| This
is the Notice of Privacy Practices for Lake Region Hospital, Lake
Region Bridgeway Care, Lake Region Skilled Nursing Facility, Lake
Region RehabCare, Lake Region Home Health Care Services and Lake
Region Healthcare Corporation members of the Medical Staff and Medical
Staff Affiliates.
THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.
OUR
DUTIES
We are required
by law to:
- maintain
the privacy of your medical information,
- give you
this Notice describing our legal duties and privacy practices,
and
- follow the
terms of the Notice currently in effect.
How
We May Use And Disclose Medical Information About You
In accordance with Federal law, we will not use or disclose your
medical information without your authorization, except as described
in this Notice. Federal law permits our use of your protected health
information for the following purposes:
Treatment.
We may use medical information about you to provide you with medical
treatment or services. For example: Information obtained by a nurse,
physician, or other member of your 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 put in your record
his or her expectations of the members of your healthcare team.
Members of your healthcare 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 subsequent
healthcare provider with copies of reports to assist him or her
in treating you.
Payment.
We may use and disclose medical information about you so that the
treatment and services you receive at the hospital may be billed
to and payment may be collected from you, an insurance company or
a third party. For example: 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, as well as your diagnosis, procedures, and
supplies used.
Health
Care Operations. We may use and disclose medical information
about you for hospital operations. These uses and disclosures are
necessary to run the hospital and make sure that all of our patients
receive quality care. For example: Members of the medical staff,
the quality improvement director, or members of the quality improvement
committee may use information in your health record to assess the
care and outcomes in your case and others like it. This information
will then be used in an effort to continually improve the quality
and effectiveness of the healthcare and services we provide.
Business
Associates. There are some services provided in our organization
through contracts with business associates. [An example is a copy
service we may use when making copies of your health record.] We
may disclose your health information to our business associate so
they can perform the job we've asked them to do. To protect your
health information, however, we require the business associate to
protect your medical information.
Facility
Directory. Unless you notify us that you object, we will
use your name, location in the facility, general condition, [and
religious affiliation] for directory purposes. This information
may be provided to members of the clergy and, except for religious
affiliation, to other people who ask for you by name.
Notification of Family. Unless you notify us that you object, we
may use or disclose information to notify or assist in notifying
a family member, personal representative, or other person responsible
for your care, of your location and general condition.
Communication
With Family. Health professionals, using their best judgment,
may disclose to a family member, other relative, close personal
friend or any other person you identify, health information relevant
to that person's involvement in your care.
Research.
We may disclose information to researchers when their research has
been approved by an institutional review board that has reviewed
the research proposal and established protocols to ensure the privacy
of your medical information.
Funeral
Director, Coroner, and Medical Examiner. Consistent with
applicable law we may disclose health information to funeral directors,
coroners, and medical examiners to help them carry out their duties.
Organ
Procurement Organizations. Consistent with applicable law,
we may disclose health information to organ procurement organizations
or other entities engaged in the procurement, banking, or transplantation
of organs for the purpose of tissue donation and transplant.
Fundraising.
We may use certain demographic information for purposes of raising
funds for the facility and its operations.
Food
and Drug Administration (FDA). We may disclose health information
to the FDA relative to adverse events, product defects, or post
marketing surveillance information to enable product recalls, repairs,
or replacement.
Public
Health. 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, including child abuse
and neglect.
Victims
of Abuse, Neglect or Domestic Violence. We may disclose
to appropriate governmental agencies, such as adult protective or
social services agencies, your health information, if we reasonably
believe you are a victim of abuse, neglect, or domestic violence.
We will only make this disclosure if you agree to the disclosure
or we are required by law to make the disclosure.
Health
Oversight. In order to oversee the health care system,
government benefits programs, entities subject to governmental regulation
and civil rights laws for which health information is necessary
to determine compliance, we may disclose health information for
oversight activities authorized by law, such as audits and civil,
administrative, or criminal investigations.
Court
Proceeding. We may disclose health information in response
to requests made during judicial and administrative proceedings,
such as court orders or subpoenas.
Law
Enforcement. Under certain circumstances, we may disclose
health information to law enforcement officials. These circumstances
include reporting required by certain laws (such as the reporting
of certain types of wounds), pursuant to certain subpoenas or court
orders, reporting limited information concerning identification
and location at the request of a law enforcement official, reports
regarding suspected victims of crimes at the request of a law enforcement
official, reporting death, crimes on our premises, and crimes in
emergencies.
Inmates.
