Notice of Privacy Practices for Protected Health Information Effective March 26, 2013

Transcription

1 Ntice f Privacy Practices fr Prtected Health Infrmatin Effective March 26, 2013 This ntice describes hw medical infrmatin abut yu may be used and disclsed and hw yu can get access t this infrmatin. Please review it carefully. During yur treatment at Olmsted Medical Center, dctrs, nurses, and ther caregivers may gather infrmatin abut yur medical histry and yur current health. This ntice explains hw that infrmatin may be used and shared with thers. It als explains yur privacy rights regarding this kind f infrmatin. The terms f this ntice apply t health infrmatin created r received by Olmsted Medical Center. We are required by law t make sure that medical infrmatin that identifies yu is kept private; give yu this ntice f ur legal duties and privacy practices with respect t medical infrmatin abut yu; fllw the terms f the ntice that is currently in effect; and ntify yu in the event there is a breach f any unsecured prtected health infrmatin abut yu. Understanding Yur Health Infrmatin: Each time yu visit a hspital, physician, r ther healthcare prvider, a recrd f yur visit is generated. Mst cmmnly, this recrd cntains yur symptms, examinatin and test results, diagnses, treatment, and a plan fr future treatment. This health infrmatin is ften referred t as yur medical recrd r chart and althugh yur medical recrd is the physical prperty f the healthcare facility that cmpiled it, the infrmatin belngs t yu. The health infrmatin cntained in yur medical recrd serves as a: basis fr planning yur care and treatment means f cmmunicatin amng the healthcare prviders wh cntribute t yur care legal dcument describing the care yu received means by which yu r yur insurance cmpany can verify that services billed were prvided tl fr educating healthcare prviders surce f data fr medical research surce f infrmatin fr public health fficials which can be used t imprve the health f ur natin tl with which we can assess and cntinually wrk t imprve the care we render and the utcmes we achieve. Understanding what is in yur medical recrd and hw yur health infrmatin is used will help yu: ensure its accuracy better understand wh, what, when, where, and why thers may access yur health infrmatin make mre infrmed decisins when authrizing disclsures t thers. Yur medical infrmatin may be used and disclsed fr the fllwing purpses: Treatment: We may use yur infrmatin t prvide, crdinate, and manage yur care and treatment. Fr example, an Olmsted Medical Center physician may share yur medical infrmatin with anther physician fr a cnsultatin r a referral. We will get yur written cnsent prir t making disclsures utside f Olmsted Medical Center fr treatment purpses, except in emergency circumstances when it is nt pssible t get yur cnsent. Payment: We may use and disclse medical infrmatin abut yu s that the treatment and services yu receive may be billed t, and payment may be cllected frm, yu, an insurance cmpany, r anther third party. Fr example, we may need t give yur health plan infrmatin abut treatment yu received at Olmsted Medical Center s yur health plan will pay us r reimburse yu fr the treatment. We may als tell yur health plan abut a treatment yu are ging t receive t btain prir apprval, t determine whether yur plan will cver the treatment, r fr purpses f an independent review f a denial f a claim based n lack f medical necessity. We will get yur written cnsent prir t making disclsures fr payment purpses rev0913 Page 1

2 Healthcare Operatins: We may use and disclse medical infrmatin abut yu fr Olmsted Medical Center s healthcare peratins. Healthcare peratins are the uses and disclsures f infrmatin that are necessary t run Olmsted Medical Center and t make sure that all f ur patients receive quality care. Fr example, we may use medical infrmatin t review ur treatment and services, and t evaluate the perfrmance f ur staff and physicians in caring fr yu. We will get yur written cnsent befre making disclsures t thers utside f Olmsted Medical Center fr healthcare peratins purpses. Appintment Reminders and Other Health Infrmatin: We may use yur medical infrmatin t send yu reminders abut future appintments. We may als send yu refill reminders r ther cmmunicatins abut yur current medicatins. Hwever, if we receive any financial remuneratin fr making such refill r medicatin cmmunicatins beynd ur csts f making the cmmunicatin, we must first