NOTICE OF
PRIVACY PRACTICES
HEALTH INSURANCE PORTABILITY
AND ACCOUNTABILITY ACT OF 1996
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.
RELEASE OF
CONFIDENTIAL INFORMATION
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 to your insurance
provider for the purpose of the hospital
receiving payment for providing
you with needed healthcare services.
For example: A bill may be sent
to you or your health care insurance company.
Information on the bill includes
identifying information along with a diagnosis
and procedures rendered.
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 healthcare 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 information
may be released to business associates
of Bigfork Valley. (Examples: Vendors,
Collection Agency, Auditors) In order
for them to perform the work we have
asked them to do, we may need to disclose
some health information. We require
business associates to safeguard
information in the same manner we do.
The healthcare center has an
agreement with Scenic Rivers Health
Systems - Bigfork that allows them to do
required committee work for the healthcare
center. Some of that committee
work will require that physicians review
records on patients not under their care.
Your records could be included in those
reviews. In accordance with the special
agreement between the healthcare center
and the clinic, the physicians are required
to extend all privacy protections
to these records, too.
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: Director of Health Information
Systems/Privacy Officer, Bigfork
Valley, PO Box 258, Bigfork, MN
56628.
You may be contacted by the
healthcare center 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
healthcare center for the purposes of
raising funds to support the healthcare
center’s operations. If you do not want
the healthcare center to contact you for
fundraising efforts, you must notify the
healthcare center at (218) 743-3177.
The healthcare center will not
require individuals to waive their right
to file a complaint with the Secretary of
HHS in order to receive treatment and/or
payment.
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 or in the
event you have an emergency situation.
To request restrictions, you must
make your request in writing to: Director
of Health Information Systems/Privacy
Offecer, Bigfork Valley, P.O. Box
258, Bigfork, MN 56628
In your request, you must tell us: (1)
What information you want to limit, (2)
Whether you want to limit our use, disclosure
or both; and (3) 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: Director
of Health Information Systems/Privacy
Officer, Bigfork Valley, P.O. Box
258, Bigfork, MN 56628.
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: Director of Health Information
Systems/Privacy Officer, Bigfork Valley,
P.O. Box 258, Bigfork, MN 56628. In
addition, you must provide a reason that
supports your request.
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 medical 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.
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: Director of Health Information
Systems/Privacy Officer, Bigfork
Valley, P.O. Box 258, Bigfork, MN
56628.
Your request must state a time period
which may not be longer than six (6)
years and may not include dates before
April 14, 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 Director of Health Information
Systems/Privacy Officer at (218)
743-4149. Or you may download a copy in pdf format
here (size: 1,128KB) and print it off.
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.
HEALTH CARE 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 Health Care Center.
Complaints
You have the right to complain to the
health care center or with the Secretary
of the Department of Health and Human
Services if you believe your rights to privacy
have been violated.
To file a complaint, please contact
Bigfork Valley Administration at (218)
743-3177.
All complaints will be investigated.
There will be no retaliation for filing a
complaint.
This notice is effective as of April 14, 2003.
Revised September 2005.
|
