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This notice describes how medical information about you may be used or disclosed and how you can get access to this information. Please review it carefully.
For questions or concerns, contact our HIPAA Privacy Officer:
Monadnock Community Hospital
452 Old Street Rd, Peterborough, NH 03458
Phone: (603) 924-4699 x4733
Effective Date: April 2016
Last Revised: May 6, 2025
Download PDF Version >
Our Pledge Regarding Health Information
We are committed to protecting your health information.
About This Notice
We are required by law to:
-
Make sure that health information that identifies you is kept private.
-
Provide you this notice of our legal duties and privacy practices with respect to your health information.
-
To follow the terms of the notice.
We reserve the right to change this notice. Any revision will affect how your current health information is treated as well as any information we receive in the future. We will post a copy of the current notice in various locations throughout Monadnock Community Hospital (“MCH”), our affiliated medical offices, and our website.
What is Protected Health Information?
Protected Health Information (“PHI”) is information that individually identifies you and that we create or get from you or from another health care provider, health plan, your employer, or a health care clearinghouse and that relates to:
-
Your past, present, or future physical or mental health or conditions,
-
The provision of health care to you, or
-
The past, present, or future payment for your health care.
Who Will Follow This Notice
Our health care team covered by this notice includes health care providers and the staff at MCH, Monadnock Health Partners, and other providers who are involved in your care, including your primary care provider, specialty care providers, consulting providers, on-call providers, emergency/urgent care providers, hospitalists, and other hospital-based providers. Also covered are all nonclinical employees, including managerial, administrative, and support staff employed by MCH.
Your Written Authorization is Required for Uses and Disclosures, Except as Described Below
The following uses and disclosures of your PHI will be made only with your written authorization except as set forth below:
-
Most uses and disclosures of psychotherapy notes.
-
Uses and disclosures of PHI for marketing purposes.
-
Disclosures that constitute a sale of your PHI.
Other uses and disclosures of PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you do give us an authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer. We will no longer disclose PHI under the authorization, but any disclosure made in reliance on your prior authorization will not be affected.
Special Protections
Additional protections apply to the following types of PHI:
-
Treatment with mental health providers
-
Treatment for substance abuse
-
Genetic counseling
-
HIV testing and treatment
To share this information with anyone other than the treating provider, you must sign an authorization that specifically allows its release.
How We May Use and Disclose Your Protected Health Information
We may use and disclose your PHI in the following ways:
For Treatment
To provide or coordinate your medical care.
For Payment
To bill and collect payment for services from you, a health plan, or a third party.
For Health Care Operations
To review care quality and improve services.
Appointment Reminders / Treatment Alternatives / Health-Related Benefits
To contact you with reminders or information that may interest you.
Minors
PHI may be disclosed to parents or guardians unless otherwise prohibited by law.
Research
Under strict conditions, PHI may be used for research.
As Required by Law
We will disclose PHI when required by federal, state, or local law.
To Avert Serious Threats
Only when necessary to prevent harm to you or others.
Business Associates
We may share PHI with vendors under contract who must safeguard it.
Organ and Tissue Donation
As needed for donation and transplantation purposes.
Military and Veterans
As required by military command authorities.
National Security / Intelligence / Law Enforcement Custody
When necessary to fulfill legal duties.
Workers’ Compensation
To comply with laws relating to work-related injuries.
Public Health Risks
For public health activities including:
-
FDA-related concerns
-
Disease prevention/control
-
Reporting births, deaths, abuse, or reactions
-
Product recalls and exposure notifications
Abuse, Neglect, or Domestic Violence
If authorized by law or with your agreement.
Psychotherapy Notes
Only disclosed with written authorization, except under specific legal circumstances.
Health Oversight Activities
For government audits, inspections, and monitoring.
Data Breach Notification Purposes
To inform you of unauthorized access to your PHI.
Lawsuits and Disputes
As required in legal proceedings or to defend ourselves.
Law Enforcement
As permitted by law.
Coroners, Medical Examiners, Funeral Directors
To carry out their legal duties.
Inmates
For care or safety in custody situations.
Uses and Disclosures That Require You to Object or Opt Out
Individuals Involved in Your Care
We may share PHI with family or others involved in your care unless you object.
Disaster Relief
We may share your location or condition during disasters.
Fundraising
You may be contacted. You have the right to opt out. Contact the Philanthropy Department for a “Fundraising Communications Opt Out” form.
