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Privacy
Policy
Effective April 1, 2003
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Throughout this notice, the words “we,” “us,”
and “St. Michael’s” mean any one or
combination of the following: St. Michael’s Hospital/Nursing
Home/Sauk Centre Home Care and Lakeview Medical Clinic
and any other entity which we may include from time to
time as a member of our organized health care arrangement.
“You and/or Consumer” refers to anyone who
received health care services or product from us (i.e.
patient/resident/client). “Health information”
means any information, whether oral, written, or recorded
in any form, that we create or receive relating to your
past, present, or future health or health care payment.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION. We
are required by law to give you this Notice explaining
that we use and disclose your health information for the
following purposes:
• Treatment: We will use your health information
to provide you with the health care services or products
you seek. We may share your health information with doctors,
nurses, and/or other health care providers (such as x-ray,
lab, and pharmacy) who are involved in your care and who
are part of the entity providing your care. With your
consent (or the consent of your legal representative),
we may share certain health information specified by you
with your family members or others involved in your care,
other entities within St. Michael’s or other entities
or individuals outside St. Michael’s.
• Payment: We may use and disclose health information
about you so that we can bill your insurance company,
health plan, Medicare, Medical Assistance or any other
payers or programs for your health care services or products.
If your insurer or health plan requires prior approval
or other notice in order to determine whether they will
pay for those services or products, we may disclose certain
aspects of your health information to them—unless
you have asked that we not bill your insurer or plan.
• Health Care Operations: We may use and disclose
information about you within St. Michael’s to manage
and improve our health care service to you. This includes
quality assessment activities, evaluating our physicians
and nurses, licensing and accreditation activities, obtaining
legal and accounting services, and business planning and
management. We may provide you some services with the
assistance of independent personnel and companies (such
as equipment technologists, computer hardware and software
providers, and maintenance personnel) who are not employees
or affiliates of St. Michael’s. We call these individuals
or companies our “business associates.” We
may give our business associates limited access to your
health information to the extent they need it to do what
we have hired them to do. To protect your health information,
we minimize that access as much as possible and require
our business associates to safeguard your information.
• Appointment Reminders, Treatment Alternatives:
We may use and disclose your health information to contact
you to provide appointment reminders, information about
treatment alternatives, or other health-related products
or services that may be of interest to you.
• Hospital/Nursing Home Directory: If you are a
consumer at St. Michael’s, we may include certain
limited information about you in the hospital/nursing
home directory. This information may include your name,
location in the hospital/nursing home, your general condition
(e.g., fair, stable, etc.) and your religious affiliation.
This directory information may be released to people who
ask for you by name and to members of the clergy so your
family, friends, and clergy can visit you in the hospital/nursing
home and generally know how you are doing. If you do not
want your name included in the hospital/nursing home directory,
or if you want the information restricted, you will be
given the opportunity to request this when you register
at the hospital/nursing home.
• Individuals Involved in Your Care: If you agree,
we may release certain health information about you to
a friend or family member involved in your care or payment
related to your care. If you are unable to agree due to
your incapacity or emergency circumstances, we may disclose
your health information as necessary if we determine that
it is in your best interest, based on our professional
judgment. We may disclose information about you to an
organization assisting in a disaster relief effort so
that your family can be notified about your condition,
status, and location.
• Research: We will not use or disclose any health
information that identifies you or can be used to identify
you for any research purposes without either obtaining
your prior written authorization or following state law
procedures for attempting to notify you of our research
request. [**When you register to receive health care services
from us, we will seek your authorization to use and disclose
your health information to individuals within St. Michael’s
for purposes of conducting medical or scientific research.
**] You will be asked to sign additional authorizations
if you wish to participate in clinical research trials
involving treatment.
• Fundraising Activities: We may use your health
information and disclose your contact information to the
St. Michael’s Foundation or to a business associate
without your authorization in order to contact you to
raise funds for one or more nonprofit entities within
St. Michael’s. We would only disclose your name,
address, and telephone number and the dates you received
services from us, and not information about your health
or treatment. We do not sell your information to anyone.
If you do not want us to contact you for fundraising efforts,
you must notify St. Michael’s Foundation in writing
at the following address: 425 Elm Street North, Sauk Centre,
MN 56378. Any fundraising communication addressed to you
will contain instructions describing how you may “opt
out” of receiving further communications.
• Worker’s Compensation: We may release health
information about you for worker’s compensation
or similar programs to the extent authorized and necessary
to comply with related laws. These programs provide benefits
for work-related injuries or illness.
