Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed, and how you can access this information. Please review it carefully.
Our Responsibilities
Good Fellowship Club of Chester County, Inc. (“GFAC”) is required by law to protect the privacy of your health information, known as Protected Health Information (PHI). We must provide you with this notice outlining our legal duties and privacy practices and follow the terms of the current version of this notice.
How We May Use and Disclose Your PHI
We may use or share your PHI for the following purposes, without your written permission:
For Treatment
We may use or share your PHI to provide, coordinate, or manage your medical care. For example, we may receive verbal or written information from you, your doctor, or a nurse, and we may relay your PHI to a hospital or dispatch center by phone or radio.
For Payment
We may use your PHI to bill and collect payment for services we provide. This includes submitting claims to insurance companies, determining medical necessity, and following up on unpaid balances.
For Health Care Operations
We may use your PHI to support day-to-day business activities, including quality assurance, staff training, licensing, and compliance monitoring.
Other Uses Without Authorization
We may also share your PHI in certain situations without your written permission, including:
- With other health care providers for treatment, payment, or operations
- To family members or others involved in your care, if you agree or do not object
- When required by law, such as reporting abuse, neglect, or domestic violence
- For public health activities
- For health oversight or regulatory investigations
- In response to a court order or legal process
- For law enforcement purposes in specific situations
- For organ and tissue donation if you are an organ donor
- With coroners or funeral directors
- To prevent or lessen a serious health or safety threat
- For military or national security purposes
- For workers’ compensation claims
- For approved research, under strict oversight
- In de-identified form that cannot identify you
When We Need Your Written Authorization
For any use or disclosure not listed above, we will obtain your written permission. You may revoke this authorization at any time in writing, except when we’ve already relied on it.
Your Rights Regarding PHI
Right to Access
You may request to see or get a copy of your medical records. We will provide access within 30 days, and may charge a reasonable fee for copies. In limited cases, we may deny access, but you’ll have the right to appeal.
Right to Amend
You may request changes to your PHI if you believe something is incorrect. We will respond within 60 days. We may deny the request if we believe the record is accurate.
Right to an Accounting of Disclosures
You may ask for a list of certain times we disclosed your PHI over the past six years. This excludes disclosures for treatment, payment, or operations, or those you already authorized.
Right to Request Restrictions
You can ask us to limit how we use or share your PHI. While we are not required to agree, we will follow any restrictions we do accept in writing.
Right to Confidential Communications
You may request that we contact you in a specific way (for example, at a certain phone number or address).
Right to a Paper Copy
You may request a paper copy of this notice at any time, even if you received it electronically.
Changes to This Notice
We may update this notice at any time. Changes apply to all PHI we maintain. We will post updates in our facility and on our website, if available. You may request a copy of the current notice at any time.
Questions or Complaints?
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.
Contact Our Privacy Officer:
Privacy Officer
Good Fellowship Club of Chester County, Inc.
P.O. Box 361
West Chester, PA 19381
Phone: (610) 998-3332
Email: compliance@goodfellowship.org
Effective Date of the Notice: April 14, 2003