btain yur written authrizatin t make such cmmunicatins. We may cntact yu with infrmatin abut new r alternative treatments r ther healthcare services r fr purpses f care crdinatin, unless we receive financial remuneratin in exchange fr making the cmmunicatin; in that case, we will btain yur written authrizatin t make such cmmunicatins. Hwever, we are nt required t btain yur written authrizatin fr face-t-face cmmunicatins. Fundraising: Olmsted Medical Center, ne f its business assciates, r the OMC Reginal Fundatin may use certain infrmatin abut yu (specifically, yur name, address, age, gender, date f birth, and ther demgraphic infrmatin; dates yu received healthcare frm Olmsted Medical Center; department f service infrmatin; treating physician; utcme infrmatin; and health insurance status) t let yu knw abut pprtunities t raise funds fr Olmsted Medical Center. Yu have the right t pt-ut f receiving such fundraising cmmunicatins. Each fundraising cmmunicatin yu receive will include an pprtunity t pt-ut f future fundraising cmmunicatins. Alternatively, yu may ntify the fundatin assistant at t pt-ut f fundraising cmmunicatins. Facility Directry: We may include certain limited infrmatin abut yu in ur hspital directry while yu are a patient. This infrmatin may include yur name, lcatin in the facility, and yur religius affiliatin if yu prvide this infrmatin t us. The directry infrmatin, except fr yur religius affiliatin and cnditin, may be released t peple wh ask fr yu by name. This is s yur family, friends, and clergy can knw yur lcatin. Yur religius affiliatin may be given t a member f the clergy, such as a priest r rabbi, even if they dn t ask fr yu by name. If yu wuld prefer that Olmsted Medical Center nt make these disclsures, please ntify the Admissins department and/r nursing staff. T Peple Assisting in Yur Care: Olmsted Medical Center will nly disclse medical infrmatin t thse taking care f yu, helping yu t pay yur bills, r ther clse family members r friends if these peple need t knw this infrmatin t help yu, and then nly t the extent permitted by law. We may, fr example, prvide limited medical infrmatin t allw a family member t pick up a prescriptin fr yu. Generally, we will get yur written cnsent prir t making disclsures abut yu t family r friends. If yu are able t make yur wn healthcare decisins, Olmsted Medical Center will ask yur permissin befre using yur medical infrmatin fr these purpses. If yu are unable t make healthcare decisins, Olmsted Medical Center will disclse relevant medical infrmatin t family members r ther respnsible peple if we feel it is in yur best interest t d s, including in an emergency situatin. Research: Federal law permits Olmsted Medical Center t use and disclse medical infrmatin abut yu fr research purpses, either with yur specific, written authrizatin r when the study has been reviewed fr privacy prtectin by an Institutinal Review Bard r Privacy Bard befre the research begins. In sme cases, researchers may be permitted t use infrmatin in a limited way t determine whether the study r the ptential participants are apprpriate. Minnesta law generally requires that we get yur cnsent befre we disclse yur health infrmatin t an utside researcher. We will make a gd faith effrt t btain yur cnsent r refusal t participate in any research study, as required by law, prir t releasing any identifiable infrmatin abut yu t utside researchers. As Required by Law: We will disclse medical infrmatin abut yu when we are required t d s by federal, state, r lcal law rev0913 Page 2

3 T Avert a Serius Threat t Health r Safety: We may use and disclse medical infrmatin abut yu when necessary t prevent a serius threat t yur health and safety r the health and safety f the public r anther persn. Any disclsure must be nly t smene able t help prevent the threat. In additin, Minnesta law generally des nt permit these disclsures unless we have yur written cnsent, r when the disclsure is specifically required by law, including the limited circumstances in which Olmsted Medical Center healthcare prfessinals have a duty t warn. T Business Assciates: Sme services are prvided by r t Olmsted Medical Center thrugh cntracts with business assciates. Examples include Olmsted Medical Center s attrneys, cnsultants, cllectin agencies, and accreditatin rganizatins. We may disclse infrmatin abut yu t ur business assciate s that they can perfrm the jb we have cntracted with them t d. T prtect the infrmatin that