Notice of Privacy Practices
Effective Date: July 15, 2005
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.
If you have any questions about this notice, please contact St.
Joseph's Area Health Services Health Information Manager and Privacy Officer at 218-237-5785.
St. Joseph's Area Health Services is required by law to maintain
the privacy of your health information; give you notice of our
legal duties and privacy practices with respect to your health
information; and follow the terms of this notice.
This notice applies to all of your health records generated by
St. Joseph's Area Health Services, whether made by our personnel
or your personal physician. This notice will tell you about the
ways in which we may use and disclose your health information
in St. Joseph's Area Health Services and with other entities.
We also describe your rights and certain obligations we have regarding
the use and disclosure of your health information.
WHO WILL FOLLOW THIS NOTICE?
St. Joseph's Area Health Services, St. Joseph's Home Care and
Hospice, Community Dental Clinic, St. Joseph's Care Essentials,
contracted Emergency Room physicians working in St. Joseph's Area
Health Services Emergency Department and any and all other entities
owned and operated by St. Joseph's Area Health Services.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION.
We will use your health information to provide you with health
care treatment and to coordinate or manage services with other
health care providers, including third parties. We may disclose
all or any portion of your health information to your attending
physician, consulting physician(s), nurses, technicians, medical
students, or other facility or health care personnel who have
a legitimate need for such information in order to take care of
you. Different departments of the facility will share your health
information in order to coordinate the health care services you
need, such as prescriptions, lab work and X-rays. We may disclose
your health information to family members or friends, guardians
or personal representatives who are involved with your medical
care. We may also use and disclose your health information to
contact you for appointment reminders, and to provide you with
information about possible treatment options or alternatives,
and other health- related benefits and services. We also may disclose
your health information to people outside the facility who may
be involved in your health care after you leave the facility,
such as other physicians involved in your care, specialty hospitals,
skilled nursing care facilities and other health care-related
services. We may use and disclose your health information to your
employer for employment or pre-employment physicals, drug testing
or other health related services.
We will use and disclose your health information for activities
that are necessary to receive payment for our services, such as
determining insurance coverage, billing, payment and collection,
claims management, and medical data processing. For example, we
may tell your health plan about a treatment you are planning in
order to receive approval or to determine whether your plan will
cover the proposed treatment. We may disclose your health information
to other health care providers so they can receive payment for
health care services that they provided to you, such as ambulance
services. We may also give information to other third parties
or individuals who are responsible for payment for your health
care, such as the named insured under the health policy who will
receive an explanation of benefits (EOB) for all beneficiaries
who are covered under the insured's plan.
For Health Care Operations
We may use and disclose your health information for routine facility
operations, such as business planning and development, quality
review of services provided, internal auditing, accreditation,
certification, licensing or credentialing activities, including
the licensing or credentialing activities of healthcare professionals,
medical research and education for staff and students, to assess
your satisfaction with our services and to other healthcare entities
that have a relationship with you and need the information for
operational purposes. We may use and disclose your health information
to the external agencies responsible for oversight of healthcare
activities such as the Joint Commission for Accreditation of Health
Care Organizations, patient satisfaction survey organizations,
external quality assurance and peer review organizations, and
credentialing organizations. We may also disclose health information
to business associates we have contracted with to perform services
for or on our behalf and to others such as medical device manufacturers
or pharmaceutical companies in order for those companies to carry
out their legal obligations to state and federal agencies.
We may include your name, location in the facility, your general
condition and your religious affiliation in the facility directory.
The directory information, except for your religious affiliation,
may be released to people who ask for you by name. Your name and
religious affiliation may be given to a member of the clergy,
such as a priest or rabbi, even if they don't ask for you by name.
The facility directory is available so your family, friends and
clergy can visit you and generally know how you are doing. You
must notify our admissions department orally or in writing if
you do not want us to release information about you in the facility
directory. If you do not want information released in the facility
directory, we cannot tell members of the public, flower or other
service persons and organizations, and even your friends and family
that you are here and your general condition.
