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PRIVACY STATEMENT
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.
Protecting the privacy of information about your medical
conditions and health is a responsibility LifeCare Medical
Center, Inc. (LifeCare) takes very seriously. We understand that
medical information about you and your health is personal and it
is important to you that we keep it confidential. Staff members
are committed to the practices and procedures we have
established to protect the confidential nature of information
about your health.
This notice describes the ways in which we may use and
disclose information about your health to carry out treatment,
payment and health care operations, and for other purposes as
permitted or required by law. It also describes your rights and
our duties regarding the use and disclosure of protected health
information.
Uses and Disclosures of Information About Your Health WITHOUT
Your Authorization
The following categories describe different ways that we may use
and disclose information about your health without your written
authorization. For each category, we will explain what we mean
and try to give some examples. Not every use or disclosure in a
category will be listed. However, all of the ways we are
permitted to use and disclose information without written
authorization fall within one of the categories.
Treatment: We may use information about your health to provide
you with medical treatment and/or related services. We may
disclose medical information about you to doctors, nurses,
technicians, medical students, or other LifeCare personnel who
are involved in taking care of you at LifeCare.
Different departments of LifeCare also may share medical
information about you in order to coordinate other services you
may need, such as prescriptions, lab work and x-rays. We may
also disclose medical information about you to people outside
LifeCare who may be involved in your medical care after you
leave LifeCare.
Payment: We may use and disclose your health
information so that the treatment and services you receive at
LifeCare can be billed for and payment can be collected. For
example, we may need to give your health plan information about
surgery you received at the hospital so your health plan will
pay us or reimburse you for the surgery. We may also tell your
health plan about a treatment you are going to receive to obtain
prior approval or to determine whether your plan will cover the
treatment.
Health Care Operations: We may use and disclose
your health information for our organization operations. These
uses and disclosures are necessary to make sure that all of our
patients/residents/clients receive quality care. For example, we
may use medical information to review our treatment and services
and to evaluate the performance of our staff in caring for you.
We may also combine medical information about many hospital
patients to decide what additional services LifeCare should
offer, what services are not needed, and whether certain new
treatments are effective.
We may also disclose information about your health to our
business associates to enable them to perform services for us or
on our behalf relating to our operations.
Hospital Directory: We may include certain
limited information about you in the hospital directory while
you are a patient at the hospital. This information may include
your name, location in the hospital, your general condition
(i.e. fair, stable, etc.) and your religious affiliation. The
directory information, except for your religious affiliation,
may also be released to people who ask for you by name. Your
religious affiliation may be given to a member of the clergy,
such as a priest or minister, even if they don’t ask for you by
name. This is so your family, friends and clergy can visit you
in the hospital and generally know how you are doing.
Correctional Institutions: If you are an
inmate, we may disclose your health information to your
correctional facility to help provide you health care or to
provide safety to you or others.
Law Enforcement: We may release your health information
if asked to do so by a law enforcement official. For example,
disclosures may be made in response to a warrant or subpoena;
for the purpose of identifying or locating a suspect, witness or
missing persons; or to provide information concerning victims of
crimes.
Coroners, Medical Examiners and Funeral Directors:
We may release your health information to a coroner or medical
examiner during their investigations. We may also release health
information to funeral directors so that they may carry out
their duties. We may disclose personal health information to
organizations that handle donations of organs, eyes or tissue
and transplantations.
Public Health Issues: We may disclose your
health information to an authorized public health authority for
public health activities in controlling disease, injury or
disability. For example, we may disclose your personal health
information to the childhood immunization registry.
Health Oversight Activities: We may disclose
your health information to a government agency authorized to
conduct health care system or governmental procedures such as
audits, examinations, investigations, inspections and licensure
activity for public health activities.
Legal Proceedings: We may disclose your health
information in the course of any legal proceeding, in response
to a court order or administrative judge and in certain cases,
in response to a subpoena, discovery request or other lawful
process.
To Prevent a Serious Threat to Health or Safety: We may use
and disclose your health information when necessary to prevent a
serious threat to your health and safety or the health and
safety of the public or another person.
Military Activity & National Security: We may disclose your
health information to armed forces personnel under certain
circumstances and to authorized federal officials for national
security and intelligence activities.