In addition to the above-listed purposes, we may need
to use or disclose your health information without your
authorization for the following purposes:
• to the government for public health activities
as permitted or required by law to report disease statistics,
births and deaths, child or vulnerable adult abuse or
neglect, domestic violence, reactions to medications,
problems with products, and disease exposures;
• to a health oversight agency for audits, investigations,
inspections, and licensure activities;
• to prevent a serious and imminent threat to the
health or safety of a person or the public, or to help
the police apprehend an individual involved in a violent
crime which may have seriously harmed someone;
• to organ procurement organizations to facilitate
organ or tissue donation and transplantation, consistent
with applicable law;
• to a law enforcement official in response to a
court order, subpoena, warrant, summons, or similar process;
to identify or locate a suspect, witness, or missing person;
to identify a victim of crime if, under certain limited
circumstances, we are unable to obtain the victim’s
agreement; or in emergency circumstances to report the
location and perpetrator of a crime;
• to a court or party in litigation in response
to a valid court or administrative order;
• to a coroner or funeral director as permitted
or required by law to identify a deceased person, determine
the cause of death, or otherwise as necessary to carry
out their duties;
• if you are an inmate of a correctional institution,
to the institution as necessary for your health and the
health and safety of other individuals;
• for military, national security, or lawful intelligence
activities; or
otherwise as permitted or required by law.
Other uses and disclosures of your health information
will be made only with your written authorization. You
may revoke that authorization in writing at any time,
but we cannot take back any disclosures we have already
made in reliance on your authorization.
YOUR RIGHTS TO YOUR HEALTH INFORMATION: You have the following
rights regarding the health information we maintain about
you:
• Rights to Inspect and Copy. With some exceptions,
you have the right to inspect and request a copy of your
medical records, billing records, and records used to
make decisions about your care or services if those records
include health information about you and are maintained
or used by us. To inspect and request a copy of records
containing your health information, you must submit your
request in writing to Health Information Management at
the address listed at the end of the Notice. 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. In some cases, we may deny your request
to inspect and copy records. If you are denied access
to records, you may request that the denial be reviewed.
Another licensed health care professional chosen by us
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. If you feel that a record containing
your health information is incorrect or incomplete, you
may ask us to amend the information. Your request must
be made in writing and submitted to Health Information
Management at the address listed at the end of this Notice.
You must provide a reason that supports your request.
We may deny your request if (among other reasons) the
information was not created by us; is not included in
your medical, billing, or other records used to make decisions
about your care; or is otherwise accurate and complete.
• Right to Accounting of Disclosures. With limited
exceptions, you have the right to request a written accounting
of every disclosure of your health information we have
made for up to six years prior to your request, other
than disclosures to you, disclosures authorized by you
in writing, and disclosures for treatment, payment and
health care operations as described in this Notice. To
request this accounting, you must submit your request
in writing to Health Information Management at the address
listed at the end of this Notice. Your request must state
a time period, which may not be longer than six years
and may not include dates before April 14, 2003. Your
request should indicate in what form you want the accounting
(for example, on paper or electronically). The first accounting
you request within a 12-month period will be free. For
additional accountings, we may charge you for the costs
of providing the accounting. We will notify you of the
cost involved and you may choose to withdraw or modify
your request at that time before any costs are incurred.
• Right to Request Restrictions. You have the right
to request a restriction or limitation on the health information
we use or disclose about you for treatment, payment, health
care operations, or to assist others’ involvement
in your care. We are not required to agree to your request.
If we do agree, we will comply with your request unless
the information is needed to provide emergency treatment
to you. To request a restriction, you must make your request
in writing to Health Information Management at the address
listed at the end of this Notice. In your request, you
must tell us (1) what information you want to limit; (2)
whether and how 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 that we communicate health
information about you in a certain way or at a certain
location. For example, you can ask that we only contact
you at work or by mail. To request confidential communications,
you must make your request in writing at the time you
register with us, or to Health Information Management
at the address listed at the end of this Notice. We will
attempt to accommodate all reasonable requests.
OUR LEGAL DUTIES AND RIGHTS: We are required by law to
protect the privacy of your health information and to
provide this Notice about our legal duties and health
information practices. We reserve the right to change
our health information practices and the terms of this
Notice. We reserve the right to make the changed Notice
effective for health information we already have about
you as well as any information we receive after the change.
The Notice will contain an effective date on the first
page, in the top right-hand corner. We will post a copy
of the current Notice on our web site, http://www.stmichaelshospital.org,
and in a prominent place at each of our locations. In
addition, we will make this Notice available to you at
each of our sites within St. Michael’s.
COMPLAINTS: If you believe your privacy rights have been
violated, you may file a complaint with Health Information
Management at the address listed immediately below. You
may also file a complaint with the Secretary of Department
of Health and Human Services.
All complaints must be submitted in writing. You will
not be penalized for filing a complaint.
If you have any questions, please contact:
Vickie Olson, RHIT/Privacy Officer
St. Michael’s Hospital
425 Elm Street North
Sauk Centre, MN 56378, (320) 352-2221 ext 1735
ATTN: Medical Records Department
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