We may communicate to you via newsletters or other means regarding
treatment options, health related information, disease management
programs, wellness programs, or other community based initiatives
or activities our facility is participating in.
We may use your health information, or disclose your health information
to a foundation related to us for St. Joseph's Area Health Services'
fundraising efforts. We would only release information such as
your name, address and phone number and the dates that you received
treatment or services from us. If you do not want us to contact
you for fundraising efforts you must notify our Marketing/Development
Coordinator in writing, stating that you do not want to receive
We may use and disclose your health information to researchers
when the Institutional Review Board and/or Privacy Board approve
the research study and the use of your health information.
Organ and Tissue Donation
If you are an organ donor, we may release your health information
to organizations that handle organ procurement and transplantation
or to an organ donation bank, as necessary to facilitate organ
or tissue donation and transplantation.
USES AND DISCLOSURES THAT ARE REQUIRED OR PERMITTED BY LAW
Subject to requirements of federal, state and local laws, we
are either required or permitted to report your health information
for various purposes. Some of these reporting requirements include:
Public Health Activities
We may disclose your health information to public health officials
for activities such as the prevention or control of communicable
disease, injury or disability; to report births and deaths; to
report suspected child, elder, or spouse abuse or neglect; to
report reactions to medications or problems with medical products;
to report information to the Centers for Disease Control or to
national cancer registries for their data aggregation.
Disaster Relief Efforts
We may disclose your health information to an entity assisting
in a disaster relief effort so that your family can be notified
about your condition and location.
Health Oversight Activities
We may disclose your health information to a health oversight
agency for activities authorized by law. Such agencies include
federal Centers for Medicare and Medicaid Services, and state
medical or nursing boards. These oversight activities may include
audits, investigations, inspections, and licensure. These activities
are necessary for the government to monitor the health care system,
government programs and compliance with civil rights laws.
Judicial or Administrative Proceeding
We may disclose your health information in response to a court
or administrative order, a valid subpoena, discovery request,
civil or criminal proceedings, or other lawful process.
We may release your health information if asked to do so by a
law enforcement official or if we have a legal obligation to notify
the appropriate law enforcement or other agencies:
- In response to a court order, subpoena, warrant, summons or
similar legal process;
- Regarding a victim or death of a victim of a crime in limited
- In emergency circumstances to report a crime; the location
of the crime or victims; or the identity, description or location
of the person who committed the crime, including crimes that
may occur at our facility, such as theft, diversion or attempts
to obtain drugs illegally.
Coroners, Medical Examiners and Funeral
We may release health information to a coroner or a medical examiner.
This may be necessary, for example, to identify a person who died
or determine the cause of death. We may also release health information
to help a funeral director to carry out his/her duties.
We may release your health information for workers' compensation
benefits or to similar programs that provide benefits for work-related
injuries or illness, including disclosing information to the worker's
compensation carrier and your employer.
To Avert a Serious Threat to Health or
We may disclose your health information when necessary to prevent
a serious threat to your health and safety or the health and safety
of another person or the public.
We may disclose your health information to federal official(s)
for national security activities and for the protection of the
President and other Heads of State.
Military and Veterans
If you are a member of the armed forces, we may release your health
information as required by military command authorities. We may
also release health information about foreign military personnel
to the appropriate foreign military authority.
If you are an inmate of a correctional institution or in the custody
of a law enforcement official, we may release your health information
to the institution or law enforcement official. This release would
be necessary (1) for the institution to provide you with health
care; or (2) to protect your health and safety or the health and
safety of others; or (3) for the safety and security of the correctional
OTHER USES OF YOUR HEALTH INFORMATION
Other uses and disclosures of your health information not covered
by this notice or the laws that apply to us will be made only
with your written authorization. If you provide us with authorization
to use or disclose your health information, you may revoke that
authorization in writing at any time. When we receive your written
revocation we will no longer use or disclose your health information
for the purpose of that authorization. However, we are unable
to retrieve any disclosures already made based your prior authorization.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
Submit your requests to exercise your rights noted below in writing
to: Health Information Manager and Privacy Officer at St. Joseph’s Area Health Services, 600 Pleasant Ave., Park Rapids, MNÝ 56470.
