Privacy Statement

NOTICE OF PRIVACY PRACTICES

Effective Date: January 20th, 2017

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.

Madison Healthcare Services can change the terms of this notice, and the changes will apply to all information we have about you.  The new notice will be available upon request at our facilities and on our web site.

This notice of privacy practices applies to the following entities of the Madison Healthcare Services organization:

  • Madison Hospital
  • Lac qui Parle Clinic
  • Madison Lutheran Home
  • Hilltop Residence

If you have any questions, comments, concerns or complaints about this notice of privacy practices and the privacy of your health information, please contact the Information Privacy Officer at:

Madison Healthcare Services
900 2nd Avenue
Madison, MN 56256
320-598-7551

Your Rights

When it comes to your health information, you have certain rights.

This section explains your rights and some of our responsibilities to help you.

Copy of Medical Record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.
  • We will provide a copy or a summary of your health information within a reasonable time, usually within thirty days of your request.
  • We can deny your request to access your medical record or parts of your medical record under certain circumstances. You can be entitled to a review of that denial.
  • If you ask to see or receive a copy of your record for purposes of reviewing current medical care, we cannot charge you a fee.
  • If you request copies of your patient records of past medical care, or for certain appeals, we can charge you a fee.

Request to Amend Medical Record

  • You can ask us, in writing, to correct health information about you that you believe is incorrect or incomplete.
  • We can deny your request, but we will tell you why in writing within sixty days.
  • If we deny your request, you may submit a statement disagreeing with our denial, or you may direct that your request for amendment and our denial be included with any future disclosures of the information you requested to amend.
  • If you submit a statement of disagreement, we may prepare and provide you with a copy of a written statement of rebuttal. Your statement of disagreement and our rebuttal will be included in subsequent disclosures of the information.

Request Confidential Communications

  • You can ask us to contact you in a specific way (for example, by calling an office phone instead of home phone or sending mail to a P.O. Box instead of a home address).
  • We will accommodate all reasonable requests.

Request to Limit Use or Sharing of Health Information

  • You can ask us not to use or share certain health information for treatment, payment, or our operations.
  • We can deny your request if it would affect your care.
  • If you pay for a service or healthcare item out-of-pocket in full, you can ask us not to share that information for the purpose of payments or operations with your health insurer.
  • We will agree with your request unless a law requires us to share that information.

Request to Receive a List of Disclosures

  • You can ask for a list of disclosures of your protected health information for six years prior to the date you ask.
  • The list of disclosures will not include disclosures for:

o   Treatment, payment, and health care operations;

o   To you or others authorized by you;

o   To correctional institutions or law enforcement officials; and

o   For certain other purposes which the law does not require us to provide an accounting.

  • If you request a list of disclosures more than once in a twelve month period, we can charge you a fee.

Request a Copy of this Notice of Privacy Practices

  • You can ask for a paper copy of this notice of privacy practices at any time, even if you agreed to receive the notice electronically. We will provide you with a paper copy promptly.
  • You can view and print a copy of this notice of privacy practices from our website, www.mhsmn.org.

File a Complaint

  • You can file a complaint if you feel we have violated your rights by contacting us or sending us a letter to:

Attn: Information Privacy Officer
Madison Healthcare Services
900 2nd Avenue
Madison, MN 56265

  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil rights by calling 1-877-696-6775, visiting their website at www.hhs.gov/ocr/privacy/hipaa/complaints/, or by sending a letter to:

U.S. Department of Health and Human Services Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201

  • We will not retaliate against you for filing a complaint.

Your Choices

When it comes to your health information, you have certain choices.

This section explains your choices and how they affect your health information.

Choose Who We Share With

  • You can choose not to share information with your family, close friends, or others involved in your care.
  • You can choose not to share information in a disaster relief situation.
  • You can choose not to share your information in a patient directory.
  • You can choose not to have us share your information with the media.
  • If you are not able to tell us your preference, for example, if you are unconscious, we can share your information if we believe it is in your best interest. We can also share your information when needed to lessen a serious and imminent threat to health and safety.

Choose Someone to Act for You

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

Choose to Allow Us to Share

  • We will not share your information unless you give us written permission in the following cases:

o   Marketing purposes;

o   Sale of your information; or

o   Most sharing of psychotherapy notes.

Fundraising

  • We can contact you for fundraising efforts; however, you have the choice to tell us not to contact you again.

Revoke Authorization

  • If you give us authorization to share your health information, you can revoke that authorization at any time by submitting a written revocation to:

Attn: Information Privacy Officer
Madison Healthcare Services
900 2nd Avenue
Madison, MN 56256

  • We will be unable to take back any disclosures we have already made with your authorization.

Our Uses and Disclosures

This section describes how we typically use and share your information.

