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 our privacy officer at (763) 271-2275.
Our Health Information Responsibilities We have the duty to protect the privacy of your protected health information and to give you this Notice. We have a duty to abide by our current Notice of Privacy Practices.
Protected Health Information (PHI) is information, including demographic information that may identify you and relates to health care services provided to you, the payment of health care services provided to you, or your physical or mental health condition, in the past, present or future. This Notice of Privacy Practice describes how we may use and disclose PHI. It also describes your rights to access and control PHI.
Your Health Information Rights Copy In most cases, you have the right to look at, or get a copy of your health information. If you request copies, you will need to do so in writing through our Health Information Management Department. There may be charges associated with those copies.
Disclosures You also have the right to receive a list of instances where we have disclosed information about you for reasons other than treatment, payment, or related administrative purposes. You will need to make this request in writing through the Health Information Management Department.
Amend If you believe that information in your record is incorrect or if important information is missing, you have a right to amend the information. You need to make a request to amend your record. We may deny your request for an amendment if the reason does not support the request. You will need to make this request in writing through the Health Information Management Department.
Confidential Communications Normally we will communicate with you at the address and phone number you give us. You may ask us to confidentially communicate with you in another way or at another location. To request confidential communication, you must make your request in writing to the Health Information Management Department. We will not ask you the reason for your request. We will agree to your request if it is reasonable. You must specify how or where you wish to be contacted.
Restrictions You have the right to request we restrict or limit the health information that we use for treatment, payment, or health care operations. Federal law states that we do not have to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide emergency medical treatment. Please make that request in writing and provide us with the information you want to limit, whether you want to limit our use and to whom you want the limits to apply. You will need to make this request in writing through the Health Information Management Department.
Uses and Disclosure of Health Information We may use PHI about you for:
treatment, which includes working with other providers of care;
payment, such as billing for services provided; and
other heath care operations.
These are non-treatment and non-payment activities that let us run our business or provide services, for example, assessment of care for quality and improvement, reviewing the competence or qualifications of health professionals. We may disclose PHI about you without authorization for several other reasons.
Individuals involved in your care or Payment of your care We may release medical information about you to a friend or family member who is involved in your medical care or who helps pay for your care. In addition, we may disclose medical information about you to an entity assisting in disaster relief effort so that your family can be notified about your condition, status and location.
Facility Director
Medical Emergencies We may need to disclose health information to help you in a medical emergency.
Outpatient Appointment Reminders We may remind you of appointments to assure you have completed the preparations for various examinations.
Law Enforcement We may disclose certain information to law enforcement for:
Response to court order, grand jury subpoena, warrant or summons or similar process;
To identify a deceased person, or locate a missing child under age 18;
The victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
Criminal conduct at the hospital;
Emergency circumstances to report a crime; the location of the crime of victims; or the identity, description or location of the person who committed the crime; and
Other situations as required by law.
Abuse, Neglect or Threat We may disclose information to the proper authorities about possible abuse or neglect of a child or vulnerable adult. If there is a serious threat to the person we may disclose information to law enforcement.
Public Health Risks We may disclose health information about to you to public health authorities for certain public health activities. These include:
To prevent or control disease, injury or disability;
To report births and deaths;
To report child abuse or neglect;
To report reactions to medications or problems with products;
To notify people of recalls of products they may be using;
To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and
To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.
Required by Applicable Law We may release health information as required by law to;
Funeral Directors;
Organ Procurement Organizations;
The Food and Drug Administration relative to adverse events as required by law; and
Workers Compensation.
We will only make this disclosure if you agree, or when required or authorized by law.
Business Associates There are some services provided in our organization through contracts with business associates. Examples include certain outside laboratories, radiology procedures, or a copy service we use when making copies of your health record. When these services are contracted, we may disclose health information to our business associate so they can perform the job we have asked them to do and submit your bill to a third party for services rendered. To protect your information, however, we require the business associate to appropriately safeguard your information.
Affiliated Covered Entity Protected health information will be provided to your physician as necessary to carry out treatment, payment and health care operations.
Complaints If you are concerned that we have violated your privacy rights or you disagree with a decision made about access to records, you may contact the person listed below. You may also send a written complaint to the Secretary of the Department of Health and Human Services. The person listed below can provide you with the appropriate address upon request. You will not be penalized for filing a complaint.
Any change in terms of this notice will be effective for all PHI. If a change is made to this Notice, a copy of the revised Notice will be available at our facility and on the website at www.mblch.com. You will be offered a copy of this notice each time you register or are admitted to Monticello-Big Lake Hospital for treatment or services.
If you have questions or complaints, please contact our privacy officer, (763) 271-2275.