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Our Privacy Policy
HAMMER RESIDENCES,
INC.
NOTICE OF PRIVACY PRACTICES
EFFECTIVE DATE OF THIS NOTICE:
4/14/03
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW
YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
IT CAREFULLY.
Our Pledge And Legal Duty To Protect Health Information
About You.
The privacy of your health
information is important to us. We are required by federal
and state laws to protect the privacy of your health information.
We refer to this information as “protected health
information,” or “PHI”. We must give
you notice of our legal duties and privacy practices concerning
PHI, including:
-
We must protect PHI that
we have created or received about your past, present,
or future health condition, health care we provide to
you, or payment for your health care.
-
We must notify you about
how we protect PHI about you.
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We must explain how, when
and why we use and/or disclose PHI about you.
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We may only use and/or
disclose PHI as we have described in this Notice.
-
We must abide by the terms
of this Notice.
We are required to abide by
the terms of this Notice. We reserve the right to change
the terms of this Notice and to make new notice provisions
effective for all PHI that we maintain.
Minnesota Patient Consent for
Disclosures
For most disclosures of your health information we are
required by State of Minnesota Laws to obtain a written
consent from you, unless the disclosure is authorized
by Law. This consent may be obtained at the beginning
of your treatment, during the first delivery of health
care service, or at a later point in your care, when the
need arises to disclose your health information to others
outside of our organization.
USES AND DISCLOSURES
OF YOUR PROTECTED HEALTH INFORMATION
A. Uses and Disclosures of
Your Protected Health Information for Purposes of Treatment,
Payment and Health Care Operations.
Health Care Treatment. We may
use and disclose PHI about you to provide, coordinate
or manage your health care and related services. This
may include communicating with other health care providers
regarding your treatment and coordinating and managing
the delivery of health services with others. For example,
we may use and disclose PHI about you when you need a
prescription, lab work, an x-ray, or other health care
services. In addition, we may use and disclose PHI about
you when referring you to another health care provider.
Payment. We may use and disclose
your medical information to others to bill and collect
payment for the treatment and services provided to you.
For example: A bill may be sent to you or a third party
payer. The information on or accompanying the bill may
include information that identifies you, as well as your
diagnosis, procedures and supplies used. Before you receive
scheduled services, we may share information about these
services with your health plan(s). Sharing information
allows us to ask for coverage under your plan or policy
and for approval of payment before we provide the services.
We may also share portions of your medical information
with the following: 1) Billing departments; 2) Collection
departments or agencies; 3) Insurance companies, health
plans and their agents which provide you coverage; 4)
Utilization review personnel that review the care you
received to check that it and the costs associated with
it were appropriate for your illness or injury; and 5)Consumer
reporting agencies (e.g., credit bureaus).
Health Care Operations. We
may use and disclose PHI in performing business activities,
which we call “health care operations”. For
example: Members of our staff such as the risk or quality
improvement manager, or members of the quality improvement
team may use information in your health record to assess
the care and outcomes in your case and others like it.
This information will then be used in an effort to continually
improve the quality and effectiveness of the healthcare
and service we provide.
Our Business Associates. There
are some services provided in our organization through
contacts with business associates. Examples include physician
services in the Emergency Department and Radiology, certain
laboratory tests, and 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
payer for services rendered. So that your health information
is protected, however, we require the business associate
to sign a contract ensuring their commitment to protect
your PHI consistent with this Notice and to appropriately
safeguard your information.
C. Uses and Disclosures of Your Protected Health Information
that Require Your Authorization.
In addition to our use of your health information for
treatment, payment or healthcare operations, you may give
us written authorization, different from the Minnesota
Patient Consent, to use your health information or to
disclose it to anyone for any purpose. If you give us
an authorization, you may revoke it in writing at any
time. Your revocation will not affect any use or disclosures
permitted by your authorization while it was in effect.
Unless you give us a written authorization, we cannot
use or disclose your health information for any reason
except those described in this Notice.
