NOTICE OF PRIVACY PRACTICES
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 COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your protected health information (PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law (Lower Sioux Indian Community law, applicable state law, and the Health Insurance Portability and Accountability Act of 1996 (“HIPAA)) to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.
We realize that these laws are complicated, but we must provide you with the following important information:
|· Your privacy rights concerning your PHI||· How we may use and disclose your PHI|
|· Our obligation concerning the use and disclosure of your PHI|
YOUR PRIVACY RIGHTS CONCERNING YOUR PHI
You have the following rights regarding the PHI that we maintain about you:
- Request Confidential Communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, please use the contact information below to make an appointment to complete the form. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.
- Ask us to limit what we use or share. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or our operations. We are not required to agree to your request, and we may say “not” if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
- Inspection and Copies. You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records. However, you may not obtain psychotherapy notes or information compiled in reasonable anticipation of a civil, criminal or administrative action or proceeding. You must submit your request in writing using the contact information below in order to inspect and/or obtain a copy of your PHI. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.
- Ask us to correct your medical record. You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may say “no” to your request, but we’ll tell you why in writing within 60 days.
- Get a list of those with home we’ve shared information. All of our patients have the right to request an list (“accounting of disclosures”). An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your PHI for non- treatment or operations purposes. Use of your PHI as part of the routine patient care in our practice (and certain other disclosures, like the ones you authorize us to make) is not required to be documented. For example, the doctor sharing information with the nurse; or the billing department using your information to file your insurance claim. In order to obtain an accounting of disclosures, you must submit your request in writing using the contact information below. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six (6) years from the date the “accounting of disclosures” is requested and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
- Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time by contacting us utilizing the contact information below.
- Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. You will not be retaliated against for filing a complaint. To file a complaint with our practice, you can contact us at:
Lower Sioux Health Care Center
Attn: Privacy Officer
39648 Reservation Hwy 3 Morton, MN 56270
Phone: (507) 697-8600 Fax: (507) 697-8911
You may file a complaint with the U.S. Department of Health & Human Services, Office for Civil Rights by writing to them at 200 Independence Avenue SW, Washington, DC 20201, by calling 1-800-696-6775, or going to their website at: www.hhs.gov/ocr/privacy/hipaa/complaints/.
- Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note: we are required to retain records of your care.
- Right to have someone else act for you. You can authorize someone else to act on your behalf (for example, if you have given someone else medical power of attorney). We may also share information to someone who is your legal guardian. We will ensure there is proper documentation that shows others can legally act for you before we share your information in these circumstances.
DECISIONS ABOUT WHAT WE CAN SHARE ABOUT YOUR PHI
Let us know if you have a preference for how we disclose, or share, your information (we will need your authorization):
|· with your family, close friends or other(s) who are involved in your care||· when there is a disaster relief situation|
If you are not able to let us know your preference (for example, when you are unconscious), we may share your information if we believe it is in your best interests or as necessary to respond to a serious and imminent threat to health or safety.
The Center does not sell your protected health information to anyone outside of the Center.
Fundraising activities: If we engage in fundraising or marketing activities, you have a right to opt out of receiving further fundraising communications from us.
Most sharing of psychotherapy notes: we do not share this information unless you give us authorization to do so.
HOW WE MAY USE AND DISCLOSE YOUR PHI
For Treatment: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other health care providers who are involved in taking care of you now or in the future when they are part of a related entity of the Center, and in medical emergencies. In other instances, we will obtain your authorization to share your PHI with other providers who treat you.
We may also use health information about you to call you or send you a letter to remind you about an appointment, to follow up with diagnostic tests results, or to provide you with information about other treatment and care that could benefit your health.
For payment: We may use and disclose medical information about you so that the treatment and services you receive may be billed and payment may be collected from you, an insurance company or a third party, with your authorization (unless the use and disclosure is to a Center-related entity).
For healthcare operations: Our practice may use and disclose your PHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice. Every effort will be made to insure anonymity. We are required to obtain your consent before we release your health records to other providers for their own health care operations.
Business Associates: We will share your PHI with third party associates that perform various activities for the clinic. Whenever any arrangement between our clinic and a business associate involves the use of disclosure of your PHI, we will have a written contract that contains terms that will protect the privacy of your PHI.
