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Meeker Memorial Hospital
Notice of Privacy Practices
Effective Date: December 2005
Version:
1.2
Approved By: Meeker Memorial Hospital Board
of Directors
“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 the Facility
Privacy Officer by dialing 320-693-3242.
Each time you visit a hospital, physician, or other healthcare provider, a record
of your visit is made. Typically, this record contains your symptoms, examination
and test results, diagnoses, treatment, and plan for future care or treatment,
and billing related information. This notice applies to all the records of your
care generated by the hospital whether made by hospital personnel, agents of
the hospital, or your personal doctor. Your personal doctor may have different
policies or notices regarding the doctor’s use and disclosure of your
medical information created in the doctor’s office or clinic.
Our Responsibilities
We are required by law to maintain the privacy of your health information and
provide you a description of our privacy practices. We will abide by the terms
of this notice and notify you if we cannot agree to a requested restriction.
We will accommodate reasonable requests you may have to communicate health information
by alternative means or at alternative locations.
Uses and Disclosures
How we may use and disclose medical information about you.
The following categories describe examples of the way we use and disclose
medical information:
For treatment: We may use medical information about you
to provide you treatment or services. We may disclose medical information
about you to doctors, nurses, technicians, medical students, or other hospital
personnel who are involved in taking care of you at Meeker Memorial
Hospital. For example: a doctor treating you for an injury may need to know
if you have diabetes, because diabetes may slow the healing process, or if
your doctor orders physical therapy, the nursing staff will need to discuss
your care and treatment with the Physical Therapist. Different departments
of Meeker County Memorial Hospital also may share medical information about
you in order to coordinate the different things you may need, such as prescriptions,
lab work, meals, and x-rays.
We may also provide your physician or a subsequent healthcare provider with
copies of various reports to assist him or her in treating you once you are
discharged from Meeker Memorial Hospital.
For Payment: We may use and disclose medical information
about your treatment and services to bill and collect payment from you, your
insurance company or a third party payer. For example, we may need to give
your insurance company information about your surgery so they will pay us
or reimburse you for the treatment. We may also tell your health plan about
treatment you are going to receive to determine whether your plan will cover
it.
For Health Care Operations: Members of the medical staff
and/or quality improvement team may use information in your health record
to assess the care and outcomes in your case and others like it. The results
will then be used to continually improve the quality of care for all patients
we serve. For example, we may combine medical information about many patients
to evaluate the need for new services or treatment. We may disclose information
to doctors, nurses, and other students for educational purposes.
We may also use and disclose medical information:
- To business associates we have contracted with to perform the agreed
upon service and billing for that service;
- To remind you that you have an appointment for medical care;
- To assess your satisfaction with our services;
- To tell you about possible treatment alternatives;
- To tell you about health-related benefits or services;
- For population based activities relating to improving health or reducing
health care costs;
- For conducting training programs for health care professionals.
Business Associates: There are some services provided in
our organization through contracts with business associates. Examples may
include physician services in the emergency department and radiology, certain
outside laboratories, or a copy service we use when making copies of your
health record. When these services are contracted, we may disclose your health
information to our business associate so that they can perform the job we've
asked them to do and bill you or your third party for services rendered. To
protect your health information, however, we require the business associate
to appropriately safeguard your information.
Directory: Unless you notify the admission staff that you
object, we may include certain limited information about you in the Facility
directory while you are here. The information may include your name, location
in the facility, your general condition (e.g. fair, stable, etc,) and
your religious affiliation. This information may be provided to members of
the clergy and, except for religious affiliation, to other people who ask
for you by name.
Individuals Involved in Your Care or Payment for 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 a
disaster relief effort so that your family can be notified about your condition,
status, and location.
Research: We may disclose information to researchers when
an institutional review board has approved their research. The institutional
review board must have reviewed the research proposal and established protocols
to ensure the privacy of your health information.
Future Communications: We may communicate to you via newsletters,
mail outs, 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.
Organized Healthcare Arrangement: We have established
an Organized Health Care Arrangement with the following participants:
- Treatment Providers of the Allina Medical Clinic-Litchfield
- Treatment Providers of the Affiliated Medical Clinic-Litchfield
- Gold Cross Ambulance
- Outreach Physician Groups
We may use or disclose medical information about you to another participant
in the organized health care arrangement to carry out treatment, payment,
or health care operations.
Uses Without Authorization As Required by Law:
Workers Compensation: We may disclose health information to the
extent authorized by and to the extent necessary to comply with laws relating
to workers compensation or other similar programs established by law.
Public Health: As required by law, we may disclose your health information
to public health or legal authorities charged with preventing or controlling
disease, injury or disability.
Food and Drug Administration (FDA): We may disclose to the FDA health
information relative to adverse events with respect to food, supplements,
product and product defects or post marketing surveillance information to
enable product recalls, repairs or replacement.
Correctional Institution: Should you be an inmate of a correctional
institution, we may disclose to the institution or agents thereof, health
information necessary for your health, and the health and safety of other
individuals.
Law Enforcement: We may disclose health information for law enforcement
purposes as required by law, or in response to a valid subpoena.
Medical Examiners, Coroners, and Funeral Directors: We may disclose
health information to medical examiners, coroners, and funeral directors
consistent with applicable law to carry out their duties.
Organ Procurement Organizations: Consistent with applicable law,
we may disclose health information to organ procurement organizations or
other entities engaged in the procurement, banking, or transplantation of
organs for the purpose of tissue donation and transplant.
Your Health Information Rights Although your health record is the
physical property of the healthcare practitioner or facility that compiled
it, you have the 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. You also have
the right to inspect and copy billing records. We may deny your request
to inspect and copy in certain very limited circumstances. If you are denied
access to medical information, you may request that the denial be reviewed.
The person conducting the review will not be the person who denied your request.
We will comply with the outcome of the review. We may charge a fee for
copying at the rate established by Minnesota Law.
Amend: If you feel that medical information we have about
you is incorrect or incomplete, you may ask us to amend the information. You
have the right to request an amendment for as long as the information is kept
by our facility. We may deny your request for an amendment and if this occurs,
you will be notified of the reason for the denial.
An Accounting of Disclosures: You have the right to request
an accounting of disclosures. This is a list of disclosures we make of medical
information about you for purposes other than treatment, payment, or healthcare
operations.
Request Restrictions: You have the right to request a restriction
or limitation on the medical information we use or disclose about you for
treatment, payment, or health care operations. You also have the right to
request a limit on the medical information we disclose about you to someone
who is involved in your care or payment for your care, like a family member
or friend. For example, you could ask that we not use or disclose information
about a surgery you had.
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 you emergency treatment.
Request Confidential Communications: You have the
right to request that we communicate about medical matters in a certain way
or at a certain location. We will agree to the request to the extent that
it is reasonable for us to do so. For example, you can ask that we use an
alternative address for billing purposes.
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. Even if you have agreed to receive this notice electronically,
you are still entitled to a paper copy of this notice.
To exercise any of your rights, please obtain the required forms from the Privacy
Officer and submit your request in writing.
We reserve the right to change this notice and the revised or changed notice
will be effective for information we already have about you as well as any information
we receive in the future. The current notice, including the effective date,
will be posted in the hospital and is available at our Meeker County Memorial
Hospital website.
If you believe your privacy rights have been violated, you may file a complaint
with the hospital by contacting the main number, asking for the Facility Privacy
Officer, and requesting a standard form. All complaints must be submitted
in writing. If you are dissatisfied with the resolution, you may submit
a complaint with the Secretary of the Department of Health and Human Services.