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Research: We may disclose
information to external researchers with your authorization,
which we will attempt to collect in a manner consistent
with applicable state laws.
-
Marketing: We will not
be able to use or disclose your name, contact information
or other PHI for purposes of marketing without your
written authorization. This does not include informing
you about treatment alternatives or other health related
products or services that may be of interest to you.
-
Fundraising: We may use
and/or disclose PHI about you, including disclosure
to a foundation, to contact you to raise money for our
organization. We would only release contact information
and the dates you received treatment or services at
our facility. If you do not want to be contacted in
this way, you must notify in writing our contact person
listed in this Notice.
D. Uses and Disclosures
of Your Protected Health Information that Require Your
Opportunity to Agree or Object.
In the following instances
we will provide you the opportunity to agree or object
to a use or disclosure of your PHI:
-
Facility Directory: Unless
you notify us that you object, we will use your name,
location in the facility, general condition, and religious
affiliation for directory purposes. This information
may be provided to members of the clergy and, except
for religious affiliation to other people who ask for
you by name.
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Notification: We may use
or disclose information to notify or assist in notifying
a family member, personal representative, or another
person responsible for your care, your location, and
general condition.
-
Communication with Family:
Health professionals, using their best judgement, may
disclose to a family member, other relative, close personal
friend or any other person you identify, health information
relevant to that person's involvement in your care or
payment related to your care.
If you would like to object
to our use or disclosure of PHI about you in the above
circumstances, please call our contact person listed on
the cover page of this Notice.
E. Use And Disclosure
Authorized by Law that Do Not Require Your Consent, Authorization
or Opportunity to Agree or Object.
Under certain circumstances
we are authorized to use and disclose your health information
without obtaining a consent or authorization from you
or giving you the opportunity to agree or object. These
include:
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When the use and/or disclosure
is authorized or required by law. For example, when
a disclosure is required by federal, state or local
law or other judicial or administrative proceeding.
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When the use and/or disclosure
is necessary for public health activities. For example,
we may disclose PHI about you if you have been exposed
to a communicable disease or may otherwise be at risk
of contracting or spreading a disease or condition.
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When the disclosure relates
to victims of abuse, neglect or domestic violence.
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When the use and/or disclosure
is for health oversight activities. For example, we
may disclose PHI about you to a state or federal health
oversight agency which is authorized by law to oversee
our operations.
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When the disclosure is
for judicial and administrative proceedings. For example,
we may disclose PHI about you in response to an order
of a court or administrative tribunal.
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When the disclosure is
for law enforcement purposes. For example, we may disclose
PHI about you in order to comply with laws that require
the reporting of certain types of wounds or other physical
injuries.
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When the use and/or disclosure
relates to decedents. For example, we may disclose PHI
about you to a coroner or medical examiner, consistent
with applicable laws, to carry out their duties.
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When the use and/or disclosure
relates to products regulated by the 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.
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When the use and/or disclosure
relates to cadaveric organ, eye or tissue donation purposes.
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.
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When the use and/or disclosure
relates to Worker’s Compensation information:
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.
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When the use and/or disclosure
is to avert a serious threat to health or safety. For
example, we may disclose PHI about you to prevent or
lessen a serious and eminent threat to the health or
safety of a person or the public.
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When the use and/or disclosure
relates to specialized government functions. For example,
we may disclose PHI about you if it relates to military
and veterans’ activities, national security and
intelligence activities, protective services for the
President, and medical suitability or determinations
of the Department of State.
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When the use and/or disclosure
relates to correctional institutions and in other law
enforcement custodial situations. For example, in certain
circumstances, we may disclose PHI about you to a correctional
institution having lawful custody of you.
YOUR INDIVIDUAL RIGHTS
A. Right to Request Restrictions
on Uses and Disclosures of PHI.
You have the right to request
that we restrict the use and disclosure of PHI about you.
We are not required to agree to your requested restrictions.
