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This notice describes how Medical Information about you maybe used and disclosed and how you can get access to this information. Please review it carefully.

Introduction:

At Falls Memorial Hospital, we are committed to the handling of protected health information about you in a responsible manner. This Notice of Health Information Practices describes the personal information we collect, and how we use or disclose that information. It also describes your rights as they relate to your protected health information. This notice is effective April 14, 2003 and applies to all protected health information. A federal regulation, known as the Health Insurance Portability and Accountability Act “HIPAA” Privacy Rule requires that we provide detailed notice in writing of our privacy practices. We know that this Notice is long. The HIPAA Privacy Rule requires us to address many specific things in this Notice.

If you have questions and would like additional information, you may contact:

Falls Memorial Hospital’s Privacy Officer at 218-283-5412 or HIPAA Coordinator at 218-283-5471.

Falls Memorial Hospital reserves the right to make changes to this Notice and to make changes effective for all protected health information we may already have about you. If and when this Notice is changed, we will post copies in prominent registration locations throughout the facility and at our web site www.fmh-mn.com. We will also provide you with a copy of the revised Notice upon your request made to our Privacy Officer.

Understanding your Health Record Information:

Each time you visit Falls Memorial Hospital, after signing consent to receive treatment or services, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

	Basis for planning your care and treatment
	Means of communication among the many health professionals who contribute to your care
	Legal document describing the care you received
	Means by which you or a third-party payor can verify that services billed were actually provided
	Tool in educating health professionals
	Source of data for medical research
	Source of information for public health officials charged with improving the health of this state or nation
	Source of data for our planning and marketing
	Tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what is in your record and how your health information is used helps you to: ensure its accuracy; better understand who, what, when, where, and why others may access your health information; and for you to make more informed decisions when authorizing disclosure to others.

Your Health Information Rights:

Although your health record is the physical property of Falls Memorial Hospital, the information belongs to you. You have the right to request in writing:

	The opportunity to inspect and obtain a copy your protected health information with the following exceptions: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, a criminal, or an administrative proceeding; and protected health information that is subject to law that prohibits access to review.
	You may have a right to have the decision reviewed. Please contact the Privacy Officer if you have questions.
	To amend your health care information if you disagree with its content. Any discussion for amendment must be addressed to the Privacy Officer or designee.
	To request communications of your health information by alternative means or at alternative locations upon written request to the Privacy Officer.
	To obtain an accounting of disclosures of your health information.
	To request a restriction on certain uses and disclosures of your information.
	To revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Our Responsibilities:

Falls Memorial Hospital is required to:

	Maintain the privacy of your health information;
	Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you;
	Abide by the terms of this notice;
	Notify you if we are unable to agree to a requested restriction; and
	Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue using or disclosing your health information after the date on the authorization or after we have received a written revocation of the authorization according to the procedures included in the authorization.

For More Information or to Report a Problem or complaint:

If you believe your privacy rights have been violated, you can file a complaint with Falls Memorial Hospital’s Privacy Officer or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with the Privacy Officer or the Office for Civil Rights.

Contacts:

Falls Memorial Hospital’s Privacy Officer 218-283-5412; or
HIPAA Coordinator at 218-283-5471.

The Office for Civil Rights address is listed below:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue S.W.
Room 509F HHH Building
Washington, D.C. 20201

Our Commitment To Protecting Health Information About You:

In this Notice, we describe the ways that we may use or disclose health information about our patients. The HIPAA Privacy Rule requires that we protect the privacy of health information that identifies a patient, or where there is a reasonable basis to believe the information can be used to identify a patient. This information is called “protected health information” or “PHI.” This notice describes your rights as our patient and our obligations regarding the use and disclosure of PHI. We are required by law to:

	Maintain the privacy of PHI about you;
	Give you this Notice of our legal duties and privacy practices with respect to PHI; and
	Comply with the terms of our Notice of Privacy Practices that is currently in effect.

How we may use and disclosure protected health information about you:

The following categories describe the different ways we may use and disclose PHI for treatment, payment, or health care operations. The examples included with each category do not list every type of use disclosure that may fall within that category.

TREATMENT:

We may provide your physician or subsequent health care providers with copies of various reports that should assist in them treating you once you are discharged from this hospital.

For example: Information obtained by a nurse, physician, or other members of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health care team. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. We will obtain your written consent prior to making disclosures outside the facility for treatment purposes except in emergency circumstances when it is not possible to get your consent.

PAYMENT:

We may use and disclose medical 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 another third party. For example, we may need to give your health plan information about treatment you received while under our care so your plan will pay us or reimburse you for the treatment. 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. We will get your written consent upon admission for treatment which permits us to make such disclosures for payment purposes.

HEALTH CARE OPERATIONS:

We may use and disclose medical information about you for Falls Memorial Hospital health care operations.

For example: Members of our internal staff such as the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health care 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 health care services we provide. Written consent is obtained prior to disclosing such information to outside facilities.

Appointment Reminders and Other Health Information: We may use your protected health information to send you reminders or call to remind you about scheduled appointments. We may also call you and leave health related information on your voice mail. If you do not wish to have a voice mail message left for you, you have the right to request in writing how we may communicate with you. Examples of alternatives would be by mail, at work or at home.

Business Associates: There are some services provided in our organization through contracts with business associates. Examples include Falls Memorial Hospital’s reviewing agencies such as Joint Commission on the Accreditation of Healthcare Services, clearing houses associated with collections of accounts, and consultants. We may disclose your health information to our business associate(s) so that they can perform the job we have contracted them to do. To protect your health information that is disclosed, each business associate is required to sign an agreement to appropriately safeguard the information and to not re-disclose the information unless specifically permitted by law.