Health Information Exchange (HIE)
We may share your PHI with other providers via a secure network. To opt out, contact your provider’s office or the Privacy Officer.
Your Rights Regarding Your Protected Health Information
Right to Inspect and Copy
You may request access to your PHI. We may charge for copies.
Right to a Summary or Explanation
Available upon request with applicable fees.
Right to an Electronic Copy
You can request your PHI electronically.
Right to Get Notice of a Breach
You will be notified of any unauthorized breach.
Right to Request Amendments
Submit a written request if your information is incorrect. We may deny the request in some cases.
Right to an Accounting of Disclosures
You may request a list of certain PHI disclosures (exceptions apply). One free request every 12 months.
Right to Request Restrictions
You can request limits on use or disclosure. We are not required to agree unless it pertains to out-of-pocket payments.
Out-of-Pocket Payments
If you fully paid out-of-pocket, you may restrict disclosure of that service to your health plan.
Right to Request Confidential Communications
You may request how and where we contact you.
Right to a Paper Copy
You may request a printed copy of this Notice anytime.
How to Exercise Your Rights
Submit written requests to the Privacy Officer at the address above. To inspect or copy PHI, you may also call the Health Information Services Department at 603-924-4609.
Changes to This Notice
We reserve the right to change this Notice and apply the new Notice to all PHI we maintain. Current versions will be posted in our offices and on our website.
Complaints
You may file a complaint with us or with the U.S. Department of Health and Human Services if you believe your privacy rights have been violated.
No retaliation will occur for filing a complaint.
To file with us:
Contact the Privacy Officer at the address at the top of this Notice.
To file with HHS Office for Civil Rights:
Region I Office for Civil Rights
U.S. Department of Health and Human Services
Government Center, JF Kennedy Federal Building, Room 1875
Boston, MA 02203
Phone: 617-565-1340
Fax: 617-565-3809
TDD: 617-565-1343
Notice of Availability of Language Assistance Services and Auxiliary Aids and Services
If you speak a language other than English, free language assistance services are available to you. Auxiliary aids and accessible formats are also available at no charge. Speak to your provider or any member of your care team. For general inquiries, call 603-924-4691.
Monadnock Community Hospital
452 Old Street Rd
Peterborough, NH 03458
Phone: 603-924-7191
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[0] => This notice describes how medical information about you may be used or disclosed and how you can get access to this information. Please review it carefully.
For questions or concerns, contact our HIPAA Privacy Officer:
Monadnock Community Hospital
452 Old Street Rd, Peterborough, NH 03458
Phone: (603) 924-4699 x4733
Effective Date: April 2016
Last Revised: May 6, 2025
Download PDF Version >
Our Pledge Regarding Health Information
We are committed to protecting your health information.
About This Notice
We are required by law to:
-
Make sure that health information that identifies you is kept private.
-
Provide you this notice of our legal duties and privacy practices with respect to your health information.
-
To follow the terms of the notice.
We reserve the right to change this notice. Any revision will affect how your current health information is treated as well as any information we receive in the future. We will post a copy of the current notice in various locations throughout Monadnock Community Hospital (“MCH”), our affiliated medical offices, and our website.
What is Protected Health Information?
Protected Health Information (“PHI”) is information that individually identifies you and that we create or get from you or from another health care provider, health plan, your employer, or a health care clearinghouse and that relates to:
-
Your past, present, or future physical or mental health or conditions,
-
The provision of health care to you, or
-
The past, present, or future payment for your health care.
Who Will Follow This Notice
Our health care team covered by this notice includes health care providers and the staff at MCH, Monadnock Health Partners, and other providers who are involved in your care, including your primary care provider, specialty care providers, consulting providers, on-call providers, emergency/urgent care providers, hospitalists, and other hospital-based providers. Also covered are all nonclinical employees, including managerial, administrative, and support staff employed by MCH.
Your Written Authorization is Required for Uses and Disclosures, Except as Described Below
The following uses and disclosures of your PHI will be made only with your written authorization except as set forth below:
-
Most uses and disclosures of psychotherapy notes.
-
Uses and disclosures of PHI for marketing purposes.
-
Disclosures that constitute a sale of your PHI.
Other uses and disclosures of PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you do give us an authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer. We will no longer disclose PHI under the authorization, but any disclosure made in reliance on your prior authorization will not be affected.
Special Protections
Additional protections apply to the following types of PHI:
-
Treatment with mental health providers
-
Treatment for substance abuse
-
Genetic counseling
-
HIV testing and treatment
To share this information with anyone other than the treating provider, you must sign an authorization that specifically allows its release.