is disclsed, each business assciate is required t sign an agreement t apprpriately safeguard the infrmatin and nt t redisclse the infrmatin unless specifically permitted by law. Yur medical infrmatin may be released in the fllwing special situatins: Organ and Tissue Dnatin: We may release yur medical infrmatin t rganizatins that handle rgan prcurement r rgan, eye, r tissue transplantatin, r t an rgan dnatin bank, as necessary t facilitate rgan r tissue dnatin and transplantatin. The infrmatin that Olmsted Medical Center may disclse is limited t the infrmatin necessary t make a transplant pssible. Military and Veterans: If yu are a member f the armed frces, we will release medical infrmatin abut yu as requested by military cmmand authrities if we are required t d s by law, r when we have yur written cnsent. We may als release medical infrmatin abut freign military persnnel t the apprpriate freign military authrity as required by law r with written cnsent. Wrkers Cmpensatin: We may release medical infrmatin abut yu fr wrkers cmpensatin r similar prgrams. These prgrams prvide benefits fr wrk-related injuries r illness. We are permitted t disclse infrmatin regarding yur wrk-related injury t yur emplyer r yur emplyer s wrkers cmpensatin insurer withut yur specific cnsent, s lng as the infrmatin is related t a wrkers cmpensatin claim. Public Health: We may disclse medical infrmatin t public health authrities abut yu fr public health activities. These disclsures generally include the fllwing: preventing r cntrlling disease, injury r disability reprting births and deaths reprting child abuse r neglect, r abuse f a vulnerable adult reprting reactins t medicatins r prblems with prducts ntifying peple f recalls f prducts they may be using ntifying a persn wh may have been expsed t a disease r may be at risk fr cntracting r spreading a disease r cnditin reprting t the FDA as permitted r required by law. Health Oversight Activities: Olmsted Medical Center may disclse medical infrmatin t a health versight agency fr health versight activities that are authrized by law. These versight activities include, fr example, gvernment audits, investigatins, inspectins, and licensure activities. These activities are necessary fr the gvernment t mnitr the healthcare system, gvernment prgrams, and cmpliance with civil rights laws. Minnesta law requires that patient-identifying infrmatin (fr example, yur name, Scial Security number, etc.) be remved frm mst disclsures fr health versight purpses, unless yu have prvided us with written cnsent fr the disclsure. Lawsuits and Disputes: We may disclse medical infrmatin abut yu in respnse t a valid curt rder r statutry authrizatin, r with yur written cnsent. Law Enfrcement: We may release medical infrmatin if asked t d s by a law enfrcement fficial in respnse t a valid curt rder, grand jury subpena, r warrant, r with yur written cnsent. In additin, we are required t reprt certain types f wunds, such as gunsht wunds and sme burns. In mst cases, reprts will include nly the fact f injury, and any additinal disclsures wuld require yur cnsent r a curt rder rev0913 Page 3

4 We may als release infrmatin t law enfrcement that is nt a part f the health recrd (in ther wrds, nn-medical infrmatin) fr the fllwing reasns: t identify r lcate a suspect, fugitive, material witness, r missing persn if yu are the victim f a crime, if, under certain limited circumstances, we are unable t btain yur agreement abut a death we believe may be the result f criminal cnduct abut criminal cnduct at ur facility in emergency circumstances t reprt a crime; the lcatin f the crime r victims; r the identity, descriptin, r lcatin f the persn wh cmmitted the crime. Crners, Medical Examiners, and Funeral Directrs: We will release medical infrmatin t a crner r medical examiner in the case f certain types f death, and we must disclse health recrds upn the request f the crner r medical examiner. This may be necessary, fr example, t identify yu r determine the cause f death. We may als release the fact f death and certain demgraphic infrmatin abut yu t funeral directrs as necessary t carry ut their duties. Other disclsures frm yur health recrd will require the cnsent f a surviving spuse, parent, persn appinted by yu in writing, r yur legally authrized representative. Natinal Security and Intelligence Activities: We will release medical infrmatin abut yu t authrized federal fficials fr intelligence, cunter-intelligence, and