If you are an inmate of a correctional institution or under the
custody of a law enforcement official, we may release medical information
about you to the correctional institution or law enforcement official.
This release would be necessary (1) for the institution to provide
you with health care; (2) to protect your health and safety or the
health and safety of others; or (3) for the safety and security
of the correctional institution.
Threats
to Public Health or Safety. We may disclose or use health
information when it is our good faith belief, consistent with ethical
and legal standards, that it is necessary to prevent or lessen a
serious and imminent threat or is necessary to identify or apprehend
an individual.
Specialized
Government Functions. Subject to certain requirements,
we may disclose or use health information for military personnel
and veterans, for national security and intelligence activities,
for protective services for the President and others, for medical
suitability determinations for the Department of State, for correctional
institutions and other law enforcement custodial situations, and
for government programs providing public benefits.
Workers
Compensation. We may disclose health information when authorized
and necessary to comply with laws relating to workers compensation
or other similar programs.
Other
Uses. We may also use and disclose your personal health
information for the following purposes:
- to contact
you to remind you of an appointment for treatment,
- to describe
or recommend treatment alternatives to you,
- to furnish
information about healthrelated benefits and services that may
be of interest to you, or
- for certain
of our charitable fundraising purposes.
All other uses
and disclosures of your medical information will be made only with
your written authorization. Once given, you may revoke the authorization
by writing to us at:
Attn: Privacy
Manager
Lake Region Healthcare Corporation
PO Box 728
Fergus Falls, MN 56538-0728
We are unable
to take back any disclosure we have already made with your authorization.
Individual
Rights
You have many rights concerning the confidentiality of your medical
information. You have the right to:
Request
restrictions on the medical information we may use and
disclose for treatment, payment, and health care operations. We
are not required to agree to these requests. To request restrictions,
please send a written request to the address listed for the privacy
manager.
Receive
confidential communications of medical information about
you in a certain manner or at a certain location. For instance,
you may request that we only contact you at work or by mail. To
make such a request, you must write to us at the address listed
for the privacy manager, and tell us how or where you wish to be
contacted.
Inspect
or copy your medical information. You must submit your
request in writing to the address listed for the privacy manager.
If you request a copy of your medical information we may charge
you a fee for the cost of copying, mailing or other supplies. In
certain circumstances we may deny your request to inspect or copy
your medical information. If you are denied access to your medical
information, you may request that the denial be reviewed. Another
licensed health care professional will then 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.
Amend
medical 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, you must write to us at the
address listed for the privacy manager. You must also give us a
reason to support your request. We may deny your request to amend
your medical information if it is not in writing or does not provide
a reason to support your request. We may also deny your request
if the information:
- was not
created by us, unless the person that created the information
is no longer available to make the amendment,
- is not part
of the medical information kept by or for us,
- is not part
of the information you would be permitted to inspect or copy,
or
- is accurate
and complete
Receive
an accounting of disclosures of your medical information.
You must submit such a request in writing to the address listed
for the privacy manager. Not all medical information is subject
to this request. Your request must state a time period, no longer
than 6 years and may not include dates before April 14, 2003. Your
request must state in what form you would like the list (paper,
electronically). The first list you request within a 12 month period
is free. For additional lists, we may charge you the costs of providing
the list. We will notify you of this cost and you may choose to
withdraw or modify your request before charges are incurred.
Receive
a paper copy of this Notice upon request, even if you have
agreed to receive the Notice electronically. You may obtain a copy
of this notice at our website, www.lrhc.org. You must submit a request
for a paper notice in writing to the address listed for the privacy
manager.
All
requests to restrict use of your medical information for treatment,
payment, and health care operations, to receive confidential communication,
to inspect and copy medical information, to amend your medical information,
to receive an accounting of disclosures of medical information,
must be made in writing to the following address:
Attn: Privacy
Manager
Lake Region Healthcare Corporation
PO Box 728
Fergus Falls, MN 56538-0728
Complaints
If you believe that your privacy rights have been violated, a complaint
may be made to our Privacy Manager. You will not be penalized in
any way for filing a complaint. All complaints should be sent in
writing to the following address:
Attn: Privacy
Manager
Lake Region Healthcare Corporation
PO Box 728
Fergus Falls, MN 56538-0728
You may also
submit a complaint to the Secretary of the Department of Health
and Human Services.
Changes
to This Notice. We reserve the right to change our privacy
practices and to apply the revised practices to medical information
about you that we already have. Any revision to our privacy practices
will be described in a revised Notice that will be posted prominently
in our facility, and posted on our website at www.lrhc.org. |