However, even if we agree to your request, in certain
situations your restrictions may not be followed. These
situations include emergency treatment, disclosures to
the Secretary of the Department of Health and Human Services,
and uses and disclosures described in subsection 4 of
the previous section of this Notice. You may request a
restriction by submitting your request in writing to us.
We will notify you if we are unable to agree to your request.
B. Right to Request
Communications via Alternative Means or to Alternative
Locations.
Periodically, we will contact
you by phone, email, postcard reminders, or other means
to the location identified in our records with appointment
reminders, results of tests or other health information
about you. You have the right to request that we communicate
with you through alternative means or to alternative locations.
For example, you may request that we contact you at your
work address or phone number or by email. While we are
not required to agree with your request, we will make
efforts to accommodate reasonable requests. You must submit
your request in writing.
C. Right to See and
Copy PHI.
You have the right to request
to see and receive a copy of PHI contained in clinical,
billing and other records used to make decisions about
you. Your request must be in writing. We may charge you
related fees. Instead of providing you with a full copy
of the PHI, we may give you a summary or explanation of
the PHI about you, if you agree in advance to the form
and cost of the summary or explanation. There are certain
situations in which we are not required to comply with
your request. Under these circumstances, we will respond
to you in writing, stating why we will not grant your
request and describing any rights you may have to request
a review of our denial.
D. Right to Request
Amendment of PHI.
You have the right to request
that we make amendments to clinical, financial and other
health-related information that we maintain and use to
make decisions about you. Your request must be in writing
and must explain your reason(s) for the amendment and,
when appropriate, provide supporting documentation. We
may deny your request if: 1) the information was not created
by us (unless you prove the creator of the information
is no longer available to amend the record); 2) the information
is not part of the records used to make decisions about
you; 3) we believe the information is correct and complete;
or 4) you would not have the right to see and copy the
record as described in paragraph 3 above. We will tell
you in writing the reasons for the denial and describe
your rights to give us a written statement disagreeing
with the denial. If we accept your request to amend the
information, we will make reasonable efforts to inform
others of the amendment, including persons you name who
have received PHI about you and who need the amendment.
E. Right to Request
and Accounting of Disclosures of PHI.
You have the right to a listing
of certain disclosures we have made of your PHI. You must
request this in writing. You may ask for disclosures made
up to six (6) years before the date of your request (not
including disclosures made prior to April 14, 2003). The
list will include the date of the disclosure, the name
(and address, if available) of the person or organization
receiving the information, a brief description of the
information disclosed, and the purpose of the disclosure.
If, under permitted circumstances, PHI about you has been
disclosed for certain types of research projects, the
list may include different types of information. If you
request a list of disclosures more than once in 12 months,
we can charge you a reasonable fee.
F. Right to Receive
a Copy of This Notice.
You have the right to request
and receive a paper copy of this Notice at any time. We
will provide a copy of this Notice no later than the date
you first receive service from us (except for emergency
services or when the first contact is not in person, and
then we will provide the Notice to you as soon as possible).
We will make this Notice available in electronic form
and post it in our web site.
QUESTIONS OR COMPLAINTS
If you want more information about our privacy practices
or have questions or concerns, please contact our Privacy
Official. If you are concerned that we may have violated
your privacy rights, or you disagree with a decision we
made about access to your health information or in response
to a request you made to amend or restrict the use or
disclosure of your health information or to have us communicate
with you by alternative means or at alternative locations,
you may file a complain with our Privacy Official. You
can also submit a written complaint to the U.S. Department
of Health and Human Services. We will provide you with
the address to file your complaint with the U.S. Department
of Health and Human Services upon request.
We support your right to the
privacy of your health information. We will not retaliate
in any way if you choose to file a complaint with us or
with the U.S. Department of Health and Human Services.
Privacy Office Contact Information
Name: Lisbeth Vest Armstrong
Address: 1909 E. Wayzata Blvd. Wayzata MN 55391
Telephone: 952-277-2444
Fax: 952-473-8629
E-mail: lisbeth@hammer.org
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