Note: This notice describes how healthcare information about you may be used and disclosed and how you can get access to this information. Please read it carefully.
This notice is effective April 1, 2003.
If you have any questions about this notice, please contact:
Each time you receive services from a healthcare provider a record of your visit is generated. Typically this record contains your symptoms, examination, test results, diagnoses, treatment, and a plan for future care or treatment. This information is often referred to as your health or medical record and serves as a:
Understanding what is in your record and how your health information is used helps you to:
Minnewaska Lutheran Home is required to:
How we may use or disclose Personal Health Information (PHI) about you for Treatment, Payment and Health Operations:
1) We will use your personal health information for treatment purposes. For example:
Information obtained by a nurse, physician or other member of our healthcare 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/her orders for treatment and medications. Members of your healthcare team will then record the actions they take and their observations. In that way, the physician will know how you are responding to treatment.
We may disclose your medical information to facility and non-facility staff, such as physicians, nurses, nurse aides, technicians, clergy, and medical students who are involved in taking care of you while you are at our facility. We may also disclose information about you to individuals who will be involved in your care after you leave the facility. Unless you object, this may include family members, your physician or a subsequent healthcare provider.
2) We will use your personal health information for payment. For example:
We may use and disclose your medical information to bill and receive payment for the treatment and services you receive during your care at our facility. For these purposes we may disclose information to your representative, insurance or managed care company, Medicare, Medicaid, or another third party payer. We may inform a health plan about the services you are going to receive to obtain prior approval or to decide if your plan will cover the service.
3) We will use your health information for regular health operations. For example:
We may use and disclose your personal health information necessary to manage the facility and to monitor our quality of care to our residents. For example, we may use your personal medical information to review our treatment and services to residents which reflects our staff’s performance in caring for you.
Appointment Reminders: We may use/disclose medical information to contact you as a a reminder of an appointment for treatment or medical care at our facility or another facility.
Business Associates: There are some services provided in our organization through contracts with business associates. An example includes a consulting pharmacist who reviews your health record monthly to assess the appropriateness of medication use. When services are contracted, we may disclose your health information to our business associates so they can perform the job we have asked them to do. To protect your information, we require the business associate to appropriately safeguard your information in the form of a written contract.
Directory: Unless you notify us that you object, we may include certain limited information about you in the facility directory to assist our receptionist with telephone inquiries while you are a resident here. This information may include your name, location in the facility, your religious affiliation and your general condition (i.e. fair, stable, etc). Directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy such as a pastor, priest or rabbi, even if they do not ask for you by name. Unless you notify us that you object, we will post your first and last name outside of your room. Unless you object, we will include your first and last name and room number on our facility directory board. The directory provides information so your family, friends and clergy can visit you in the facility.
Visitor Book: Unless you notify us that you object, we will allow visitors to sign the visitor book which will include your name when family, friends, or members of the community come to visit you.
Local Newspaper Birthday Announcements and Activities: Unless you notify us that you object, we will provide the local newspaper with your name and birth date for publication purposes. We also provide the local newspaper with information from our Activity Department which could include information regarding your participation in an activity, event, and/or outing.
Member and/or Service Organizations: Unless you notify us that you object, we may release limited information about you such as your first/last name, location within our facility, and/or dates of stay to organizations. This is allowed only on a need-to-know basis, as defined and agreed upon by our Privacy Committee. Some examples include veteran or military service organizations, Lions Club, Knights of Columbus, and/or volunteer students from local schools who participate in our activity program (this list is not all inclusive). Your name, location within our facility, and/or dates of stay may be given to a representative of the organization even if they do not ask for you by name.
Individuals Involved in Your Care: We may disclose Protected Health Information about you to a family member or friend who is involved in your medical care or to those who assist in payment for your care. This may include informing family or friends of your condition and whether you are currently within the facility or not. We may also disclose Protected Health Information about you to an entity assisting in disaster relief efforts so that your family can be notified about your status.
As Required by Law: We may disclose Protected Health Information about you as required by federal, state or local laws.
To Avert a Serious Threat to Health or Safety: We may use and disclose Protected Health Information to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Research: We may disclose information to researchers as required by Minnesota State Law when such research has been approved by an Institutional Review Board after determining that the research proposal and established protocols ensure the privacy of your health information.
Organ and Tissue Donation Organizations: If you are an organ donor, we may disclose your Protected Health Information to organizations engaged in tissue and organ donation and transplantation.
Military and Veterans: If you are a member of the armed forces, we may disclose Protected Health Information about you as required by military command authorities. We may also disclose personal health information about foreign military personnel to the appropriate foreign military authority.
Marketing: We may verbally inform you about products, services, or disease management programs available to you as treatment options.
Fundraising: We may contact you as part of a fundraising effort for our facility. We may disclose personal health information to a foundation so the foundation may contact you as part of its fundraising efforts for our facility. We will only release contact information such as your name, address, phone number, and the dates you received treatment or services at the facility.
