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.
Cavalier County Health District is required by law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this notice while it is in effect. This Notice takes effect April 14, 2003.
Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request. We reserve the right to change our privacy practices and the terms of this Notice at any time. Changes will be available at our agency.
You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this Notice.
We are committed to protecting your privacy. Any personal health information about you that is generated by this office or received from health care providers will be kept confidential to the full extent required by law. Except as explained in this notice, we will disclose and use your protected health information only with your written authorization. The following are examples of the types of uses and disclosures of your protected health care information that the provider is permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures.
For Treatment - We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. For example, your protected health information may be provided to a doctor to whom you have been referred to ensure that the doctor has the necessary information to diagnose or treat you.
For Payment – Your protected health information will be used, as needed, in activities related to obtaining payment for your health care services. This may include your insurance company, self-funded or third party health plan, Medicare, Medicaid, or any other person or entity that may be responsible for paying or processing for payment any portion of your bill for services.
Healthcare Operations – We may use or disclose, as needed, your protected health information in order to support our business activities. For example, when we review employee performance, we may need to look at what an employee has documented in your medical record.
Other uses and disclosures of your protected health information will be made only with written authorization, unless otherwise permitted or required by law as described below. You may revoke your authorization, at any time, in writing.
We may use and disclose your protected health information in the following instances. You have the opportunity to object. If you are not present or able to object, then we may use professional judgment to determine whether the disclosure is in your best interest.
To provide appointment reminders – We may disclose limited health information to provide you with appointment reminders or information on other health activities we provide, such as voicemail messages, postcards, or letters.
Others involved in your care – Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in you health care.
Emergencies – In an emergency treatment situation, we will provide you a Notice of Privacy Practices as soon as reasonably practical after the delivery of treatment.
Communication Barriers – We may use and disclose your protected health information if we have attempted to obtain acknowledgement from you of our Notice of Privacy Practices but have been unable to do so due to substantial communication barriers and we determine, using professional judgment, that you would agree.
We may use or disclose your protected health information in the following situations without your authorization or opportunity to object.
Public Health – for public health purposes to a public health authority or to a person who is at risk of contracting or spreading a disease.
Health Oversight – to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.
Abuse or Neglect – to an appropriate authority to report child abuse or neglect, if we believe that you have been a victim of abuse, neglect, or domestic violence.
Food and Drug Administration – as required by the Food and Drug Administration to track products.
Legal Proceedings – in the course of legal proceedings.
Law Enforcement – for law enforcement purposes, such as pertaining to victims of a crime or to prevent a crime.
Coroners, Funeral Directors, and Organ Donation – for the coroner, medical examiner, or funeral director to perform duties authorized by law and for organ donation purposes.
Research – to researchers when their research has been approved by an Institutional Review Board or Privacy Board.
Soldiers, Inmates, and National Security – to military supervisors of Armed Forces personnel or to custodians of inmates, as necessary. Preserving national security may also necessitate disclosure of protected health information.
Workers’ Compensation – to comply with workers’ compensation laws.
Compliance – to the Department of Health and Human Services to investigate our compliance.
In general, we may use or disclose your protected health information as required by law and limited to the relevant requirements of the law.
You have the right to:
Access – You have the right to inspect and obtain a copy of your protected health information, with limited exceptions, for example; we may refuse to provide access to certain psychotherapy notes or information for a civil or criminal proceeding.
Request restrictions – You may ask us not to use or disclose certain parts of your protected health information for treatment, payment or healthcare operations. You may also request that information not be disclosed to family members or friends who may be involved in your care. Your request must state the specific restriction requested and to whom you want the restriction to apply. We are not required to agree to a restriction that you may request, but if we do agree, than we must act accordingly.
Confidential communication – You have the right to request to receive confidential communication from us by alternative means or at alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request.
Amendment – You may request an amendment of protected health information about your. If we deny your request for amendment, we will provide you with a written explanation. If we deny your request, you have the right to file a statement of disagreement that will be added to the information you wanted changed.
Disclosure accounting – You have a right to receive an accounting of certain disclosures we may have made. This right applies to disclosures for purposes other that treatment, payment or healthcare operations. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures. The right to receive this information is subject to certain exceptions, restrictions and limitations.
Questions and Complaints – If you want more information about our privacy practices or have questions or concerns, please contact us. If you are concerned that we may have violated your privacy rights or if you disagree with a decision we made about use or disclosure of your personal health information, you may the person listed below. You will not be penalized for filing a complaint. You also may submit a written complaint to the Secretary of the US Department of Health and Human Services, 200 Independence Avenue, S.W., Room 515R HHH Bldg., Washington, D.C. 20201.
If you have any questions or complaints, please contact:
Cavalier County Health District
901 3rd Street, Suite 11
Langdon, ND 58249
This notice is effective beginning April 14, 2003 and remains in effect until amended.