or your representative.  We will charge you per page if you request a copy of the information.  We will also charge for the postage if you request a mailed copy and will charge for preparing a summary of the requested information if you request such summary.  You may obtain an Authorization for Release of Medical Information/Patient Access Form from the Health Information Management/Medical Records Department.

You have the right to obtain an electronic copy of your health information that exists in an electronic format, and you may direct that the copy be transmitted directly to an entity or person designated by you, provided that any such designation is clear, conspicuous, and specific with complete name and mailing address or other identifying information.  We will charge you a fee for our labor and supplies in preparing your copy of the electronic health information.

Amendments to Your Protected Health Information: You have the right to request in writing that protected health information we maintain about you be amended or corrected.  We are not obligated to make all requested amendments but will give each request careful consideration.  In order to be considered by us, all amendment requests must be submitted using an Amendment Request Form signed by you or your representative.  This form is available from the Health Information Management/Medical Records Department.  If any amendment or correction you request is made by us, we may also notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary.

Accounting of Disclosures of Your Protected Health Information: You have the right to receive an accounting of certain disclosures by us of your protected health information for six years prior to the date of your request.  Requests must be made in writing and signed by you or your representative.  Submit your request to the Health Information Management/Medical Records Department.  The first accounting in any 12-month period is free.  You will be charged a fee for each subsequent accounting you request within the same 12-month period.

Restrictions on Use and Disclosure of Your Protected Health Information: You have the right to request, in writing, restrictions on certain of our uses and disclosures of your protected health information for treatment, payment, or health care operations.  Please send your restrictions request to the Health Information Management/Medical Records Department.  We are not required to agree to your restriction request but will attempt to accommodate reasonable requests when appropriate.  We retain the right to terminate an agreed-to restriction if we believe such termination is appropriate.  In the event of a termination by us, we will notify you of such termination.  You also have the right to terminate, in writing, any agreed-to restriction by sending such notice to Health Information Management/Medical Records Department, Atrium Medical Center, One Medical Center Drive, Middletown, Ohio 45005.  We will honor any request to restrict disclosures to your health plan if the information to be disclosed pertains solely to a health care item or service for which Atrium Medical Center has been paid in full.

Breach Notification: In the unlikely event that there is a breach or unauthorized release of your protected health information, you will receive notice and information on steps you may take to protect yourself from harm.

Complaints: If you believe your privacy rights have been violated, you can file a complaint, in writing, with the Privacy Officer, Premier Health, 110 N. Main Street, Suite 930, Dayton, Ohio 45402.  You may also file a complaint, in writing, within 180 days of a violation of your rights with the Office for Civil Rights, U.S. Department of Health and Human Services, 233 N. Michigan Ave., Suite 240, Chicago, IL 60601.  There will be no retaliation for filing a complaint.

For Further Information

If you have questions or need further assistance regarding this Notice, you may contact the Privacy Officer, 110 N. Main Street, Suite 930, Dayton, Ohio 45402.

As a patient, you have the right to obtain a paper copy of this Notice of Privacy Practices, even if you have requested such copy by e-mail or other electronic means.

Effective Date
This Notice of Privacy Practices is effective September 1, 2013


Content Updated: April 13, 2017

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