Associates in Women’s Health
Obstetrics & Gynecology
A Division of Obstetrics & Gynecology Associates
NOTICE OF PRIVACY PRACTICES
FOR PROTECTED HEALTH INFORMATION
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 or wish to receive additional information about the matters covered by this Notice of Privacy Practices, please contact Privacy Officer Bronagh MacCafferty at 952.806.0011.
Associates in Women’s Health(“AWH”) is required to abide by the terms of this Notice of Privacy Practices (“Notice”). AWH reserves the right to change the terms of this Notice at any time. The revised Notice will apply to all protected health information (“PHI”) AWH received or created in the past, as well as all PHI AWH receives or creates in the future. A current copy of the Notice will be posted in the reception area of each of AWH’s offices. The effective date of the Notice is April 14, 2003. If this Notice has been changed since your last appointment, AWH will provide a copy of the current Notice to you when you sign in for your future appointment. Additionally, you may obtain a copy of the current Notice by calling your physician and requesting that one be sent to you in the mail or by asking for one when you are in the office.
Your “protected health information” or PHI, consists of all individually identifiable information which is created or received by the AWH and which relates to your past, present or future physical or mental health of condition, the provision of health care to you or the past, present or future payment for health care provided to you.
USE AND DISCLOSURE OF PHI FOR WHICH YOUR
CONSENT OR AUTHORIZATION IS NOT REQUIRED
1. Treatment. Although federal law allows disclosure of PHI, generally, for purposes of treatment, payment and health care operations, Minnesota law requires that AWH obtain your consent before using your PHI for these purposes. Minnesota law does, however, allow AHW to use and disclose your PHI with AWH in order to provide, coordinate, or manage your health care and related services by AWH. Minnesota law also allows AWH to use and disclose your PHI to providers outside AWH for emergency purposes. AWH will use and disclose your PHI consistent with state law and any consent you may provide.
2. Appointment Reminders. AWH may use or disclose your PHI in order to contact you and remind you of a scheduled appointment.
3. Baby Pictures and Holiday Cards. Many of AWH’s patients choose to send AWH baby photographs or holiday cards, which may include family photographs, for inclusion on AWH’s bulletin board in its office lobbies. Photographs and holiday cards often include PHI. If you choose to share such information with AWH for inclusion on its bulletin boards, AWH may post such photographs and cards. If you wish to share photographs or holiday cards with AWH, but you do not want these items to be posted on AWH’s bulletin boards, please notify AWH’s Privacy Officer.
4. Treatment Alternatives. AWH may use or disclose your PHI to inform you about treatment alternatives.
5. Health Related Benefits and Services. AWH may use and disclose your PHI to inform you about health-related benefits and services that may be of interest to you.
6. Others Involved in Your Health and Disaster Relief. In the event of an emergency, AWH may disclose to a family member, other relative, close personal friend or any other person identified by you PHI related to the person’s involvement in your health care or payment related to your health care, if it is in your best interests. In the event of an emergency, AWH may also use or disclose to a person responsible for your care your PHI that relates to your location, general condition or death, if it is in your best interests. Additionally, AWH may disclose PHI relating to your location, general condition or death to any public or private entity authorized to assist in disaster relief efforts.
7. Public Health. AWH may disclose your PHI to a public health authority authorized to collect such information for the purpose of:
a. Preventing or controlling diseases, injury or disability;
b. Reporting disease or injury;
c. Reporting vital events such as births or deaths;
d. Conducting public health surveillance, public health investigations and public health interventions;
e. At the direction of public health authority, to an official of a foreign government agency acting in collaboration with a public health authority; or,
f. Reporting child abuse or neglect.
8. Food and Drug Administration. AWH may disclose your PHI to a person subject to the jurisdiction of the Food and Drug Administration (“FDA”) for the purposes of activities related to the quality, safety or effectiveness of FDA regulated products.
9. Communicable Diseases. AWH may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of spreading a disease or condition.
10. Employer. AWH may disclose your PHI to your employer if AWH is providing health care to you at the request of your employer to conduct an evaluation relating to medical surveillance relating to your workplace or to evaluate whether you have work-related illness or injury. AWH will notify you before your PHI relating to the medical surveillance of the workplace and work-related illnesses and injuries is disclosed to your employer by providing you with written notice of the time AWH renders health care to you.
11. Abuse, Neglect or Domestic Violence. AWH may disclose your PHI to a government authority to receive reposts of abuse, neglect or domestic violence if AWH reasonably believes that you are a victim of abuse, neglect or domestic violence. Any such disclosure will be made (1) to the extent it is required by law, (2) to the extent that the disclosure is authorized by statute or regulation and AWH believes the disclosure is necessary to prevent serious harm to you or other potential victims or (3) if you agree to the disclosure.
12. Health Oversight Activities. AWH may disclose your PHI to a health oversight agency for any oversight activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions, civil, criminal or administrative actions or proceedings, or other activities necessary for the oversight of the health care system, government benefit programs, compliance with government regulatory program standards or compliance with applicable civil right law.
13. Judicial and Administrative Proceedings. AWH may, upon certain conditions, disclose your PHI in the course of any judicial or administrative proceedings in response to an order of a court or administrative tribunal, a subpoena, discovery request, or other lawful process.
