Notice of Privacy Practices
Our Duty to Safeguard Your Protected Health Information
Individually identifiable information about your past, present, or future health or condition, the provision of health care to you, or payment for health care is considered “Protected Health Information” (PHI). We are required to extend certain protections to your PHI, and to give you this notice about our privacy practices that explains how, when, and why we may use or disclose your PHI.
Except in specific circumstances, we must use or disclose only the minimum necessary PHI to accomplish the intended purpose of the use or disclosure. We are required to follow the privacy practices described in the notice. We reserve the right to change our privacy practices and the terms of this notice at any time. We are required to provide you with a new notice upon your request. Requests should be made to the Privacy Officer by calling (507) 304-7020.
How We May Use and Disclose Your Protected Health Information
We use and disclose PHI for a variety of reasons. We have a limited right to use and/or disclose your PHI for purposes of treatment, payment and for our health care operations. For use beyond that, we must have your written authorization unless the law permits or requires us to make the use or disclosure without your authorization. If we disclose your PHI to an outside entity for that entity to perform a function on our behalf, we must have in place an agreement from the outside entity that it will extend the same degree of privacy protection to your information that we must apply to your PHI. However, the law provides that we are permitted to make uses/disclosures without your consent or authorization. The following describes and offers examples of potential uses/disclosures of your PHI.
Uses and Disclosures Relating to Treatment, Payment, Or Health Care Operations
Generally, we may use or disclose your PHI as follows:
For Treatment: We may use and disclose your health information to provide, coordinate and manage your services. Information about you may be shared with Surdy Family Services staff, students, or volunteers. For example, a staff person may need to speak with his or her supervisor about the services that you are receiving. Your PHI may also be shared with other health care providers involved in the provision and/or coordination of your care.
To Obtain Payment: We may use and disclose your PHI, as needed and allowed by law, to obtain payment for the services provided to you. For example, a bill for services, sent to you or to a third-party payer such as Medicaid, Insurance Companies, or County Human Services, might include identifying information about you such as your name, your diagnosis and services received.
For Health Care Operations: We may use or disclose your PHI to support and improve the activities of Surdy Family Services. For example, staff may use information in your clinical record for the purpose of staff training or to evaluate the services that you received.
Uses and Disclosures of Protected Health Information Requiring Authorization
For uses and disclosures beyond treatment, payment, and operations, we are required to have your written authorization, unless the use or disclosure falls within one of the exceptions listed below. Authorizations can be revoked at any time to stop future uses/disclosures, except to the extent that we have already undertaken the action in reliance upon your authorization.
Uses and Disclosures of PHI from Mental Health and Other Therapy Records Not Requiring Consent and Authorization
The law provides than we may use/disclose your PHI from your records without consent or authorization in the following circumstances:
When Required by Law: We may disclose PHI when a law requires that we report information about suspected abuse, neglect or domestic violence, relating to suspected criminal activity, or in response to a court order. We must also disclose PHI to authorities that monitor compliance with these privacy requirements.
For Public Health Activities: We may disclose PHI when we are required to collect information about disease or injury, or to report vital statistics to public health authorities.
For Health Oversight Activities: We may disclose PHI to agencies responsible for monitoring the health care system for such purposes as reporting or investigation of unusual incidents and monitoring of the Medicaid program.
Relating to Decedents: We may disclose PHI related to a death to coroners, medical examiners, or funeral directors, and to organ procurement organizations.
For Research Audit and Evaluation Purposes: In certain circumstances, we may disclose PHI to research staff and their designees in order to assist mental health research and program evaluation.
To Avert Threat to Health and Safety: In order to avoid a serious threat to health and safety, we may disclose PHI as necessary to law enforcement or other persons who can reasonably prevent or lessen the harm or threat.
Your Rights Regarding Your Protected Health Information
You have the following rights relating to your protected health information:
To Request Restrictions on Uses/Disclosures: You have the right to ask that we limit how we use or disclose your PHI. We will consider your request but are not legally bound to agree to the restriction. To the extent that we do agree to any restriction on our use/disclosure of your PHI, we will abide by it except for emergency situations. We cannot agree to limit uses/disclosures that are required by law.
To Choose How We Contact You: You have the right to request that we communicate with you in certain way, or at a certain location, such as contacting you at home rather than work. We will abide by your request where it is reasonable for us to do so.
To Inspect and Request A Copy of Your PHI: You have the right to see your PHI upon written request. We will respond to your request within 30 days. If we deny your access, we will give you written reasons for the denial and explain any right to have the denial reviewed. If you want copies of your PHI, a charge for copying may be imposed.
To Request an Amendment of Your PHI: If you believe there is a mistake or missing information in our record of your PHI, you may request in writing that we correct or add to the record. We will respond within 60 days of receiving your request. We may deny the request if we determine that the PHI is: (1) correct and complete; (2) not created by us and/or not part of our record; (3) not permitted to be disclosed. Any denial will state the reasons for denial, and explain you rights to have the request and denial, along with any statement that you provide, appended to your PHI. If we agree with your request, we will change the PHI and inform you.
To Find Out What Disclosures Have Been Made: You have the right to request a list of when, to whom, for what purpose, and what content of your PHI has been released other than instances of disclosure: for treatment, payment, and operations; or to you and your family. This list will not include any disclosures made that do not require your consent or authorization, as provided by law, or disclosures made before April 14th, 2003. We will respond to your request within 60 days of receiving it. Your request can relate to disclosures going as far back as six years.
You Have the Right to Receive This Notice
You have the right to receive a paper copy of this notice.
This document describes how mental health and other therapy information about you may be used and disclosed and how you can get access to this information.
Please read it carefully.
How to Complain About Our Privacy Practices
If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the Privacy Officer at (507) 304-7020. You may also file a complaint with the Minnesota Department of Health (651) 282-6314
Contact Person for Information or To Submit A Complaint
If you have any questions about this notice or any complaints about our privacy practices, please contact our Privacy Officer at Surdy Family Services at (507) 304-7020
How to Complain About Our Privacy Practices
If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the Privacy Officer at (507) 304-7020. You may also file a complaint with the Minnesota Department of Health (651) 282-6314
Contact Person for Information or To Submit A Complaint
If you have any questions about this notice or any complaints about our privacy practices, please contact our Privacy Officer at Surdy Family Services at (507) 304-7020