Workers’ Compensation: We may disclose your health
information as required by workers’ compensation laws.
As Required by Law: We may use or disclose your personal
health information when required to do so by federal, state (MN
statute 144.45, Subd.5a) or local law.
Uses and Disclosures of Information About Your Health WITH Your
Authorization
Other uses or disclosures of protected health information
that are not described in this notice or are not otherwise
permitted by law will be made only with your written
authorization. You may revoke such authorization as described in
this notice.
Your Rights Regarding Information About Your Health
You have the following rights regarding the health
information we maintain about you, which you may exercise by
submitting your request in writing to:
Privacy Officer
LifeCare Medical Center, Inc.
715 Delmore Drive
Roseau, MN 56751
mprachar@lifecaremc.org
Right to Revoke Authorization: You may revoke your
authorization (in writing) at any time, as provided by law. If
you revoke your permission, we will no longer use or disclose
medical information about you for the reasons covered by your
written authorization. You understand that we are unable to take
back any disclosures we have already made with your
authorization, and that we are still required to retain our
records relating to the care we have provided to you.
Right to Request Restrictions: You have the right to request
a restriction or limitation on certain uses/disclosures of
protected health information for treatment, payment or health
care operations. The law, however, does not require us to agree
to these restrictions. If we do agree, we will comply with your
request unless the information is needed to provide you with
emergency treatment.
In your written 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, for example, disclosures to your spouse.
Right to Request Confidential Communications: You have
the right to request (in writing) 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 written request must
specify how or where you wish to be contacted.
Right to Inspect and Copy: You have the right to inspect
and copy medical information that may be used to make decisions
about your care. Your request may be denied if the provider has
determined that the information is detrimental to the physical
health of the patient, or is likely to cause the patient to
inflict self harm or to harm another. If you are denied access
to medical information, you may request that the denial be
reviewed. We will comply with the outcome of the review.
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.
Right to Amend: If you feel that medical information we
have about you is incorrect or incomplete, you may ask us (in
writing) to amend the information. In your written request, you
must also provide a reason that supports your request.
You have the right to request an amendment for as long as
the information is kept by or for LifeCare.
We may deny your request if you ask us to amend records that:
-were not created by us;
-are not part of the medical information kept by or for LifeCare;
-are determined to be accurate and complete.
Right to Request an Accounting: You have the right to
request (in writing) information about the times we have
disclosed your personal health information for any purpose other
than the following exceptions:
-Treatment, payment or health care operations
-Disclosures that you or your personal representative have
authorized.
Your request must state a time period which may not be
longer than six years and may not include dates before April 14,
2003.
Right to a Copy of this Notice: You have the right to obtain
a copy of this notice at any time. You may obtain a copy of this
notice at our website, www.LifeCarenc.com or by submitting your
request to the contact listed below.
Our Duties Regarding Information About Your Health
We are required by law to:
-Maintain the privacy of information about your health;
-Provide you with this notice of our legal duties and health
information privacy practices; and
-Abide by the terms of this notice.
Changes to this Notice
We reserve our right to change the terms of 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 hospital and nursing homes. In
addition, each time you register at or are admitted to the
hospital for treatment or health care services as an inpatient
or outpatient, we will offer you a copy of the current notice in
effect. If you are receiving home care or hospice services, a
current notice will be made available.
For More Information or to File a Complaint
If you believe your privacy rights have been violated, you may
either:
1.) Call us at (218) 463-2500.
2.) File a written complaint with our privacy officer.
715 Delmore Drive
Roseau, MN 56751
3.) Notify the Secretary of the U.S. Department of Health &
Human Services (DHHS) by sending your complaint to:
Medical Privacy Complaint
Division
Office for Civil Rights
U.S. DHHS
200 Independence Avenue,
SW
Room 509F, HHH Building
Washington, DC 20201
Please be assured that you will not be retaliated against
for filing a complaint about our privacy practices either with
us or DHHS.
Contact Person:
If you have questions, complaints or would like additional
information, please contact:
Privacy Officer
715 Delmore Drive
Roseau, MN 56751
(218) 463-2500
mprachar@lifecaremc.org
This notice was published and became effective on April 14,
2003. |
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