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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.
If you have any questions about this notice, please contact the
ECUMEN Privacy Officer or Lakeshore’s
privacy officer Sandy Fulton at 218-625-8409 or email her at SandyFulton@ecumen.org.
OUR PLEDGE REGARDING YOUR HEALTH INFORMATION.
Your health information is personal. We are committed to protecting
the health information we have about you.
We create written and computer records of the care and services
you receive from us. We need these records to provide you with
quality care and to comply with certain legal requirements.
This notice applies to all records of your care we have or other
health information about you, whether maintained by our staff
or by your personal doctor while providing services to you in
our facilities. Your personal doctor may have different policies
or notices regarding use and disclosure of your health information
created in the doctor's office or clinic.
This notice tells you about the ways we may use and disclose your
health information. We also describe your rights and certain obligations
we have regarding the use and disclosure of your health information.
We are required by law to:
- make sure that health information that identifies you is
kept private;
- give you this notice of our legal duties and privacy practices
with respect to your health information; and
- follow the terms of the Privacy Notice that is currently in
effect.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT
YOU.
We use and disclose your health information in many ways for many
purposes related to your care. The law may require us to obtain
your consent or authorization for some of the uses and disclosures
we will describe. We will ask you or your representative to sign
a consent or authorization when necessary.
There are three primary reasons we regularly use and disclose
your health information:
For Your Treatment.
We use health information to provide you with health treatment
or services. We disclose health information about you to our staff
when they take care of you. 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, your
doctor may need to tell our dietitian if you have diabetes so
that we can arrange for appropriate meals. Different departments
also may share health information about you in order to coordinate
the different services you need, such as physical and occupational
therapy or social services.
To Receive Payment for our Services.
We will use and disclose health 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 some other
third party. For example, we may need to give your health plan
information about care you received 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.
For Our Health Care Operations.
We use and disclose health information to assist in our health
care operations, so that all of our residents and clients receive
quality care. For example, we may use health information about
you and others to review our treatment and services, to evaluate
the performance of our staff, and to make improvements in services
and programs.
There are a variety of other ways we may use and disclose your
health information. Among them are:
- Appointment Reminders: to contact you as
a reminder that you have an appointment for treatment or health
care from us.
- Treatment Alternatives: to tell you about
or recommend possible treatment options or alternatives that
may be of interest to you.
- Health-Related Benefits and Services: to
tell you about health-related benefits or services that may
be of interest to you.
- Fundraising: to contact you in an effort
to raise money for our programs. We will only disclose contact
information, such as your name, address, telephone number and
the dates you received services from us, to Lakeshore Lutheran
Home Foundation, so that it may contact you to ask for your
contribution.
- Facility Directory. Unless you object, we
will include certain limited information in a facility directory
while you are a resident. Each program’s directory will
contain different information. Each program will disclose the
directory information to any one who asks for you by name. This
is so your family, friends and clergy can visit you in the facility.The
facility will disclose your name, location in the facility,
your general condition (e.g., fair, stable, etc.) and your religious
affiliation (only to clergy).
- Individuals Involved in Your Care or Payment for Your
Care. We will disclose health information about you
to your health care agent, conservator or guardian of the person,
or to other individuals as you may authorize. Unless you object,
and using our best judgment, we will also disclose health information
about you to family members or close personal friend who is
involved in your health care, to the extent the disclosure is
in your best interests and to the extent they need that information
for the type of involvement they have. We will also disclose
information to someone who helps you pay for your care to extent
it is necessary for that purpose. We will also tell your family
or friends your general condition and that you are in the facility.
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.
- As Required By Law, Especially for Health Oversight
Activities. We will disclose health information to
a health oversight agency (such as the Minnesota Department
of Health) for activities authorized by law. These oversight
activities include, for example, audits, investigations, inspections,
and licensure. We will also disclose health information about
you when required to do so by any federal, state or local law.
- To 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 the
health and safety of the public or another person. Any disclosure,
however, would only be to someone able to help prevent the threat.
There are also some other special situations that don’t
occur very often, but that we want you to know about:
- 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.
- Military and Veterans. If you are a member
of the armed forces, we may release health information about
you as required by military command authorities. We may also
release health information about foreign military personnel
to the appropriate foreign military authority.
- Workers' Compensation. 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 health
information about you for public health activities, such as
the reporting of certain diseases.
- Judicial and Administrative Proceedings.
We may disclose health information in response to a court or
administrative order. We may also disclose health information
in response to a subpoena, discovery request, or other lawful
process by someone else involved in a proceeding, but only if
efforts have been made to tell you about the request or to obtain
an order protecting the information requested.
- Law Enforcement. We may release health information
if asked to do so by a law enforcement official, for example,
in emergency circumstances to report a crime.
- Coroners, Health Examiners and Funeral Directors.
We may release health information to a coroner or medical examiner
as permitted by state law. We may also release health information
about our residents or clients to funeral directors as necessary
to carry out their duties.