How We May Use and Disclose Your Protected Health Information
We may use and disclose your PHI in the following ways:
For Treatment
To provide or coordinate your medical care.
For Payment
To bill and collect payment for services from you, a health plan, or a third party.
For Health Care Operations
To review care quality and improve services.
Appointment Reminders / Treatment Alternatives / Health-Related Benefits
To contact you with reminders or information that may interest you.
Minors
PHI may be disclosed to parents or guardians unless otherwise prohibited by law.
Research
Under strict conditions, PHI may be used for research.
As Required by Law
We will disclose PHI when required by federal, state, or local law.
To Avert Serious Threats
Only when necessary to prevent harm to you or others.
Business Associates
We may share PHI with vendors under contract who must safeguard it.
Organ and Tissue Donation
As needed for donation and transplantation purposes.
Military and Veterans
As required by military command authorities.
National Security / Intelligence / Law Enforcement Custody
When necessary to fulfill legal duties.
Workers’ Compensation
To comply with laws relating to work-related injuries.
Public Health Risks
For public health activities including:
-
FDA-related concerns
-
Disease prevention/control
-
Reporting births, deaths, abuse, or reactions
-
Product recalls and exposure notifications
Abuse, Neglect, or Domestic Violence
If authorized by law or with your agreement.
Psychotherapy Notes
Only disclosed with written authorization, except under specific legal circumstances.
Health Oversight Activities
For government audits, inspections, and monitoring.
Data Breach Notification Purposes
To inform you of unauthorized access to your PHI.
Lawsuits and Disputes
As required in legal proceedings or to defend ourselves.
Law Enforcement
As permitted by law.
Coroners, Medical Examiners, Funeral Directors
To carry out their legal duties.
Inmates
For care or safety in custody situations.
Uses and Disclosures That Require You to Object or Opt Out
Individuals Involved in Your Care
We may share PHI with family or others involved in your care unless you object.
Disaster Relief
We may share your location or condition during disasters.
Fundraising
You may be contacted. You have the right to opt out. Contact the Philanthropy Department for a “Fundraising Communications Opt Out” form.
Health Information Exchange (HIE)
We may share your PHI with other providers via a secure network. To opt out, contact your provider’s office or the Privacy Officer.
Your Rights Regarding Your Protected Health Information
Right to Inspect and Copy
You may request access to your PHI. We may charge for copies.
Right to a Summary or Explanation
Available upon request with applicable fees.
Right to an Electronic Copy
You can request your PHI electronically.
Right to Get Notice of a Breach
You will be notified of any unauthorized breach.
Right to Request Amendments
Submit a written request if your information is incorrect. We may deny the request in some cases.
Right to an Accounting of Disclosures
You may request a list of certain PHI disclosures (exceptions apply). One free request every 12 months.
Right to Request Restrictions
You can request limits on use or disclosure. We are not required to agree unless it pertains to out-of-pocket payments.
Out-of-Pocket Payments
If you fully paid out-of-pocket, you may restrict disclosure of that service to your health plan.
Right to Request Confidential Communications
You may request how and where we contact you.
Right to a Paper Copy
You may request a printed copy of this Notice anytime.
How to Exercise Your Rights
Submit written requests to the Privacy Officer at the address above. To inspect or copy PHI, you may also call the Health Information Services Department at 603-924-4609.
Changes to This Notice
We reserve the right to change this Notice and apply the new Notice to all PHI we maintain. Current versions will be posted in our offices and on our website.
Complaints
You may file a complaint with us or with the U.S. Department of Health and Human Services if you believe your privacy rights have been violated.
No retaliation will occur for filing a complaint.
To file with us:
Contact the Privacy Officer at the address at the top of this Notice.
To file with HHS Office for Civil Rights:
Region I Office for Civil Rights
U.S. Department of Health and Human Services
Government Center, JF Kennedy Federal Building, Room 1875
Boston, MA 02203
Phone: 617-565-1340
Fax: 617-565-3809
TDD: 617-565-1343
Notice of Availability of Language Assistance Services and Auxiliary Aids and Services
If you speak a language other than English, free language assistance services are available to you. Auxiliary aids and accessible formats are also available at no charge. Speak to your provider or any member of your care team. For general inquiries, call 603-924-4691.
Monadnock Community Hospital
452 Old Street Rd
Peterborough, NH 03458
Phone: 603-924-7191
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