ther natinal security activities nly as required by law r with yur written cnsent. Prtective Services fr the President and Others: We will disclse medical infrmatin abut yu t authrized federal fficials s they may prvide prtectin t the President, ther authrized persns, r freign heads f state, r cnduct special investigatins nly as required by law r with yur written cnsent. Inmates: If yu are an inmate f a crrectinal institutin r under the custdy f a law enfrcement fficial, we will release medical infrmatin abut yu t the crrectinal institutin r law enfrcement fficial nly as permitted by law r with yur written cnsent. Yu have the fllwing rights regarding medical infrmatin we maintain abut yu: Right t Inspect and Cpy: Yu have the right t inspect and receive a cpy f yur medical infrmatin that is used t make decisins abut yur care. Usually, this includes medical and billing recrds maintained by Olmsted Medical Center. If yu wish t inspect and cpy medical infrmatin, yu must submit yur request in writing t Olmsted Medical Center, Health Infrmatin Management Medical Recrds, 210 Ninth Street SE, Rchester, MN (phne , fax ). If yu request a cpy f the infrmatin, we may charge a reasnable fee fr the csts f cpying, mailing, r ther supplies assciated with yur request, t the extent permitted by state and federal law. If we maintain yur health infrmatin electrnically as part f a designated recrd set, yu have the right t receive a cpy f yur health infrmatin in electrnic frmat upn yur request. Yu may als direct us t transmit yur health infrmatin (whether in hard cpy r electrnic frm) directly t an entity r persn clearly and specifically designated by yu in writing. We may deny yur request t inspect and cpy yur infrmatin in certain very limited circumstances. Fr example, we may deny access if yur physician believes it will be harmful t yur health, r culd cause a threat t thers. In these cases, we may supply the infrmatin t a third party wh may release the infrmatin t yu. If yu are denied access t medical infrmatin, yu may request that the denial be reviewed. Anther licensed healthcare prfessinal chsen by Olmsted Medical Center will review yur request and the denial. The persn cnducting the review will nt be the persn wh denied yur request. We will cmply with the utcme f the review rev0913 Page 4

5 Right t Request Amendment: If yu believe that medical infrmatin we have abut yu is incrrect r incmplete, yu have the right t ask us t change the infrmatin. Yu have the right t request an amendment fr as lng as the infrmatin is kept by r fr Olmsted Medical Center. T request a change t yur infrmatin, yur request must be made in writing and submitted t Olmsted Medical Center, Attn: Infrmatin Privacy Specialist, 210 Ninth Street SE, Rchester, MN In additin, yu must prvide a reasn that supprts yur request. Olmsted Medical Center may deny yur request fr an amendment if it is nt in writing r des nt include a reasn t supprt the request. In additin, we may deny yur request if yu ask us t amend infrmatin that: was nt created by Olmsted Medical Center, unless the persn r entity that created the infrmatin is n lnger available t make the amendment is nt part f the medical infrmatin kept by r fr Olmsted Medical Center is nt part f the infrmatin which yu wuld be permitted t inspect and cpy is accurate and cmplete. Right t an Accunting f Disclsures: Yu have the right t request an accunting f disclsures. This is a list f the disclsures we made f medical infrmatin abut yu. This list will nt include disclsures fr treatment, payment, and healthcare peratins; disclsures that yu have authrized r that have been made t yu; disclsures fr facility directries; disclsures fr natinal security r intelligence purpses; disclsures t crrectinal institutins r law enfrcement with custdy f yu; disclsures that tk place befre April 14, 2003; and certain ther disclsures. T request this list f disclsures, yu must submit yur request in writing t Olmsted Medical Center, Attn: Infrmatin Privacy Specialist, 210 Ninth Street SE, Rchester, MN Yur request must state a time perid fr which yu wuld like the accunting. The accunting perid may nt g back further than six years frm the date f the request, and it may nt include dates befre April 14, Yu may receive ne free accunting in any 12-mnth perid. We will charge yu fr additinal requests. Right t Request Restrictins: Yu have the right t request a restrictin r limitatin n the medical infrmatin we use r