Communication with others involved with your care: Our health professionals may, in the event you are incapacitated or in an emergency circumstance, using their judgment, disclose to a family member, or other relative, close personal friend or any other person you identify, health information directly relevant to that person’s involvement in your care or payment related to your care.
Research: We may use and disclose health information about you from your medical record for external research purposes, with your authorization.
Required by law: We may use or disclose your PHI to the extent that the use or disclosure is required by law.
The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such disclosures.
Public Health Risks: Our practice may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:
|· Maintaining vital records, such as births and deaths||· Reporting child abuse or neglect|
|· Preventing or controlling disease, injury or disability||· Notifying a person regarding potential exposure to a communicable disease|
|· Notifying a person regarding a potential risk for spreading or contracting a disease or condition||· Reporting reactions to drugs or problems with products or devices|
|· Notifying individuals if a product or device they may be using has been recalled or withdrawn, needs repairs or replacement||· Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are requiring or authorized by law to disclose this information|
|· Reporting adverse reactions to medications|
Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.
Health Oversight Activities: Our practice may disclose your PHI to a health oversight agency for activities authorized by law.
Legal Proceedings: We generally may disclose your PHI in the course of judicial or administrative proceedings with your consent, unless we disclose pursuant to a valid court order, subpoena or warrant.
Law Enforcement: We may release PHI if asked to do so by a law enforcement official:
|· Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement||· Concerning a death, we believe has resulted from criminal conduct|
|· Regarding criminal conduct at our offices||· In response to a warrant, summons, court order, subpoena or similar legal process|
|· To identify/locate a suspect, material witness, fugitive or missing person||· In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identify or location of the perpetrator)|
We generally are required to obtain your consent for sharing your PHI for law enforcement purposes, unless the disclosure is in response to a valid court order, subpoena or warrant.
Deceased Patients: Our practice may release PHI to a medical examiner or coroner, with the authorization from the decedent’s authorized representative, to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.
Organ and Tissue Donation: Our practice may release your PHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor, generally with authorization from the decedent’s authorized representative.
Research: Our practice may use and disclose your PHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your PHI for research purposes except when:
(a) our use or disclosure was approved by an Institutional Review Board or a Privacy Board;
(b) we obtain the written agreement of a researcher that
(i) the information being sought is necessary for the research study;
(ii) the use or disclosure of your PHI is being used only for the research and
(iii) the researcher will not remove any of your PHI from our practice; or
(c) the PHI sought by the researcher only relates to decedents and the researcher agrees in writing that the use or disclosure is necessary for the research and, if we request it, to provide us with proof of death prior to access to the PHI of the decedents.
Serious Threats to Health or Safety: Our practice may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent or lessen the threat.
Military: Our practice may disclose your PHI if you are a member of the U.S. Armed Forces, a veteran, or a member of foreign military forces for activities deemed necessary by appropriate military commend authorities, including the Department of Veteran’s Affairs for the purpose of your eligibility for or entitlement to certain benefits provided by law when it is specifically required by law (otherwise we will obtain your consent).
National Security: Our practice may disclose your PHI to federal officials for intelligence and national security activities authorized by law (otherwise we will obtain your consent). We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations when it is specifically required by law.
Inmates: Our practice may disclose your PHI to correctional institutions or law enforcement officials if you are under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you (b) for the health, safety and security of the institution, and its officers and employees and/or (c) to protect your health and safety or the health and safety of other individuals.
Workers’ Compensation: Our practice may release your PHI for workers’ compensation and similar programs to the extent necessary to comply with applicable laws.
Required Uses and Disclosures: Under the law, we must make disclosures to you and, when required by the Secretary of the Department of Health and Human Services, to investigate or determine our compliance with applicable law.
We will not use information in your records for marketing purposes.
Other uses and disclosures from your medical record will be made only with your written authorization or approval.
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see: www.hhs.gov/ocr/privacy/hipaa/ understanding/consumers/noticepp.html.
Changes to the Terms of This Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.
Lower Sioux Health Care Center
Attn: Privacy Officer
39648 Reservation Hwy 3 Morton, MN 56270
Phone: (507) 697-8600 Fax: (507) 697-8911
This revised version of this Notice is effective as of May 27, 2021.