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DIAMOND WOMEN'S CENTER
NOTICE OF PRIVACY PRACTICES
Effective date of this notice: October 21, 2004
OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your individually identifiable health information. In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your individually identifiable health information ("Health Information").
THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW TO GAIN ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION
Described as follows are ways we may use and disclose health information ("Health Information") that identifies you. Except for the following purposes we will use and disclose Health Information only with your written permission. You may revoke such permission at any time by writing to our practice's privacy officer.
Treatment - Our practice may use protected health care information to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests) and we may use the results to help us reach a diagnosis for you. We might use your protected Health Information to write a prescription for you. Many of the people who work for our practice - including but not limited to: our doctors and nurse practitioners - may use or disclose your Health Information in order to treat you or to assist others in your treatment.
Payment - Our practice may use and disclose your protected Health Information in order to bill and collect payment for the services and items you receive from us. For example, we may contact your health insurance provider to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurance carrier with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We may also use and disclose your Health Information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your Health Information to bill you directly for services or items.
Health Care Operations - Our practice may use and disclose your protected Health Information for health care operation purposes. These uses and disclosures are necessary to make sure that all of our patients receive quality care and to operate and manage our office. For example our practice may use and disclose this information to evaluate the quality of care you received from us. We also may share information with other health care providers that have a relationship with us (for example your health plan) for their health care operation activities.
Appointment Reminders, Treatment Alternatives, and Health Related Benefits and Services - We may use and disclose Health Information to contact you and to remind you that you have an appointment with us. We also may use and disclose Health Information to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.
Individuals Involved in Your Care or Payment of Care - When deemed appropriate by your health care provider, we may share Health Information with a person who is involved in your care or payment of care, such as your family or close friend. We also may notify your family about your location or general condition or disclose such information to an entity in assisting in a disaster or relief effort.
SPECIAL SITUATIONS
As Required By Law - We will disclose Health Information when required to do so by international, federal, state, or local law.
To Avert a Serious Threat to Health or Safety - Our practice may use and disclose Health Information when necessary to reduce or prevent a serious threat to your health or safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to prevent the threat.
Public Health Risks - Our practice may disclose Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury, or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; inform a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition; and report to the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities - Our practice may disclose Health Information by a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes - If you are involved in a lawsuit or a dispute, our practice may disclose Health Information in response to a court or an administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement - Our practice may release Health Information if asked by a law enforcement official if the information is (1) in response to a court order, subpoena, warrant, summons, or similar process (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the person's agreement; (4) concerning a death we believe has resulted from criminal conduct; (5) about criminal conduct on our premises (6) in an emergency to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime.
National Security - Our practice may release Health Information to authorized federal officials for intelligence, counterintelligence or other national security activities as authorized by law. We may also disclosure your Health Information in order to protect the president, other officials or foreign heads of state, or to conduct special investigations.
Military - Our practice may disclose your Health Information if you are a member of the U.S. or foreign military forces (including veterans) as required by military command authorities.
Inmates or Individuals in Custody - If you are an inmate of a correctional institution or under the custody of a law enforcement official, our practice may disclose Health Information to the correctional institution or law enforcement official. This release would be made if necessary (1) for the institution to provide you with health care (2) to protect your health and safety or the health and safety of others (3) for the safety and security of the correctional institution.
Workers' Compensation - Our practice may release Health Information for workers' compensation or similar programs. These programs provide benefits or work-related injuries or illness.
Our practice will obtain a written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your protected health information may be revoked at any time in writing. Please note we are required to maintain records of your care.
YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION
You have the following rights regarding Health Information we maintain about you. All correspondence should be addressed to:
Privacy Officer
6545 France Avenue South
Suite 540
Edina, MN 55435
If you have questions regarding this notice or our health information privacy policies, please contact:
Privacy Officer, at 952-927-4045.
Right To Request Confidential Communications - You have the right to request that our practice communicate with you about your health or related issues in a certain way or at a certain location. For example, you might ask that we contact you at home rather than work. To request confidential communications, you must make your request, in writing to our Privacy Officer. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests. You do not have to give a reason for your request.
Right to Request Restrictions - You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the Health Information we disclose to someone involved in your care or the payment of your care, like a family member or friend. For example, you could ask that we do not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request in writing to our Privacy Officer. We are not required to agree to your request. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
Right to Inspect and Copy - You have a right to inspect and copy Health Information that may be used to make decisions about your care or payment for your care including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing in order to inspect and/or obtain a copy of your Health Information to our Privacy Officer. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a reviewal of that denial. Another licensed health care professional chosen by us will conduct reviews.
Right to Amend - If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our office. To request an amendment, your request must be made in writing to our Privacy Officer. You must provide us with a reason that supports your request for amendment. Our practice may deny your request in certain circumstances as provided by the regulation.
Right to an Accounting of Disclosures - You have the right to request a list of certain disclosures we made of Health Information for purposes other than treatment, payment and health care operations or for which you provided written authorization. This accounting of disclosures may not include dates before October 21, 2004, and may not be longer than six years from the date of the disclosure. You must make your request in writing to our Privacy Officer to obtain the list of disclosures.
Right to obtain a paper copy of This Notice - You have a right to receive a paper copy of our Notice of Privacy Practices from Diamond Women's Center upon request. This right extends to an Individual who has agreed to receive the Notice electronically. To obtain a paper copy of this notice please contact our office at (952) 927-4045.
Right to File a Complaint - Individuals may complain to Diamond Women's Center and to the Secretary of the Department of Health and Human Services, without fear of retaliation by the organization, if they believe their privacy rights have been violated. To file a complaint with our practice, contact:
Privacy Officer
Diamond Women's Center
6545 France Avenue South
Suite 540
Edina, MN 55435
All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Diamond Women's Center is required to abide by the terms of this Notice currently in effect. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created and maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times. You may request a copy of our most current Notice at any time.
Diamond Women's Center ©2004
Page revised on October 21, 2004.
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