The Good Shepherd Community
Notice of Privacy Practices
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 Good Shepherd Community HIPAA Contact Department (Social Services)
OUR PLEDGE REGARDING YOUR HEALTH INFORMATION.
Your health information is personal. We are committed to protecting the health information we have about you.
We create written and computer records of the care and services you receive from us. We need these records to provide you with quality care and to comply with certain legal requirements.
This notice applies to all records of your care we have or other health information about you, whether maintained by our staff or by your personal doctor while providing services to you in our facilities. Your personal doctor may have different policies or notices regarding use and disclosure of your health information created in the doctor's office or clinic.
This notice tells you about the ways we may use and disclose your health information. We also describe your rights and certain obligations we have regarding the use and disclosure of your health information.
We are required by law to:
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU.
We use and disclose your health information in many ways for many purposes related to your care. The law may require us to obtain your consent or authorization for some of the uses and disclosures we will describe. We will ask you or your representative to sign a consent or authorization when necessary.
There are three primary reasons we regularly use and disclose your health information:
For Your Treatment.
We use health information to provide you with health treatment or services. We disclose health information about you to our staff when they take care of you. For example, if our nurses are caring for your broken leg, they may need to know if you have diabetes because diabetes may slow the healing process. In addition, your doctor may need to tell our dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments also may share health information about you in order to coordinate the different services you need, such as physical and occupational therapy or social services.
To Receive Payment for our Services.
We will use and disclose health information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company or some other third party. For example, we may need to give your health plan information about care you received so your health plan will pay us or reimburse you for that care. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
For Our Health Care Operations.
We use and disclose health information to assist in our health care operations, so that all of our residents and clients receive quality care. For example, we may use health information about you and others to review our treatment and services, to evaluate the performance of our staff, and to make improvements in services and programs.
There are a variety of other ways we may use and disclose your health information. Among them are:
The facility will disclose your name, location in the facility, your general condition (e.g., fair, stable, etc.) and your religious affiliation (only to clergy).
There are also some other special situations that don’t occur very often, but that we want you to know about:
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU.
You have the following rights regarding health information we maintain about you:
You may access, review, and copy health information that may be used to make decisions about your care. Usually, this includes health and billing records, but it does not include psychotherapy notes.
To access, review and copy health information that may be used to make decisions about you, submit your request to the facility Health Information Manager. If you request a copy of the information to review your current health care, we will provide that without cost. For other requests, we may charge a fee, as allowed by state law, for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If we deny you access to health information, we will provide it to an appropriate third party or to another provider, and that other provider or third party may release the information.
If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You may request an amendment for as long as the information is kept by or for us.
You may make your request in writing to the facility Health Information Manager. In addition, please provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
You may request a list of the disclosures we made of your health information. Not all disclosures are subject to this accounting right.
To request this list or accounting of disclosures, submit your request in writing to the facility Health Information Manager. 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 list (for example, on paper, electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. 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.
You may request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You may also request a limit on the health information we disclose about you to someone who is involved in your care or the 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 required to agree to your requested restriction if the information is to be released to persons outside our programs, unless you are being transferred to another health care facility, if the release is required by law, for third party payment purposes, or to provide you with emergency care. However, in some circumstances, we are not required to agree to your request, because we may not be able to provide you with quality care if the restrictions were upheld. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions, make your request in writing to the facility Health Information Manager. In your request, tell us (1) what information you want to limit; (2) whether 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.
You may request that we communicate with you about health matters 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, make your request in writing to the facility Health Information Manager. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
You may ask for additional copies of this Notice at any time. Even if you have agreed to receive this Notice electronically, you may still have additional paper copies of this Notice. You may also obtain a copy of this Notice at our website: (www.shepherdnet.org). To obtain additional copies of this Notice, please ask any nursing supervisor, social services personnel or the program director.
CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time as our policies and procedures change. Any changes we make may be effective for health information we already have about you as well as any information we receive in the future. We will provide a copy of our most current notice, if requested, and we will keep a copy of our most current notice posted in each of our facilities. If we change the notice while you are still our resident or client, we will give you a copy of the revised notice. Every notice will contain its effective date on the first page, in the lower right-hand corner.
If you believe your privacy rights have been violated, you may file a complaint with the facility or with the Office for Civil Rights of the United States Department of Health and Human Services.
To file a complaint with the facility, contact the HIPAA Contact Department (Social Services) at:
HIPAA Contact Department (Social Services)
The Good Shepherd Community
1115 4th Ave N
Sauk Rapids, MN 56379
To file a complaint with the Office for Civil Rights, contact:
Region V, Office for Civil Rights
U.S.Department of Health and Human Services
233 N. Michigan Ave., Suite 240
Voice phone: (312) 886-2359
FAX: (312) 886-1807
TDD: (312) 353-5693
If sent by email, the complaint should go to: OCRComplaint@hhs.gov.
All complaints must be submitted in writing.
You will not be penalized for filing a complaint.