HIPAA Notice


Southeastern Virginia Health System

Effective Date: September 23, 2013


If you have any questions about this notice, please contact Valda Branch, Privacy Officer at (757) 591-0643.

  1. About This Notice


 We (SEVHS) understand that health information about you and your health care is personal.  We are committed to protecting health information about you.  We create a record of the care and services you receive from us.  We need this record in order to provide you with quality care and to comply with certain legal requirements.  This notice applies to all of the records of your care generated by this health care practice, whether made by your personal physician or others working in this office.  This notice will tell you about the ways in which we may use and disclose health information about you.  We also describe your rights to the health information we keep about you, and describe certain obligations we have regarding the use and disclosure of your health information.

We are required by law to:

  • Make sure that health information that identifies you is kept private
  • Give you this notice of our legal duties and privacy practices with respect to health information about you
  • Follow the terms of this Notice
  • Notify you following a breach of unsecured health information
  1. How This Organization May Use and Disclose Health Information About You

 The following categories describe different ways that we may use and disclose health information.


We may use health information about you to provide you with health care treatment or services.  We may disclose health information about you to doctors, nurses, technicians, health students or other personnel, both inside and outside of our organization, who are involved in your care.  For example,

  • Information may be disclosed to personnel at our offices, at the hospital if you are hospitalized under our supervision, or at another doctor’s office;
  • To help coordinate your care, information may be disclosed to different entities such as laboratories, pharmacies or other health care providers to whom we may refer you for consultation, to take x-rays, to perform lab test, to have prescriptions filled or for other treatment purpose.


We may use and disclose your information for billing and payment purposes.  For example,

  • Your information may be disclosed to insurance companies, or a third party so that payment may be received for services provided to you.
  • Insurance companies and other payers may require prior approval to cover certain treatments or procedures.  Your information will be disclosed to gain this approval.
  • Your information may be disclosed to insurance companies and other payers so they can review our billing practices.

Health Care Operations:

We may disclose health information about you for operations of our health care practice.  These uses and disclosures are necessary to run our practice and make sure that all of our patients receive quality care.  For example,

  • We may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you.
  • We may also combine health information about many patients to decide what additional services we should offer, what services are not needed, whether certain new treatments are effective, or to compare how we are doing with others and to see where we can make improvements.

 *We may remove information that identifies you from this set of health information so others may use it to study health care delivery without learning the specific identities of our patients.

 Business Associates:

 There are some services we provide through the use of outside people and entities.  We may disclose your health information to our business associates so they can perform the job we ask them to do. To protect your health information, however, we require the business associates to appropriately protect your information, and they are required to do so by law.

 III.        Special Situation Involving Your Medical Information

Family and Friends:

 We may use or disclose to a family member, close friend, or any other person involved in your health care, health information relevant to that person’s involvement in your care or payment related to your care. If appropriate, these communications may also be made after your death, unless you have told us not to make such communication.  We may use or disclose your health information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, of your location, general condition, or death.

 Workers’ Compensation:

We may release health information about you for workers’ compensation or similar programs.  These programs provide benefits for work-related injuries or illness.

Public Health Risks:

We may disclose health information about you for public health activities.  These activities generally include the following:

  • To prevent or control disease, injury or disability
  • To report births and deaths
  • To report child abuse or neglect
  • To report reactions to medications or problems with products
  • To notify persons of recalled products they may be using
  • To notify persons or organizations required to receive information of FDA-regulated products
  • To notify persons who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
  • To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence; we will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities:

We may disclose health information to a health oversight agency for activities authorized by law.  Theses 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:

If you are involved in a lawsuit or dispute, we may disclose health information about you in response to a court or administrative order.  We may also disclose health information about you in response to a subpoena, discovery request or other lawful process by someone else involved in the 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 health information if asked to do so by a law enforcement official:

  • In reporting certain injuries, as required by law, gunshot wounds, burns, injuries to perpetrators of a crime.
  • In response to a court order, subpoena, warrant, summons, or similar process
  • To identify or locate a suspect, fugitive, material witness, or missing person:
    1. Name and address
    2. Date of birth or place of birth
    3. Social security number
    4. Blood type or Rh factor
    5. Type of injury
    6. Date and time of treatment and/or death
    7. A description of distinguishing physical characteristics
    8. About criminal conduct at one of our facilities.

Any amendment we make to your health information will be disclosed to those with whom we disclose information as previously specified.

Right to an Accounting of Disclosure:

You have the right to request a list accounting for any disclosures of your health information we have made, except for certain uses and disclosures, including uses and disclosures for treatment, payment, and health care operations, as previously described.

To request this list of disclosures, you must submit your request in writing to Valda Branch, Privacy Officer.  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 first list you request within a 12 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.  We will mail you a list of disclosers in paper form within 30 days of your request, or notify you if we are unable to supply the list within that time period and by what date we can supply the list; this date will not exceed a total of 60 days from the date you made the request.

Right to Request Restrictions:

You have the right to request a restriction or limitation on the health 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 health information we disclose about you to someone who is involved in your care or the payment of your care, such as a family member or friend.  For example, you could ask that we restrict a specified nurse from use of your information or that we not disclose information to your spouse about a surgery you had.

We are not required to agree to your request for restrictions if it is not feasible for us to ensure our compliance or if we believe it will negatively impact the care we may provide you.  We are only required to agree to your request if it is a request not to disclose health information to your health care plan relating to a service for which you have already paid in full out of pocket.  If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.  To request a restriction, you must make your request in writing to Valda Branch, Privacy Officer.  In your request, you must tell us what information you want to limit and to whom you want the limits to apply.  For example, you may request that we only contact your at work or by mail to a post office box.

Right to Request Confidential Communication:

You have the right to request confidential communications; you must make your request in writing to Valda Branch, Privacy Officer.  We will not ask the reason for your request.  Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of this Notice:

You have the right to obtain a paper copy of this notice at any time.  To obtain a copy, please request it from Valda Branch, Privacy Officer.

You may also obtain a copy of this notice from either our website, www.sevhs.org or by requesting a copy of this notice be sent through electronic mail to .  If we know that the electronic message has failed to be delivered, a paper copy of the notice will be provided.  Even if you have received a notice electronically, you still retain the right to receive a paper copy upon request.

If the first service delivery is delivered electronically, other than by telephone, we provide electronic notice in the same medium, automatically and contemporaneously in response to a first request for service.

Changes to this Notice:

We reserve the right to change this notice.  We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future.  We will post a copy of the current notice in our facility.  This notice will contain on the first page, in the top right hand corner, the effective date.  In addition, each time you register for treatment or health care services, we will offer you a copy of the current notice in effect.


If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services.  To file a complaint with us, contact Valda Branch, Privacy Officer.  All complaints must be submitted in writing.  You will not be penalized for filing a complaint.

Other Uses of Health Information:

Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission.  Thus, for example, we will require your authorization before we would use or disclose your health information for marketing purposes and, if applicable, for most uses of psychotherapy notes.  In addition, we will not sell your health information without a specific authorization from you.  If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time.  If you revoke your permission, we will no longer use or disclose health information about you 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 our records of the care that we provided to you.

Acknowledgement of Receipt of this Notice:

We will request that you sign a separate form or notice acknowledging you have received a copy of this notice.  If you choose, or are not able to sign, a staff member will sign their name and date.  This acknowledgement will be filed with your records.