Privacy Policy

Pomerene Hospital collects and maintains a great deal of personal health information about our patients. The federal HIPAA regulations on patient privacy and confidentiality require us to provide notice to our patients and the public about how this information may be used and disclosed by our organization. All employees are required to comply with provisions of this policy.  


Timing of Provision. The Notice of Privacy Practices was made available, distributed, and posted on or after April 14, 2003. This policy was last reviewed in October 2007. 
Availability to the Public.
A copy of the Notice of Privacy Practices must be made available on request to any person who requests it in each separate building where patients receive treatment.                

Distribution to Patients. All patients must be provided a copy of the Notice of Privacy practices no later than the date of the first service delivery on or after April 14, 2003, including service delivered electronically, to such patient. A Notice of Privacy Practices must be provided to a patient for each separate admission or outpatient encounter. We are not required to provide Notice to any patient who is also an inmate in a correctional facility.        

E-Mail Delivery of Notice. If the first service delivery to a patient is delivered electronically, provide an electronic copy of the Notice of Privacy Practices automatically and contemporaneously in response to the patient's first request for service.  The Notice of Privacy Practices may be provided to other patients by e-mail, if the patient agrees to electronic notice and such agreement has not been withdrawn. If you know that the e-mail transmission has failed, you  must provide a paper copy of the Notice to the patient. The patient who is the recipient of an electronic notice retains the right to obtain a paper copy of the Notice upon request.

Acknowledgement of Receipt. After providing the patient with a copy of the Notice of Privacy Practices, obtain the patient's signature on the "Receipt of Notice of Privacy Practices Acknowledgement Form." In the case of an emergency when the patient is not able to sign the acknowledgement form, attempt to obtain the patient's signature as soon as practicable. If the Notice is delivered electronically by e-mail, require the patient to acknowledge receipt of the e-mail electronically by replying to the Notice delivery e-mail. When the patient refuses to sign the form or you are otherwise unable to obtain a signature, document the attempts made to obtain the signature and the reasons why you were unsuccessful. Retain the signed acknowledgement forms and the documentation of failed attempts to obtain the signed form with the medical record.        

Posting the Notice.Copies of the Notice of Privacy Practices must be posted in each separate building where patients receive treatment. The Notice must be posted in a clear and prominent location where it is reasonable to expect patients to be able to see and read the Notice.        

Website Posting. A copy of the most current Notice of Privacy Practices must be posted prominently on our website and must be accessible by a link from the front page of the website.        

Revisions to the Notice. Whenever the Notice of Privacy Practices is revised, make the revised Notice available upon request on or after the effective date of the revision, distribute the revised Notice as required in paragraph 3; promptly post the revised Notice as required in paragraph 5; and post the revised Notice on the website as required in paragraph 6. All patients arriving for treatment after the effective date of a revised Notice must be given the appropriate revised Notice.        

Medical Record Access

A patient may obtain a copy of their medical record by visiting the Health Information Department located on the first floor. You will need to bring one type of identification with you, i.e. driver's license or Social Security card in addition to completing one of our release forms. We also require 48-hour advance notice in order to process and prepare your records for release.

Hours of Operation

The Health Information Department is open Monday-Friday from 7:30 am to 4:00 pm.

Additional Information

Please click here to download our Medical Information Release Form. You may also have your physician fax the completed form to (330) 674-1259.

Main Campus

981 Wooster Road
Millersburg, Ohio 44654
(330) 674-1015


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