Directory: We may include certain limited information about you in our directory while you are a patient. This information may include your name, location in the facility, and your religious affiliation if you provide this information to us. The directory information, except for your religious affiliation and condition, may be released to people who ask for you by name. This is so your family, friends, and clergy can know your location. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don’t ask for you by name. If you prefer that Falls Memorial Hospital not make these disclosures, please notify the registration clerk at the time of admission for services, or the Privacy Officer.

Notification to People Assisting in Your Care: Falls Memorial Hospital will only disclose medical information to those taking care of you, helping you pay your bills, or other close family members of friends if these people need to know the information to help you, and then only to the extent permitted by law. We may, for example, provide limited medical information to allow a family member to pick up a prescription for you.

Generally, we will get your written consent prior to making disclosures about you to family or friends. If you are able to make your own health care decisions, Falls Memorial Hospital will ask your permission before using your medical information for these purposes. If you are unable to make health care decisions, Falls Memorial will disclose relevant medical information to family members or other responsible people if we feel it is in your best interests to do so, including an emergency situation.

Research: Falls Memorial Hospital does not do research. However, Federal law permits Falls Memorial Hospital to use and disclose medical information about you for research purposes, either with your specific written authorization or when the study has been reviewed for privacy protection by an Institutional Review Board or Privacy Board before research begins. In some cases, researchers may be permitted to use information in a limited way to determine whether the study or the potential participants are appropriate. Minnesota law requires that we get your general consent before we disclose your health information to an outside researcher. We will make a good faith effort to obtain your consent or refusal to participate in any research study, as required by law, prior to releasing any identifiable information about you to outside researchers.

As Required by Law: We will disclose medical information about you when we are required to do so by federal, state, or local laws.

To Avert a Serious Threat or Health Safety: We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure must be only to someone able to prevent that threat. In addition, Minnesota law generally does not permit these disclosures unless we have your written consent to do so or when the disclosure is specifically required by law, including the limited circumstances in which Falls Memorial Hospital care professionals have a “ duty to warn. ”

Your Medical Information may be released in the following special situations:

Coroners, Medical Examiners and Funeral Directors: We will release medical information to a coroner or medical examiner in the case of certain types of death, and we must disclose health records upon request of the coroner or medical examiner. This may be necessary, for example, to identify you or to determine the cause of death. We may also release the fact of death and certain demographic information about you to funeral directors as necessary to carry out their duties. Other disclosures from your health record will require the consent of the surviving spouse, parent, or a person appointed by you in writing, or your legally authorized representative.

Military and Veterans: If you are a member of the armed forces, we will release medical information about you as requested by military command authorities if we are required to do so by law, or when we have your written consent. We may also release medical information about foreign military personnel to the appropriate foreign military authority as required by law or written consent.

National Security and Intelligence Activities: We will release medical information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities only as required by law or with your written consent.

Protective Services for the President and Others: We will disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state, or conduct special investigations only as required by law or with your written consent.

Organ Procurement Organizations: We may release your medical information to organizations that handle organ procurement or organ, eye or tissue transplantation, or to an organ donation bank, as necessary to facilitate organ or a tissue donation and transplantation. The information that Falls Memorial Hospital may disclose is limited to the information necessary to make a transplant possible.

Fundraising: Occasionally, Falls Memorial Hospital may use limited information (your name address, and the dates you were seen for medical services) to let you know about fundraising or other charitable events.

Marketing: Falls Memorial Hospital will not participate in marketing efforts in any way without first consulting with you or obtaining your written consent.

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 pos- marketing surveillance information to enable product recalls, repairs, or replacement.

Workers Compensation: We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses. We are permitted to disclose this information to the parties involved in the claim without any specific consent, so long as the information is related to a workers’ compensation claim.

Public Health: We may disclose medical information to public health authorities about you for public health activities. These disclosures generally include the following:

	Preventing or controlling disease, injury, or disability;
	Reporting births or deaths;
	Reporting child abuse or neglect or abuse of a vulnerable adult;
	Reporting reactions to medications or problems with products;
	Notifying people of recalls of products that we may be using;
	Notifying a person who may have been exposed to a disease or may be at the risk for contracting or spreading a disease or condition; or
	Reporting to the Federal Food and Drug Administration as permitted or required by law.

Correctional Institution/Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we will release medical information about you to the correctional institution or law enforcement official only as required by law or with your written consent.

Law Enforcement: We may release medical information if asked to do so by a law enforcement official in response to a valid court order, grand jury subpoena, or warrant, or with your written consent. In addition, we are required to report certain types of wounds, such as gun shot wounds and some burns. In most cases reports will include only the fact of injury, and any disclosures would require your consent or a court order. We may also release information to law enforcement that is not part of your health record (in other words, non-medical information) for the following reasons:

	To identify or locate a suspect, fugitive, material witness, or missing person.
	If you are the victim of a crime and if, under certain limited circumstances, we are unable to obtain your agreement.
	The information relates to a death we believe may be the result of a criminal conduct.
	The information relates to criminal conduct at our facility.
	In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime.

Lawsuits and Disputes: If you are involved in a lawsuit, dispute, or other judicial proceedings, we will disclose medical information about you only in response to a valid court order, administrative order, or a grand jury subpoena, or with your written consent.

Thank you for choosing Falls Memorial Hospital for your health care services.


References:

Federal Register, 45 CFR Parts 160 and 164 - Standards for Privacy and Individually Identifiable Health Information; Original and Final Rule

MN Statute 144.335

Field Guide to HIPAA Implementation
American Medical Association – 2002

Fredrick & Byron, P.A.
HIPPA Forms and Explanation