Notice of Privacy Practice
This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.OUR PLEDGE REGARDING MEDICAL INFORMATION
We know that medical information about you and your health is personal. We are charged with protecting health information about you. We create a record of the care and services you receive at Pen Bay Healthcare. We need this record to provide you with quality care and to comply with certain laws. This Notice applies to all the records of your care developed by Pen Bay Healthcare (and its affiliated organizations) whether made by Pen Bay Healthcare staff or your doctor, or provided to Pen Bay Healthcare by other healthcare providers or facilities that have provided healthcare or services to you. Your doctor may have other policies or notices about his or her use and disclose of your health information created in his or her office or clinic.
This Notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain duties we have with respect to the use and disclosure of your health information.
If you have any questions about this Notice, please speak to the person who gave it to you, or contact the:
Pen Bay Healthcare Privacy Officer
6 Glen Cove Drive
Rockport, ME 04856
Pen Bay Healthcare uses our best efforts to respect the privacy of our online visitors. We believe that you should have control over who receives your personal information, and we are focused on helping you share information in a secure environment. We do not give out or use information about your visits to our website, your name, where you live, your email or telephone number to anyone outside of our organization.
While you are at Pen Bay Medical Center, a confidential record will be kept by your health care team. This record contains your medical history, details of your treatment, and the progress you have made while in the hospital. As a Pen Bay patient, you may obtain a copy of your record according to hospital policy. When you are admitted to the hospital, the forms you sign give Pen Bay permission to release pertinent information to your insurance company, if it is requested.
Generally, your health care information is strictly confidential and will not be released without your prior consent. Pen Bay Medical Center may, however, disclose to another health care provider or health care facility information necessary for the purposes of diagnosis, treatment, or care in an emergency situation. If you would like a copy of your records, you can contact the Health Information department at 207-921-8240.
Release of Information
If you would like a copy of your medical record, please print and complete the Authorization to Release Medical Information and Records and mail or fax it to the address below.
E-mail is not private or secure, and we cannot accept e-mail requests for copies of medical records.The patient’s original signature or authorized representative’s original signature is required.
Mail or Fax to:
Health Information Department
Pen Bay Medical Center
6 Glen Cove Drive
Rockport, ME 04856
Please include your name, address, and phone number in case we need to contact you.
Birth certificates for babies born at Pen Bay can be obtained from the Town Clerk at the Rockport Town Office.
About Your Privacy and Confidentiality
Your medical record is private and confidential. Pen Bay Medical Center will safeguard your record and any related computerized information, and will only allow others to access it when you give us the authority to do so.
The hospital and its medical staff hold in confidence all information about you, including medical, social, family, and financial matters. The only exception is when the hospital is permitted or required by law to report information (such as infectious diseases) to the state.
If you need more information, you may call the Health Information Department at 207-921-8240 during business hours, 8 a.m. – 4:30 p.m., Monday through Friday.
During your hospital stay, when you sign the “release of information” section of the hospital’s Patient Consent Form, you are giving Pen Bay the authority to release information to other healthcare organizations, facilities, or individuals who provided care for you after you leave the hospital. It also authorizes Pen Bay to provide specific information in your medical record to your insurance company or to other parties paying for your care (including your employer).
You may cancel this authorization at any time by contacting the Health Information Department at 207-921-8240.