- National Security, Intelligence Activities, Protective
Services for the President and Others. We may release
health information about you to authorized federal officials
for intelligence, counterintelligence, and other national security
activities authorized by law.
- Correctional Institution. If you are an inmate
of a correctional institution or under the custody of a law
enforcement official, we may release health information about
you to the correctional institution or law enforcement official.
- Research. Under certain circumstances, we
may use and disclose health information about you for research
purposes, unless you object. If you object, the records will
not be disclosed. For example, a research project may involve
comparing the health and recovery of all patients who received
one medication to those who received another, for the same condition.
All research projects for which we use or disclose health information
will be approved through a special research approval process.
We will use reasonable efforts to obtain 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.
- Other Uses. Other uses and disclosures of
health information not specified by this notice or required
by the laws that apply to us will be made only with your written
authorization. If you provide us authorization to use or disclose
health information about you, you may revoke that authorization,
in writing, at any time. If you revoke your authorization, 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.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU.
You have the following rights regarding health information we
maintain about you:
- Right to Access, Review and Copy. You may
access, review, and copy health information that may be used
to make decisions about your care. Usually, this includes health
and billing records, but it does not include psychotherapy notes.
To access, review and copy health information that may be used
to make decisions about you, submit your request to Health Information
Services. If you request a copy of the information to review
your current health care, we will provide that without cost.
For other requests, we may charge a fee, as allowed by state
law, for the costs of copying, mailing or other supplies associated
with your request.
We may deny your request to inspect and copy in certain very
limited circumstances. If we deny you access to health information,
we will provide it to an appropriate third party or to another
provider, and that other provider or third party may release
the information.
- Right to Request an Amendment of Your Health Information.
If you feel that health information we have about you is incorrect
or incomplete, you may ask us to amend the information. You
may request an amendment for as long as the information is kept
by or for us.
You may make your request in writing to Health Information Services.
In addition, please 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:
- We did not create, 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 us;
- 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 may request a list of the disclosures we made of your health
information. Not all disclosures are subject to this accounting
right.
To request this list or accounting of disclosures, submit your
request in writing to Health Information Services. Your request
must state a time period, which may not be longer than six years
and may not include dates prior to admission to the facility.
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 on the Use or Disclosure
of Your Health Information.
You may request a restriction or limitation on the health information
we use or disclose about you for treatment, payment or health
care operations. You may also request a limit on the health
information we disclose about you to someone who is involved
in your care or the payment for 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 required to agree to your requested restriction if the
information is to be released to persons outside our programs,
unless you are being transferred to another health care facility,
if the release is required by law, for third party payment purposes,
or to provide you with emergency care. However, in some circumstances,
we are not required to agree to your request, because we may
not be able to provide you with quality care if the restrictions
were upheld. If we do agree, we will comply with your request
unless the information is needed to provide you emergency treatment.
To request restrictions, make your request in writing to Health
Information Services. In your request, tell us (1) what information
you want to limit; (2) whether you want to limit our use, disclosure
or both; and (3) to whom you want the limits to apply, for example,
disclosures to your spouse.
- Right to Request Confidential Communications.
You
may request that we communicate with you about health matters
in a certain way or at a certain location. For example, you
can ask that we only contact you at work or by mail.
To request confidential communications, make your request in
writing to Health Information Services. 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 Request Additional Copies of This Notice.
You may ask for additional copies of this notice at any time.
Even if you have agreed to receive this notice electronically,
you may still have additional paper copies of this notice. You
may also obtain a copy of this notice at our website: bsm1.org/contact.htm
.
To obtain additional copies of this notice, please ask any nursing
supervisor, social services personnel or the program director.
CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time as our
policies and procedures change. Any changes we make may be effective
for health information we already have about you as well as
any information we receive in the future. We will provide a
copy of our most current notice, if requested, and we will keep
a copy of our most current notice posted in each of our facilities.
If we change the notice while you are still our resident or
client, we will give you a copy of the revised notice. Every
notice will contain its effective date on the first page, in
the lower right-hand corner.
COMPLAINTS
If you believe your privacy rights have been violated, you may
file a complaint with the facility or with the Office for Civil
Rights of the United States Department of Health and Human Services.
To file a complaint with the facility, contact the ECUMEN Privacy Officer at:
Privacy Officer
Ecumen
3530 Lexington Ave. N.
Shoreview, MN 55126
If sent by email, the complaint should go to: PrivacyOfficer@ecumen.org.
To file a complaint with the Office for Civil Rights, contact:
Region V, Office for Civil Rights
U.S. Department of Health and Human Services
233 N. Michigan Ave., Suite 240
Chicago, IL 60601
Voice phone: (312) 886-2359
FAX: (312) 886-1807
TDD: (312) 353-5693
If sent by email, the complaint should go to: OCRComplaint@hhs.gov.
All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
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