THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice, please contact Privacy Officer at address below.
Who Will Follow This Notice
This notice describes Samaritan Bethany Inc.’s practices and that of:
- Any health care professional authorized to enter information into your facility chart.
- All departments and units of the facility.
- Any member of a volunteer group we allow to help you while you are in the facility.
- All employees, staff and other facility personnel.
Our Pledge Regarding Health Information
We understand that health information about you and your health is personal. We are committed to protecting health information about you. We create a record of the care and services you receive at the facility. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the facility, whether made by facility personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your health information created in the doctor’s office or clinic.
This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information. This revised notice is effective as of 2013.
We are required by law to:
- make sure that health information that identifies you is
- give you this notice of our legal duties and privacy
notices with respect to health information about you;
- follow the terms of the notice that is currently in effect.
How We May Use and Disclose Health Information About You
The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
We may use health information about you to provide you with medical treatment or services. We may disclosure health information about you to doctors, nurses, technicians, medical students, or other facility personnel who are involved in taking care of you at the facility. 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, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of the facility also may share health information about residents in order to coordinate the different services you need, such as physical and occupational therapy or social services. We also may disclose health information about you to people outside the facility who may be involved in your medical care after you leave the facility, such as family members, clergy or others we use to provide services that are part of your care.
We may use and disclose health information about you so that the treatment and services you receive at the facility may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about care you received at the facility 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.
Health Care Operations
We may use and disclose health information about you for facility operations. These uses and disclosures are necessary to run the facility and make sure that all of our residents receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. Minimal necessary health information may be shared with your volunteers or medical escorts. We may also combine health information about many facility residents to decide what additional services the facility should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students, and other facility personnel for review and learning purposes. We may also combine the health information we have with health information from other facilities to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of health information so others may use it to study health care and health care delivery without learning who the specific residents are.
We may use and disclose health information to contact you as a reminder that you have an appointment for treatment or medical care at the facility.
We may use and disclose health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services
We may use and disclose health information to tell you about health-related benefits or services that may be of interest to you.
We may use health information to contact you in an effort to raise money for the facility and its operations. We may disclose health information to a foundation related to the facility so that the foundation may contact you in raising money for the facility. We only would release contact information, such as your name, address and phone number and the dates you received treatment or services at the facility. If you do not want the facility to contact you for fundraising efforts, you must notify the Privacy Officer at address listed below in writing.
Unless you object, we may include certain limited information about you in the facility directory while you are a resident at the facility. This information may include your name, location in the facility.The directory information, except for your religious affiliation, may also be released to people who ask for you by name. 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. This is so your family, friends and clergy can visit you in the facility and generally know how you are doing.
Individuals Involved in Your Care or Payment for Your Care
We may release health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. In addition, we may disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
Under certain circumstances, we may use and disclose health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all residents who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with residents’ need for privacy of their health information. Before we use or disclose health information about you to people preparing to conduct a research project, for example, to help them look for residents with specific medical needs, so long as the health information they review does not leave the facility. We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the facility.
Required By Law
We will disclose health information about you when required to do so by federal, state or local law.
Avert A Serious Threat to Health or Safety
We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or to the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Organ and Tissue Donation
If you are an organ donor, we may release health 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 tissue donation and transplantation.
We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks
We may disclose medical information about you for public health activities. These activities generally include the following:
- to prevent or control disease, injury or disability;
- to report births and deaths;
- to report reactions to medications or problems with products;
- to notify people of recalls of products they may be using;
- to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
- to notify the appropriate government authority if we believe a resident 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
We may disclose health information to 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, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else 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.
We may release health information if asked to do so by a law enforcement official:
- In response to a court order, subpoena, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim or a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct at the facility; and
- In emergency circumstances to report a crime; the location or the crime or victims; or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors
We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about residents of the facility to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities
We may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others
We may disclose health 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.
Your Rights Regarding Health Information About You
Although your health records is the property of the facility, the information belongs to you. You have the following rights regarding your health information.
Right to Inspect and Copy
You have the right to inspect and copy health information that may be used to make decisions about your care. This does not include psychotherapy notes.
You have the right to request restrictions on certain uses and disclosures of your health information, including uses and disclosures to carry out treatment, payment, and health care operations and disclosures to family members and friends involved in your care or payment for your care. We are not required to agree to your request except for a request to restrict disclosure of health information about you to a health plan if 1) the disclosure is for payment or health care operations purposes and is not otherwise required by law, and 2) the health information pertains solely to a health care item or service for which you or a person other than the health plan on your behalf has paid us in full. We will make reasonable efforts to address your concerns. You must submit your request in writing to the facility at the address listed below. In your request, you must tell us what information you desire to limit and to whom you desire the limits to apply.
Right to Request Alternate Communications
You have the right to request to receive communications of your health information by alternative means or at alternative locations. For example, you may ask that we only contact you via mail to a post office box. You must submit your request in writing to the facility at the address listed below. Your request must specify how or where you wish to be contacted; we will not ask the reason for your request. We will accommodate all reasonable requests.
Right to Amend
If you feel that health information we have about you 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 the facility.
To request an amendment, your request must be made in writing and submitted to the facility address below. In addition, you must 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:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the health information kept by or for the facility;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
Right to an Accounting of Disclosures
You have the right to request an “accounting of disclosures”. This is a list of the disclosures we made of health information about you. Not all disclosures are subject to this accounting requirement.
To request this list or accounting of disclosures, you must submit your request in writing to the facility at the address below. Your request must state a time period which may not be longer than six years and may not include dates before the admission date. 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.
Right to Request Restrictions
You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment of 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 not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions or opt out, you must make your request in writing to the facility at the address below. In your request, you must tell us:
- what information you want to limit;
- whether you want to limit our use, disclosure or both; and
- to whom you want the limits to apply, for example, disclosures to your spouse.
Right to Request Confidential Communications
You have the right to request that we communicate with you about health matters in a certain way or at a certain location.
To request confidential communications, you must make your request in writing to the facility at the address below. 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.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
The facility will also abide by applicable state laws governing the privacy of your health information.
Minnesota laws generally prohibits a facility from releasing a resident’s health information to a person without a signed and dated consent from the resident or the resident’s legally authorized representative authorizing the release, specific authorization in law or a representation from a provider that holds a signed and dated consent from the resident authorizing the release. These restrictions do not apply in medical emergencies and to disclosures between providers within related health care entities when necessary for the resident’s current treatment.
Changes to This Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the facility. The notice will contain on the first page, in the top right-hand corner, the effective date.
If you believe your privacy rights have been violated, you may file a complaint with us at the address listed below, call us at the number listed below, or file a complaint with the Secretary of the Department of Health and Human Services. You will not be retaliated against for filing a complaint.
Other Uses of Health Information
Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
If you have questions about our privacy practices or to contact the facility regarding matters covered by this Notice, please contact us at:
ATTN: Privacy Officer
PO Box 5947
Rochester, MN 55903