NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Our Duty to Protect Your Privacy
- We have a legal duty to protect the privacy of your health information – and to give you this Notice.
- We have a legal duty to abide by our current Notice of Privacy Practices.
- We may change this Notice and make the new Notice effective for all health information we have. This includes health information we created or received before we made the changes.
- We will make any revised Notice available in paper copy and by displaying it in our facilities and on our web site. Also, you can request the revised Notice in-person or by mail.
Who will Follow this Notice
This notice describes our facility’s practices and that of any employee, student, intern, or contracted service provider authorized to enter information into your medical and billing records.
Your Health Information Rights
“Health information” means, generally, information about your past or present health status, condition, diagnosis, treatment, prognosis, or payment for health care (i.e., your medical and billing record).
We will collect health information from you for the purpose of providing health care services to you. The intended uses and possible disclosures of this information our explained in this Notice. In most cases, you are not required to provide the information we request of you; if you do not provide the information requested, however, we may not be able to provide services to you.
Restrictions on Use or Disclosure. This Notice describes some restrictions on how we can use and give out your health information. In addition, you may ask us for extra limits on how we use or to whom we give the information, such as not allowing a certain employee to review your information. You need to make your request in writing. We are not required to agree to your request. If we do agree, we will follow our agreement, except:
- in an emergency when the information is needed to provide you timely and effective treatment
- if you give us written permission to use or give out your information
- if you or we end the restriction, or
- as otherwise required by law.
Normally, we will communicate with you at the address and phone you give us at the time of registration. You may ask us to communicate with you by other ways or at another location, at any time. Your request needs to explain how you want the information communicated and where. We will agree to your request if it is reasonable. If you restrict us from providing information to your insurer, you also need to explain how you will pay for your treatments.
You may look at or get copies of your health information. (There are some exceptions.) You need to make your request in writing. If you ask for copies, we may charge fees as allowed for by law. If you ask for copies in a format other than paper copies, we will give you that other format if practical. If you ask for your records in a format we can provide, we will charge a reasonable fee based on our costs. If your request is denied, we will send the denial in writing. This will include the reason and describe any right you may have to a review of the denial.
You may ask us to change certain health information. You need to make your request in writing. You must explain why the information should be changed. If we accept your change, we will try to inform others (including people you list in writing) of the change. We will include the changes in future disclosures of your health information. If your request is denied, we will send the denial in writing. This denial will include the reason and describe any steps you may take in response.
You may receive a free list of disclosures of your health information made without your authorization by us or our business associates. The list does not include:
- disclosures made for treatment, payment or health care operations
- disclosures made before April 14, 2003
- disclosures you have authorized
- certain other disclosures, as provided for by law.
You need to make your request in writing. If you ask for a list more than once in a 12-month period, we may charge you a fee for each extra list. You may withdraw or change your request to reduce or eliminate the charge.
Paper Copy of Notice
You may receive a paper copy of our current Notice of Privacy Practices.
How to Use These Rights
Please contact us at the office and number listed on the last page to use any of these rights or receive more information about any related fees.
Uses and Disclosures of Health Information
To provide you care, we have certain reasons we use and disclose health information. We make all uses and disclosures according to our privacy policies and the law. We may use and give your health information as follows:
Treatment, Payment and Health Care Operations
We may use and give your health information for the following purposes, provided you have signed a Consent Form allowing these disclosures:
(examples: working with another provider, within or outside of Hennepin County; coordinating care with another healthcare agency; etc.)
(example: providing information to an insurance company)
Health care operations.
These are activities that support us in providing services to patients. (examples: quality assessment and conducting training programs)
We may use or give your health information as necessary to help you in a medical emergency.
Appointment Reminders; Treatment Alternatives.
We may send you appointment reminders, or tell you about treatments and health-related benefits or services that you may find helpful.
We may give certain health information to law enforcement. This could be:
- when there may have been crime at the facility, or
- when there is a serious threat to the health or safety of another person or people.
We may give health information of an inmate or other person in custody to law enforcement or a correctional institution.
Abuse or Neglect.
We may give health information to the proper authorities about possible abuse or neglect of a child or a vulnerable adult.
Military Authorities/National Security.
We may give health information to authorized people from the U.S. military, foreign military, and U.S. national security or protective services.
Health Oversight Activities.
We may give health information to government, licensing, auditing and accrediting agencies for actions allowed or required by law.
In limited situations, we may disclose health information to researchers when the research as been approved by an institutional review board or privacy board.
Public Health Risks.
We may give health information about you for public health purposes. These purposes include the following:
- reporting and controlling disease (such as tuberculosis), injury or disability
- reporting adverse events related to food, medications, or problems with health products
- notifying a person who may have been exposed to a disease or be at risk for catching or spreading a disease or condition.
We may give health information in response to a state or federal court order, legal orders, subpoenas, or other legal documents.
Required by Other Laws.
We may use or give health information as required by other laws. For example:
We may give health information to the U.S. Department of Health and Human Services during an investigation.
We may give health information under workers’ compensation or similar laws.
We may give health information:
– To social services and other agencies or people allowed to receive information about certain injuries or health conditions for social service, health or law enforcement reasons.
– About an emancipated minor or a minor receiving confidential services to prevent a serious threat to the health of the minor.
With Your Authorization
Except for the types of disclosures listed above, we may use or give health information only if you give us written permission. If you give written permission, you may revoke it at any time by notifying us in writing. Your permission will end when we receive your revocation or when we have acted on your request.
Questions and Complaints
If you have questions about our privacy practices, please contact our Privacy Official at 651 644-8515, email@example.com, or at 1821 University Ave Suite N385, Saint Paul, MN, 55104. If you think your privacy rights have been violated, or if you disagree with a decision about any of your rights, you may also file a complaint with us at this same address.
You also may send a written complaint to the U.S. Department of Health and Human Services. We will give you the address to file a complaint if you ask for it. We will not punish you or retaliate if you choose to file a complaint.
This Notice replaces our original Notice. It is effective January 1, 2007, and it will be effective until we replace it.