You have the following rights regarding your health information:
Right to Inspect and Copy
You have the right to inspect your health information and copy
medical, billing or other records that may be used to make decisions
about your care. The right to inspect and copy does not apply
to psychotherapy notes that are maintained separately from the
health record or otherwise excluded according to Minnesota State
Statute. We charge a fee for document requests to cover the costs
of copying, mailing or other supplies.
In limited circumstances we may deny your request to inspect
and copy your health information. If you are denied access to
your health information, you may request that the denial be reviewed.
A licensed health care professional chosen by St. Joseph's Area
Health Services will review your request and the denial. The person
who conducts the review will not be the same person who denied
your request. We will comply with the outcome of the review.
Right to Amend
You have the right to request an amendment to your health information
that you believe is incorrect or incomplete.
Submit your request in writing, using a Request for Amendment
to PHI form, and including your reason for the amendment.
We may deny your request for an amendment if it is not in
writing or does not include a reason to support the request.
We may also deny your request if you ask us to amend information
- Was not created by St. Joseph's Area Health Services,
unless the person or entity that created the information is
no longer available to make the amendment;
- Is not part of the
medical information kept by or for St. Joseph's Area Health
- Is not part of the information that you would be permitted
to inspect and copy;
- or Is accurate and complete.
a paper copy of this request, contact the Health Information Manager and Privacy Officer.
Right to an Accounting of Disclosures
We are required to maintain a list of disclosures of your health
information. However, we are not required to maintain a list of
disclosures that we made by acting upon your written authorizations.
You have the right to request an accounting of disclosures that
were not subject to your written authorization. Submit your request
in writing. Your request must state a time period, not longer
than six years, and may not include dates before April 14, 2003.
The first list you request within a 12-month period will be free.
For additional lists, we may charge you for the costs of providing
the list. We will notify you of the cost involved and you may
choose to withdraw or modify your request before any costs are
Right to Request Restrictions
You have the right to request a restriction or limitation on how
much of your health information we use or disclose for treatment,
payment or health care operations. You also have the right to
request a restriction on the disclosure of your health information
to someone who is involved in your care or payment for your care,
such as a family member or friend.
We are not required to agree to your request. However, if we
do agree, we will comply with your request unless the information
is needed to provide you with emergency treatment.
Submit your request in writing or request and submit a Request
for Restrictions to Protected Health Information form. You must
include: (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
health care matters in a certain way or at a certain location.
For example, you can ask that we only contact you at an alternative
location from your home address, such as work, or only contact
you by mail instead of by phone.
You must make your request in writing or request and submit a
"Confidential Communications Opt Out" form. Your request must
specify how or where you wish to be contacted. We do not require
a reason for the request. We will accommodate all reasonable requests.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice. You may ask
us to give you a copy of this notice at any time.
If you have agreed to receive this notice electronically, you
are still entitled to a paper copy of this notice.
You may obtain a copy of this notice at our Web site, www.sjahs.org.
To obtain a paper copy of this notice, contact our Health Information Manager and Privacy Officer.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right
to make the revised or changed notice effective for health information
we already have about you as well as any information we receive
in the future. We will post a copy of the current notice in the
facility and on the Web site if applicable at http://www.sjahs.org.
The notice will contain on the first page, in the top right-hand
corner, the effective date. Upon your initial registration or
admittance to the facility for treatment or health care services
as an inpatient or outpatient, we will offer you a copy of the
current notice in effect. Whenever the notice is revised, it will
be available to you upon request.
You may file a complaint with us or with the Secretary of the
Department of Health and Human Services if you believe that we
have not complied with our privacy practices. You may file a complaint
with us orally or in writing by contacting St. Joseph's Area Health
Services Health Information Manager and Privacy Officer at 218-237-5785.
You will not be penalized for filing a complaint.