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Notice of Privacy Practices
Last Revision 4/03
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF
1996
NOTICE OF PRIVACY PRACTICES
___________________________________________________________________________
The following notice describes how your medical information may be used and disclosed, and how you can get access to this information. Please review the information carefully.
- Your confidential healthcare information may be released
to other healthcare professionals within the hospital for the purpose
of providing you with
quality healthcare.
For Example: All information obtained by a nurse, physician, or other member of the healthcare team will be documented in your record and used to communicate with other members of the healthcare team involved in your care.
- Your confidential healthcare information may
be released for routine healthcare facility operations.
For Example: Your health information will be reviewed by medical staff and other professionals in an effort to continually improve the quality of healthcare and services we provide. Storing the information involves entering some of the data into databases as well as filing and storing the paper documents in your chart. These functions may be handled by a number of different employees in the facility.
- Your confidential health care information may be released to public
or law enforcement officials in the event of an investigation in
which you
are a victim of abuse, a crime, or domestic violence.
- Your confidential healthcare information may be released to other
healthcare providers in the event you need emergency care.
- Your confidential healthcare information may be released to a
public health organization or federal organization in the event of
a communicable
disease or to report a defective device or untoward event
to a biological product (food or medication).
- Your confidential healthcare information
may be released for workers’ compensation
or similar programs.
-
Your confidential healthcare information may not be released without your written authorization for any purpose other than that stated above.
-
You may revoke your permission to release confidential healthcare information at any time. If you wish to revoke your authorization, please do so in writing and submit to:
Trina Lower, RHIA
Director of HIS/Privacy Officer/Quality Coordinator
710 South Kenwood Avenue
Moose Lake, MN 55767
-
You may be contacted by the hospital to remind you of any appointments, healthcare treatment options, or other health services that may be of interest to you.
-
You may be contacted by the hospital for the purposes of raising funds to support the hospital’s operations. If you do not want the healthcare center to contact you for fundraising efforts, you must notify the healthcare center at (218) 485-4481
YOUR RIGHTS
You have specific rights regarding confidential information about you created by us or kept here in either your medical records or your billing records.
Right to Request Restrictions
You have the right to request restrictions on the use of your confidential healthcare information. However, the hospital may chose to refuse your restriction if it is in conflict with providing you with quality healthcare of in the event you have an emergency situation.
To request restrictions, you must make your request in writing to:
Trina Lower, RHIA
HIS Director/Privacy Officer/Quality
Coordinator
Mercy Hospital and Health Care
Center
710 South Kenwood Avenue
Moose Lake, MN 55767
In your request, you must tell us:
-
What information you want to limit;
-
Whether you want to limit our use, disclosure or both; and
-
To whom you want the limits to apply.
Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. (For example, you can ask that we only contact you at work or by mail). We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to Inspect and Copy
You have the right to review, inspect, and receive a photocopy of any/all portions of your healthcare information. This includes medical and billing records.
To inspect and/or receive a photocopy of your healthcare information, you must submit your request in writing to:
Health Information
Services Department
Mercy Hospital
and Health Care
Center
710 South Kenwood
Avenue
Moose Lake, MN
5576
If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed healthcare professional chosen by the hospital will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend
You have the right to request changes to your healthcare information. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information.
To request an amendment, your request must be made in writing and submitted to the following address. In addition, you must provide a reason that supports your request.
Trina
Lower,
RHIA
HIS
Director/Privacy
Officer/Quality
Coordinator
Mercy
Hospital
and
Health
Care
Center
710
South
Kenwood
Avenue
Moose
Lake,
MN
55767
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that
-
Was not created by us;
-
Is not part of the health information kept by or for the healthcare center;
-
Is not part of the information which you would be permitted to inspect and copy; or
-
Is accurate and complete.Notice of Privacy Practices
Right to an Accounting of Disclosures
You have the right to know who
has accessed your confidential healthcare information and for what
purpose.
To request an accounting of disclosures, you must submit your request
in writing to:
Trina Lower, RHIA
HIS Director/Privacy Officer/Quality Coordinator
Mercy Hospital and Health Care Center
710 South Kenwood Avenue
Moose Lake, MN 55767
Your request must state a time period which may not be longer than six (6) years and may not include dates before April 15, 2003.
Right to a Paper Copy of this Notice
You have the right to possess
a copy of this Privacy Notice upon request. You may ask us to give
you a copy of this notice at
any time. This
copy can be in the form of an electronic transmission or on
paper.
To obtain a paper copy of this notice, please contact Trina
Lower, RHIA, at (218) 485-5544
We reserve the right to change this notice and make the new terms effective for all confidential health information we maintain. We will post a current copy of the notice in the healthcare center. The notice will contain, on the first page, in the top right hand corner, the last revision date. In addition, each time you register at or are admitted to the healthcare center for treatment or services, we will offer you a copy of the current notice.
HEALTHCARE CENTER DUTIES
The healthcare center is required by law to protect the privacy of its patients. It will keep confidential any and all patient healthcare information and will provide patients with a list of duties or practices that protect confidential healthcare information as required by law. The healthcare center is required to abide by the terms of this notice.
The medical staff are independent healthcare professionals and are not under the control of the healthcare center. The healthcare center and members of the medical staff are part of an Organized Health Care Arrangement (OHCA). The OHCA allows the healthcare center to utilize such physicians for purposes of committees work, case review, etc. The OHCA also designates distribution of this Notice of Privacy Practices to serve as notice from the medical staff.
You have the right to complain to the healthcare center or to the Secretary of the Department of Health and Human Services if you believe your rights to privacy have been violated. To file a complaint with the healthcare center, contact Trina Lower, HIS Director/Privacy Officer/Quality Coordinator at (218) 485-5544. All complaints must be submitted in writing.
All complaints will be investigated.
You will not be penalized for filing a complaint.
For further information about this Privacy Notice, please contact:
Trina Lower, RHIA
HIS Director/Privacy Officer/Quality Coordinator
Mercy Hospital and Health Care Center
710 South Kenwood Avenue
Moose Lake, MN 55767
(218) 485-5544
This notice is effective as of April 14, 2003.
Reference:
Medical Consultants Network, Inc.
