Patient Rights

Individual Rights

You have many rights concerning the confidentiality of your medical information. You have the right:

  • to request restrictions on the medical information we may use and disclose for treatment, payment, and health care operations. We are not required to agree to these requests. To request restrictions, please send a written request to the address below.
  • to receive confidential communications of medical information about you in a certain manner or at a certain location. For instance, you may request that we only contact you at work or by mail. To make such a request, you must write to us at the address below and tell us how or where you wish to be contacted.
  • to inspect or copy your medical information. You must submit your request in writing to the address below. If you request a copy of your medical information, we may charge you a fee for the cost of copying, mailing, or other supplies. In certain circumstances, we may deny your request to inspect or copy your medical information. If you are denied access to your medical information, you may request that the denial be reviewed. Another licensed healthcare professional will then 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.
  • to amend your medical information. If you feel the medical information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, you must write to us at the address below. You must also give us a reason to support your request. We may deny your request to amend your medical information if it is not in writing or does not provide a reason to support your request. We may deny your request if:
    • the information was not created by us, unless the person or entity who created the information is no longer available to make the amendment,
    • the information is not part of the medical information kept by or for us,
    • the information is not part of the information you would be permitted to inspect or copy, or
    • the information is accurate and complete.
  • to receive an accounting of disclosures of your medical information. You must submit a request in writing to the address below. Not all medical information is subject to this request. Your request must state a time period, no longer than 6 years and may not include dates before April 14, 2003. Your request must state how you would like to receive this report (paper, electronically). The first list you request within a 12-month period is free. For additional lists, we may charge you the cost of providing the list. We will notify you of this cost and you may choose to withdraw or modify your request before charges are incurred.
  • to receive a paper copy of this Notice upon request, even if you have agreed to receive the Notice electronically. You may obtain a copy of this notice at our website, http://www.madisonlutheranhome.com. To receive a paper copy, you must submit a written request to the address below.

All requests to restrict use of your medical information for treatment, payment, and healthcare operations, to inspect and copy medical information, to amend your medical information, or to receive an accounting of disclosures of medical information must be made in writing to the following address:

Madison Lutheran Home
900 Second Avenue
Madison, MN 56256

Attention: Privacy Officer

Complaints

If you believe that your privacy rights have been violated, a complaint may be made to our Privacy Officer. You may also submit a complaint to the Secretary of the Department of Health and Human Services.

You will not be penalized in any way for filing a complaint.

All complaints should be sent in writing to the following address:

Madison Healthcare Services
900 Second Avenue
Madison, MN 56256

Attention: Privacy Officer

Changes to This Notice

We reserve the right to change our privacy practices and to apply the revised practices to medical information about you that we already have. We will post a copy of the current notice at each of our sites as well as on our website. The notice will list on the first page, in the upper right-hand corner, the effective date. In addition, each time you register at or are admitted to one of our sites for treatment or services, we will offer you a copy of the current notice.