disclse abut yu. If yu pay ut-f-pcket in full fr an item r service, then yu may request that we nt disclse infrmatin pertaining slely t such item r service t yur health plan fr purpses f payment r healthcare peratins. We are required t agree with such a request, unless yu request a restrictin n the infrmatin we disclse t a health maintenance rganizatin ( HMO ) and the law prhibits us frm accepting payment frm yu abve the cst-sharing amunt fr the item r service that is the subject f the requested restrictin. Hwever, we are nt required t agree t any ther request. If we d agree, we will cmply with yur request unless the infrmatin is needed t prvide yu emergency treatment r yu request that we remve the restrictin. T request restrictins, yu must submit yur request in writing t Olmsted Medical Center, Attn: Infrmatin Privacy Specialist, 210 Ninth Street SE, Rchester, MN In yur request, yu must tell us (1) what infrmatin yu want t limit; (2) whether yu want t limit ur use, disclsure, r bth; and (3) t whm yu want the limits t apply, fr example, if yu want t prhibit disclsures t yur spuse. Right t Request Cnfidential Cmmunicatins: Yu have the right t request that we cmmunicate with yu abut medical matters in a certain way r at a certain lcatin. Fr example, yu can ask that we nly cntact yu nly at wrk r nly by mail. T request cnfidential cmmunicatins, yu must make yur request in writing t Olmsted Medical Center, Attn: Infrmatin Privacy Specialist, 210 Ninth Street SE, Rchester, MN We will nt ask yu the reasn fr yur request. We will accmmdate all reasnable requests. Yur request must specify hw r where yu wish t be cntacted, and we may require yu t prvide infrmatin abut hw payment will be handled rev0913 Page 5

6 Right t Revke Authrizatin t Use r Disclse Health Infrmatin: Yu have the right t revke yur authrizatin t use r disclse health infrmatin except t the extent that actin has already been taken. T revke authrizatin t use r disclse health infrmatin, yu must make yur request in writing t Olmsted Medical Center, Attn: Infrmatin Privacy Specialist, 210 Ninth Street SE, Rchester, MN Right t a Paper Cpy f This Ntice: Yu have the right t receive a paper cpy f this ntice. Yu may ask us t give yu a cpy f this ntice any time. This ntice is n ur website, under Yur Privacy fund at the bttm f the page. Other Uses and Disclsures f Prtected Health Infrmatin We are required t btain a written authrizatin frm yu fr mst uses and disclsures f psychtherapy ntes, uses and disclsures f prtected health infrmatin fr marketing purpses, and disclsures that cnstitute a sale f prtected health infrmatin. Except as described in this Ntice, Olmsted Medical Center will nt use r disclse yur prtected health infrmatin withut a specific written authrizatin frm yu. If yu prvide us with this written authrizatin t use r disclse medical infrmatin abut yu, yu may revke that authrizatin, in writing, at any time. If yu revke yur authrizatin, we will n lnger use r disclse medical infrmatin abut yu fr the reasns cvered by yur written authrizatin, except t the extent we have already relied n yur authrizatin. We are unable t take back any disclsures we have already made with yur permissin, and we are required t retain ur recrds f the care that we prvided t yu. Questins r Cmplaints If yu have questins abut this ntice and wuld like additinal infrmatin, yu may cntact Olmsted Medical Center s infrmatin privacy fficer at If yu believe yur privacy rights have been vilated, yu may file a cmplaint with Olmsted Medical Center r with the Office fr Civil Rights. T file a cmplaint with Olmsted Medical Center, yu must submit yur cmplaint in writing t Olmsted Medical Center, Attn: Infrmatin Privacy Officer, 210 Ninth Street SE, Rchester, MN. Yu will nt be penalized fr filing a cmplaint. Changes t This Ntice The effective date f this ntice is April 14, 2003, and it has been updated effective March 26, 2013 with cmpliance by September 23, We reserve the right t change this ntice. We reserve the right t make the revised r changed ntice effective fr medical infrmatin we already have abut yu, as well as any infrmatin we receive in the future. If the terms f this ntice are changed, Olmsted Medical Center will prvide yu with a revised ntice upn request, and we will pst the revised ntice at and in designated lcatins at Olmsted Medical Center. Translated Versins - Infrmatin Sheet Ntice f Privacy Practices fr Prtected Health Infrmatin English Spanish rev0913 Page 6