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Patient Privacy Deer River HealthCare Center1002 Comstock Drive Deer River, Minnesota 56636 NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW PROTECTED MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY 1 WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI). We are legally required to protect the privacy of your health information. We call this information "protected health information" or "PHI" for short and it includes information that we have created or received about your past, present or future health or condition, the provision of health care to you or the payment of this health care. We must provide you with this notice about our privacy practices that explains how, when, and why we use and disclose your PHI. With some exceptions, we may not use or disclose any more PHI than is necessary to accomplish the purpose of the use or disclosure. We are legally required to follow the privacy practices that are described in this notice. We reserve the right to change the terms of this notice and our privacy policies at any time. Any changes will apply to the PHI we already have. Before we make an important change to our policies, we will promptly change this notice and post a new notice in the Admission Office. You can also request a copy of this notice from the contact person listed in Section 5 below at any time and can view a copy of this notice on our Web site at http://www.drhc.org. 2 HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION. We use and disclose health information for many different reasons. Below, we describe the different categories of uses and disclosures. A. Uses and Disclosures Relating to Treatment, Payment or Health Care Operations. 1. For treatment. Information obtained by a nurse, physician or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health care team. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. We will also provide your physician or a subsequent health care provider with copies of various reports that should assist him or her in treating you once you are discharged from this facility. 2. To obtain payment for treatment. A bill may be sent to you or a third party payer. The information on or accompanying the bill may include information that identifies you and your diagnosis, the diagnostic tests done, procedures performed and supplies used. 3. For health care operations. We may disclose your PHI in order to operate this hospital. We may use your PHI in order to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided health care services to you. We may also provide your PHI to our accountants, attorneys, consultants and others in order to make sure we are complying with the laws that affect us. 4. Business associates. There are some services provided in our organization through contracts with business associates. Examples include physician services in the emergency, surgical, radiology and laboratory departments. This also includes the service we use to transcribe PHI and the service we use to destroy PHI. When these services are contracted, the business associates have access to your PHI on a "need to know basis" so that they can perform the job we have asked them to do. Business associates must appropriately safeguard your PHI as part of their contract. B. Certain Uses and Disclosures. We may use and disclose your PHI without your authorization for the following reasons: 1. When a disclosure is required by federal, state or local law, judicial or administrative proceedings or law enforcement matters. For example, we make disclosures when a law requires that we report information (mandatory reporting) to government agencies and law enforcement personnel about victims of abuse, neglect or domestic violence or when dealing with traumatic brain injuries, gunshot wounds or when court ordered in a judicial or administrative proceeding. 2. For public health activities. As required by law, we report information about births, deaths and various diseases to government officials in charge of collecting that information, and we provide coroners, medical examiners and funeral directors necessary information relating to an individualıs death. 3. For health oversight activities. We provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization. 4. For purposes of organ donation. We may notify organ procurement organizations to assist them with organ donations. 5. For research purposes. We may provide PHI in order to conduct medical research. 6. To avoid harm. In order to avoid a serious threat to the health or safety of a person or the public, we may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm. 7. For specific government functions. We may disclose PHI of military personnel and veterans when obtaining financial assistance for personal needs or durable medical equipment. We may disclose PHI for national security purposes such as protecting the President of the United States or conducting intelligence operations. 8. For workersı compensation purposes. We may provide PHI in order to comply with workersı compensation laws. 9. Appointment reminders and health related benefits or services. We may use PHI to provide appointment reminders or distribute information about treatment alternatives or other health care services or benefits we offer. 10. Fundraising activities. We may use PHI to raise funds for our organization. The money raised through these activities is used to expand and support the health care services and educational programs we provide to the community. If you do not wish to be contacted as part of our fundraising efforts, please contact the person listed in section 5 below. 11. Marketing: We may contact you to provide appointment reminders or distribute information about treatment alternatives or other health related benefits and services that may be of interest to you. 12. Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health or safety or the health or safety of other individuals. C. You to Have the Opportunity to Object to the Following: 1. Patient directories. We may include your name, location in this facility, general condition and religious affiliation in our patient directory for use by clergy and visitors who ask for you by name unless you object in whole or in part. 2. Disclosures to family, friends or others. We may provide your PHI to a family member, friend or other person indicated by you to be involved in your care unless you object in whole or in part. D. All Other Uses and Disclosures Require Your Prior Written Authorization. In any other situation not described in sections 2 above we will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke that authorization in writing to stop any future uses and disclosures. 3 WHAT RIGHTS YOU HAVE REGARDING YOUR PHI You have the following rights with respect to your PHI: A. The Right to Request Limits on Uses and Disclosures of Your PHI. (45 CFR 164.522) You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make. B. The Right to Choose How We Send PHI to you. You have the right to ask that we send information to you at an alternate address (sending information to your work address rather than your home address), or by alternate means (e-mail instead of regular mail). We must agree to your request as long as we can easily provide it in the format you requested. C. The Right to See and Get Copies of Your PHI. (45 CFR 164.524) You have the right to look at or get copies of your PHI available in our files but you must make the request in writing. If we do not have your PHI but we know who does, we will tell you how to get it. We will respond to you as soon as possible after receiving your written request. In certain situations, we may deny your request. If this is the case, we will tell you in writing our reasons for denial and explain your right to have the denial reviewed. If you request copies of your PHI, we will charge you a fee according to current billing guidelines. D. The Right to Get a List of the Disclosures We Have Made. (45 CRF 164.528) You have the right to get a list of instances in which we have disclosed your PHI. The list will not include uses or disclosures that have already been made for treatment, payment, health care operations, been given directly to you, released by a valid authorization signed by you or your legal representative, or been disclosed from our facility directory. The list will not include uses and disclosures made for national security purposes, to corrections or law enforcement personnel, or uses prior to April 14, 2003. We will respond within 60 days of receiving your request. This list will include the date of the disclosure, to whom PHI was disclosed (including their address, if known), a description of the information disclosed and the reason for the disclosure. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a fee for each additional request. E. The Right to Amend or Update Your PHI. (45 CFR 164.528) If you believe that there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we amend the existing information or add the missing information. You must provide the request and your reason for the request in writing. We will respond within 60 days of receiving your request. We may deny your request in writing if the PHI is correct and complete, not created by us, not allowed to be disclosed, or not part of our records. Our written denial will state the reasons for the denial and will explain your right to file a written statement of disagreement with the denial. 4 HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES If you think that we may have violated your privacy rights or you disagree with a decision we made about access to your PHI, you may file a complaint with the person listed in Section 5 below. You also may send a written complaint to the Secretary of the Department of Health and Human Services, Minnesota Department of Health, P. O. Box 64975, St. Paul, MN 55164-0975. We will take no retaliatory action against you if you file a complaint about our privacy practices. 5 PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES If you have any questions about this notice or any complaints about our privacy practices or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact the Chief Executive Officer, Deer River Healthcare Center, 1002 Comstock Drive, Deer River, MN 56636. Telephone # 218 246-3001. 6 EFFECTIVE DATE OF THIS NOTICE April 14, 2003. 33-020-0403
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