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.
You have privacy rights under the Minnesota Government Data Practices Act and the federal Health Insurance Portability and Accountability Act (HIPAA). These laws protect your privacy but also let us give information about you to others if the law requires it. We may tell you before we give the information. These laws require us to keep you health information private and to give you notice of our legal duties and practices to protect private information.
Meaning of "you," "we," and "us."
In this notice, when we say "we" or "us", we mean the staff of Access North Center for Independent Living of Northeastern Minnesota. When we say "you," "your", or "yours," we mean you as an individual and members of your family or household who live with you.
Understanding Your Personal Health Information.
Personal health information is any information created and used by Access North, or received from a health care provider, about your health care. Information may include your name, address, birth date, phone number, social security number, Medicare number, health insurance policies, health information, your diagnoses, and the medical treatments you received.
Access North's Confidentiality Commitment.
Access North is committed to protecting your privacy. Any personal health information about you that is generated by Access North or received from health care providers will be kept confidential to the full extent required by the law. You may ask us not to share certain personal health information. We will say "yes" unless a law requires us to share that information. The law requires us to maintain the privacy of protected health information, to provide you with this notice, and to abide by what this notice says. We may change what this notice says, but will provide you with information about any changes made if you are then receiving services from Access North or upon your request.
How Information is Used By Access North.
Except as explained in this notice, we will disclose and use your personal health information only with your written authorization. We may use your personal health information for treatment, payment and health care operations without your written authorization (except if you are being treated for alcohol or drug abuse). "Treatment information" is information you give to us or a health care provider gives to us that will be used to determine the course of treatment and to document treatment you have received or will receive. "Payment information" includes a bill for services sent to you or to a health insurance company or Medicare and a bill for services from a health care provider, and may include information that identifies you, your diagnosis or other necessary information for accurate payment. "Health care operations information" includes information used to assess the care and outcomes in your case and other cases and to assure the quality and effectiveness of healthcare services. We may also use or disclose your personal health information to:
- Keep you informed about appointments, program information, and benefits and services that may be of interest to you;
- Notify another person responsible for your care if necessary;
- Communicate with any person you identify about that person's involvement in your care or payment for your care;
- Business associates that perform functions on behalf of Access North.
- Other agencies as required for oversight activities such as licensure, inspections, investigations, audits, or facility accreditation;
- Law enforcement personnel for specific purposes, including reporting any suspected child abuse or neglect;
- Staff or research projects that ensure the continued privacy and protection of protected health information;
- Public health agencies to prevent or control disease and for statistical reporting, to the Food and Drug Administration for reporting reactions to medications, to Workplace Safety and Insurance (formerly known as Workers Compensation) for benefit coordination, to government agencies in cases of national security or for military purposes, or to correctional institutions;
- Respond to a court order, or subpoena if efforts have been made to tell you about the request or to obtain an order protecting the information requested; and
- Share with our business partners who perform case management, coordination of care, other assessment activities, or payment activities, and who must abide by the same confidentiality requirements.
Your Health Information Rights.
You have the following rights regarding your personal health information maintained by Access North:
- You may request restriction on certain uses and disclosure of your information. We may not be able to agree to the requested restriction, but if approved, we will abide by it except in an emergency treatment situation or as required by law.
- If you feel that some information Access North has created about you is wrong, you may ask to change that information. In certain situations, we may deny your request. We will notify you if we deny your request and tell you how to request a review of the denial.
- You may inspect and obtain a copy of your personal health information in our possession. We may limit or deny you access in very limited circumstances. You have the right to request a review of most denials. We will notify you if we deny your request and tell you how to request a review of the denial. We may charge a fee for copies you request for personal use.
- You may obtain a paper copy of this notice upon request.
- You may revoke a signed authorization for the use or disclosure of your protected health information except to the extent we have already acted based on your authorization.
- If you request, we will account for disclosures we have made of your protected health information made by us beginning in April 2003, except for disclosures to you, under an authorization, for treatment, payment, or health operations purposes, and a few other situations. We will not charge for the first accounting given to you in a twelve-month period. We will charge a fee for an additional accounting requested in that twelve-month period.
- You may request that we contact you about personal health care matters only in a certain way (phone, e-mail, in writing) and at a certain location (home, office, at an address you have given).
For More Information or to Report a Problem.
If you have questions and would like additional information, you may contact the Executive Director toll-free at 1-800-390-3681, Access North Center for Independent Living of Northeastern Minnesota, 1309 East 40th Street, Hibbing, MN 55746. If you believe that your privacy rights have been violated, you may file a complaint with the Access North office where you received services.
You may also file a complaint with a Privacy Official by calling or writing to: Minnesota Department of Human Services, 444 Lafayette Rd N., St. Paul, MN 55155-3813 or call 651-296-5764 or with the Secretary of Health and Human services by calling or writing to: 200 Independence Ave SE, Washington, DC 20201 or call 1-877-696-6775.
There will be no retaliation against you for filing a complaint.
Access North Center for Independent Living of Northeastern Minnesota, Inc.
1309 E. 40th Street
Hibbing MN 55746
toll free (800) 390-3681
(218) 262-6677 FAX