Your Consent Needed

  • We need your consent before we disclose protected health information to professionals outside of our network for treatment, payment, and operations purposes, unless the disclosure is to a related entity, or the disclosure is for a medical emergency and we are unable to obtain your consent due to your condition or the nature of the medical emergency.

Treatment

  • We can use your health information and share it with other professionals within our network to ensure you get the best possible treatment.
  • We can share your health information with other professionals outside of our network only with your consent, unless it is an emergency and you are unable to give consent due to the nature of the emergency.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Organization Operations

  • We can use and share your health information to run our healthcare organization, improve your care, and contact you when necessary. We are required to obtain your consent before we release your health records to other providers for their own health care operations.

Example: We use health information about you to manage your treatment and services.

Bill for Your Services

  • We can use and share your health information to bill and get payment from health plans or other entities only if we obtain your consent.

Example: We give information about you to your health insurance plan so they will pay for your services.

Involvement in the Patient’s Care

  • We can disclose your health information to your family, relative, friends or any other person identified by you who may be involved in your care or payment for such care.

o   You may choose not to tell us not to share your information with anyone you choose.

Appointment Reminders

  • We can use your health information to set up or remind you about future appointments.

Treatment Alternatives

  • We can use and share your health information to provide information about treatment and health-related benefits or services that may be of interest to you.

Record Locator Services/Health Information Exchange

  • We can use and share your information to help enable record locator services or health information exchanges to locate services you received at our facility if you do not object.

Clergy Members

  • We can share your information with a clergy member.

Public Health and Safety

  • We can share health information about you for certain situations such as:

o   Preventing disease;

o   Helping with product recalls;

o   Reporting adverse reactions to medications;

o   Reporting suspected abuse, neglect, or domestic violence; or

o   Preventing or reducing a serious threat to anyone’s health or safety.

Research

  • We can use or share your information for health research if you do not object.

Comply with the Law

  • We will share information about you if local, state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with the federal privacy law.

Law Enforcement

  • We can use or share your health information for law enforcement purposes permitted or required by law such as responding to requests from administrative agencies, help locate missing persons, reporting criminal activity or providing information about victims of crimes.

Organ, Eye and Tissue Donation

  • We can share health information about you with organ procurement organizations for the purpose of facilitating organ, eye or tissue donation and transplantation with your consent or the consent of you being an organ donor.

Inmate at Correctional Institution

  • If you are an inmate at a correctional institution, we may use or disclose your health information to provide health care to you or to protect your health and safety or that of others or the security of the correctional institution.

Medical Examiner, Coroner, Funeral Director

  • We can share information with a coroner and medical examiner to help identify a deceased person, determine a cause of death, or as authorized by law.
  • We need consent to share information with a funeral director.

Business Associates

  • We can use or share health information about you with business associates that perform functions on our behalf or provide us with services. Our business associates are required to enter into contracts with us that require them to protect the privacy of your health information and prohibit them for using your health information for any purpose other than that specified in our contract with them.

Workers’ Compensation

  • We can use or share health information about you for workers’ compensation claims.

Government Functions

  • We can use or share health information about you with health oversight agencies for activities authorized by law such as licensure, governmental audits and fraud and abuse investigations.
  • We can use or share health information about you for special government functions such as military, national security, intelligence activity, and protective services for the president and others with your consent, unless required by law.

Respond to Legal Actions

  • We can share health information about you in response to a court or administrative order, a subpoena, a discovery request or other lawful processes.

Patient Directories

  • We can share certain health information about you in a public patient directory such as:

o   Your name;

o   Location within the facility; and

o   General condition;

  • We can share your patient directory information with those who ask for your information by name.
  • We can share your religious affiliation to clergy members only.
  • You may choose not to share your information in a patient directory.

Media Relations

  • We can share health information contained in the patient directories with media, except religious affiliation.

Fundraising Activities

  • We may use your health information to contact you for fundraising efforts if you do not object.

Incidental Disclosure

  • We take precautions to minimize the possibility health information being incidentally disclosed to unauthorized individuals, such as overheard conversations or unintentional chart observation. However, we recognize because of the nature of our environment this incidental disclosure may happen.

Our Responsibilities

This section explains our responsibilities to you as it relates to the privacy of your health information.

Maintain Privacy and Security

  • We are required by law to maintain the privacy and security of your protected health information.

Inform of Breach

  • We will let you know promptly if a breach occurs that can have compromised the privacy and security of your information.

Follow Notice of Privacy Practices

  • We must follow the duties and privacy practices described in this notice of privacy practices.
  • We will not use or share your health information other than as described here unless you tell us we can. If you tell us we can, you can change your mind at any time. Let us know in writing if you change your mind.