Food and Drug Administration (FDA): We may disclose your name to the FDA regarding health information relative to adverse events with respect to food, supplement, product and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
Workers Compensation: We may disclose personal health information necessary for compliance with laws relating to workers compensation or other, similar programs as established by law.
Public Health Risks as Required by Law: We may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Law Enforcement: We may disclose health information for law enforcement purposes as required by law including: compliance with a court order, warrant, subpoena, summons, investigative demand or similar legal process; identification or locating a suspect, fugitive, material witness, or missing person, when information is requested about the victim of a crime, if the individual agrees or under other limited circumstances, reporting information about a suspicious death; providing information about criminal conduct occurring at the facility, reporting information in emergency circumstances about a crime or where necessary to identify or apprehend an individual in relation to a violent crime or an escape from lawful custody or in response to a valid subpoena.
Health Oversight Activities: We may disclose your personal health information to a health oversight agency for activities authorized by law. These may include, for example: audits, investigations, inspections and licensure actions or other legal proceedings. These activities are necessary for government oversight of the health care system, government payment, or compliance with regulatory programs and civil right laws.
Coroners, Medical Examiners and Funeral Directors: We may disclose medical information to a coroner or medical examiner. This may be necessary to identify a deceased person or determine the cause of death. We may also disclose personal health information about residents of the facility to funeral directors as necessary to perform their duties.
National Security and Intelligence Activities: We may disclose personal health information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities as authorized by law.
Health Insurance: When applicable, a group health plan, health insurance issuer, or HMO may disclose protected health information as provided under contract to the sponsor of the plan.
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the:
Right of Access to Personal Health Information: You have the right to inspect and/or receive a copy of medical information that may be used to make decisions about your care. This includes medical and financial records but does not include psychotherapy notes filed separately from your medical record.
You may submit a request to the facility's Privacy Officer either orally or in writing. If you request a copy to review your current medical care, we will provide it, without cost, within 2 working days. For other requests, we may charge a fee for copying costs as defined by our facility's policies and procedures. We will allow you to inspect your records within 24 hours of your request (excluding hours occurring during a weekend or holiday). We may deny your request to inspect or receive copies under certain limited circumstance as defined by Minnesota State Law. If you are denied access to your personal health information, you may request the denial be reviewed. Another licensed health care professional chosen by our facility will review your request and the reason for the denial. The facility will comply with the outcome of the review.
Right to Request Amendment: If you feel the medical information contained in your medical record is incorrect or incomplete, you may request an amendment. You must make the request in writing to our facility’s Privacy Officer. We may deny your request for an amendment, if it is not made in writing or does not include a reason in support of your request. We also may deny it if the information was not created by our facility, is not part of the personal health information maintained by or for our facility, is not part of the information to which you have the right of access; or is already accurate and complete as determined by our facility. If we deny your request for amendment, we will provide the denial in writing including the reason for the denial as well as your right to submit a written statement disagreeing with the denial.
Right to Request Restrictions: You have the right to request restrictions be placed on the use or disclosure of your personal health information for treatment, payment, or health care operations. You also have the right to restrict what personal health information we may disclose to a family member, friend, or others involved in your care or the payment for your care. We will make all reasonable efforts to comply with your request in an effort to protect the privacy of your personal health information; however, we are not required to comply with your requests. We will honor your request unless the information is needed to provide you emergency treatment, you are being transferred to another health care institution, or the disclosure is required by law. You must make your request in writing to our Privacy Officer. In your request, you must state: 1) what information you want to limit, 2) whether you want us to limit our use, disclosure or both, and 3) to whom you want the limits to apply (for example, your family members).
Right to an Accounting of Disclosure: You may request an "accounting of disclosure." This is a list of the disclosures we have made of your PHI. Not all disclosures are subject to this requirement.
To request this "accounting of disclosure," you must submit a written request to our Privacy Officer. Your request must state a time period, which may not be longer than six years or include dates prior to 4/14/2003. The first list you request within a 12-month period will be provided free of charge. For additional requests within the 12-month period, we may charge you a processing fee. We will notify you of the cost involved, and you may choose to withdraw or modify your request before any costs are incurred.
If you believe your privacy rights have been violated you may file a written complaint with our Privacy Officer or with the Office of Civil Rights. We will not retaliate against you if you file a complaint.
Other uses of personal health information: Other uses and disclosures of medical information not covered by this notice or applicable law will be made only with your written permission. If you provide us permission to use or disclose personal health information about you, you may revoke that permission in writing at any time. If you revoke the permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made in good faith with your permission. You have a right to request communication of your health information by alternative means or at alternative locations.
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will post the updated notice at the facility, provide you with a copy of the updated notice during your current stay or upon readmission, and have copies available for distribution.
Date of Last Update of Privacy Notice Text: 2/13/2013 (H.M.)