Notice of Privacy Practices

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.

The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential.  This Act gives you, the patient, significant new rights to understand and control how your health information is used.  HIPAA provides penalties for covered entities that misuse personal health information.

As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.

We may use and disclose your medical records for each of the following purposes:

treatment, payment, health care operations, and our business associates:

• Treatment means providing, coordinating, or managing health care and related services by one or more health care providers.

• Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review.  An example of this would be sending a bill to your insurance company for payment.

• Health Care Operations to include the business aspects of running our organization, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service.  An example would be an internal quality assessment review.  (Another example would be: members of our staff such as the risk or quality improvement manager, or members of the quality improvement team may use information in your health 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 healthcare and service we provide.

• Our Business Associates   there are some services provided in our organization through contacts with business associates.  Examples include physician services in the Emergency Department and Radiology, certain laboratory tests, and a copy service we use when making copies of your health record.  When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we have asked them to do and bill you or your third party payer for services rendered.  So that your health information is protected, however, we require the business associate to sign a contract ensuring their commitment to protect your health information consistent with Notice and to appropriately safeguard your information.

We may also create and distribute de-identified health information by removing all references to individually identifiable information.

Any other uses and disclosures will be made only with your written authorization.  You may revoke such authorization in writing, and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

Use and disclosure authorized by Law that Do Not Require Your Consent, Authorization or Opportunity to Agree or Object.

• Federal government investigation, when required by the Secretary of Health and Human Services to investigate or determine our compliance with federal regulation.

• Federal, state or local law requirements.

• Public health activities, for example to report communicable diseases or death; or for matters involving the Food and Drug Administration.

• Reporting of abuse, neglect or domestic violence.

• Health oversight activities by a health oversight agency.  (A health oversight agency is an organization authorized by the government to oversee eligibility and compliance and to enforce civil rights laws.)

• Law enforcement purposes, for example to report certain types of wounds or other physical injuries or to identify or locate a suspect, fugitive, material  witness, or missing person.

• Use by coroners, medical examiners, or funeral directors.

• Facilitating organ, eye, or tissue donation.

• Research, provided that very strict controls are enforced.

• Averting a serious threat to your health or safety or that of the public.

• Specialized government functions such as military or veterans’ affairs; national security, and intelligence activities.

• Workers’ compensation.

 You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Privacy Officer:

• Right to Request Restrictions on Uses and Disclosures of protected health information.  

• The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.

• The right to inspect and copy your protected health information.

• The right to amend your protected health information.

• The right to receive an accounting of disclosures of protected health information.

• The right to obtain and we have the obligation to provide to you a paper copy of this notice from us at your first service delivery date.

• The right to provide and we are obligated to receive a written acknowledgement that you have received a copy of our Notice of Privacy Practices.

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This notice is effective as of  April 14, 2003 and we are required to abide by the terms of the Notice of Privacy Practices currently in effect.  We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain.  We will post and you may request a written copy of a revised Notice of Privacy Practices from this office.

If you want more information about our privacy practices or have questions or concerns, please contact our Compliance Officer. You have recourse if you feel that your privacy protections have been violated.  You have the right to file a formal, written complaint with us at the address below.  If you feel your complaint was not satisfactorily address by Sheriffs Youth Programs you can also submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.

Please contact us for more information or to file a complaint:

HIPAA Compliance Officer                                                                             

Jacqueline Reding                                                   

Sheriffs Youth Programs of Minnesota 

2925 Buckley Way

Inver Grove Heights, MN 55076

(651) 552-5754