14. Law Enforcement Purposes. AWH may disclose your PHI for law enforcement purposes to a law enforcement official.
a. In compliance with a court order, a court-ordered warrant, a subpoena or summons issued by a judicial officer or an administrative request;
b. In response to a request for information for the purposes of identifying or locating a suspect, fugitive, material witness or missing person;.
c. In response to a request about an individual that is suspected to be a victim of a crime, if, under limited circumstances, AWH is not able to obtain your consent;
d. If the information relates to a death AWH believes may have resulted from criminal conduct;
e. If the information constitutes evidence of criminal conduct that occurred on the premises of AWH; and,
f. In certain emergency circumstances, to alert law enforcement of the commission and nature of a crime, the location and victims of the crime and the identity, or description and location of the perpetrator of the crime.
15. Coroners, Medical Examiners and Funeral Directors. AWH may disclose your PHI to a coroner or medical examiner for the purpose of identifying you, determining a cause of death or other duties authorized by law. AWH may disclose your PHI to a funeral director, consistent with all applicable laws, in order to allow a funeral director to carry out his or her duties.
16. Organ and Tissue Donation. AWH may disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating organ, eye and tissue donation and transplantation.
17. Medical Research. AWH may disclose your PHI for research purposes, provided that an institutional review board authorized by law or a privacy board waives the authorization requirement and provided that the researcher makes certain representations regarding the use and protection of the PHI to be disclosed.
18. Serious Threat to Health or Safety. AWH may disclose your PHI, in a manner that is consistent with applicable laws, if the disclosure is necessary to prevent or lessen a serious threat to health or safety or the information is necessary to apprehend an individual.
19. Military and Veterans Activities. AWH may, if you are a member of the United States or foreign Armed Forces, disclose your PHI for activities that are deemed necessary by appropriate military command authorities to assure the proper execution of a military mission.
20. National Security and Protection of the President and Others. AWH may disclose your PHI to authorized federal officials for the conduct of lawful intelligence, counter-intelligence and other national security activities authorized by law. Additionally, AWH may disclose your PHI to authorized federal officials for the provision of protective services of the President, foreign heads of state, or other people authorized by law and to conduct investigations authorized by law.
21. Inmates. AWH may disclose your PHI to a correctional institution or a law enforcement official having lawful custody of you if the correctional institution or law enforcement official represents that the information is necessary to (1) provide health care to you; (2) the health and safety of other inmates; (3) the health and safety of the officers and employees of the correctional institution or the people responsible for transporting the inmates; (4) law enforcement on the premises of the correctional institution; or, (5) the administration and maintenance of the safety, security and good order at the correctional institution.
22. Workers’ Compensation. AWH may disclose your PHI as authorized by, and in compliance with, laws relating to workers’ compensation and other similar programs established by law that provide benefits for work-related illnesses and injuries without regard to fault.
OTHER USES AND DISCLOSURE OF PHI
Any use of disclosure of your PHI that is not listed above will be made with your written authorization. You have the right to revoke your authorization at any time, except to the extent that AWH has already used or disclosed your PHI in reliance on the authorization. To request a copy of an authorization form, please contact AWH’s Privacy Officer.
YOUR RIGHTS REGARDING YOUR PHI
1. Restriction of Use and Disclosure. You have the right to request that AWH restrict the PHI AWH uses and discloses in carrying out treatment, payment and health care operations. You also have the right to restrict the PHI AWH discloses to a family member, other relative or any other person identified by you, which is relevant to such person’s involvement in your treatment or payment for your treatment.
If AWH agrees to a restriction, however, AWH may only disclose your PHI in accordance with that restriction, unless the information is needed to provide emergency health care to you.
If you wish to request a restriction on the use and disclosures of your PHI, please send a written request to the Privacy Officer which specifically sets forth (1) whether you are restricting the use or the disclosure of your PHI, (2) what Phi you wish to limit, and (3) to whom you wish the limits to apply (i.e. your spouse). AWH will not ask why you are requesting the restriction. The Privacy Officer will review your request and notify you whether or not AWH will agree to your requested restriction.
2. Confidential Communications. You have the right to request that you receive communications of your PHI from AWH in alternative means or at alternative locations. AWH will accommodate all reasonable requests.
To request that AWH make communications of your PHI by alternative means or at alternative locations, please send a written request to the Privacy Officer setting forth the alternative means by which you wish to receive communications or the alternative location at which you wish to receive such communications. AWH will not ask why you are making such a request. When appropriate, AWH may condition the provision of a reasonable accommodation upon receiving information relating to how payment, if any, will be received.
3. Access to PHI. You have the right to inspect and obtain a copy of your PHI that AWH maintains in a designated record set, for so long as the PHI is maintained in a designated record set. A “designated record set” is a group of records maintained by or for AWH, which includes billing records and records used in whole or in part to make decisions about you. You do not have the right to, inspect or copy psychotherapy notes, information compiled in reasonable anticipation of, or for use in, civil, criminal or administrative action or proceedings, or information that AWH is otherwise prohibited by law form disclosing.
If you wish to inspect or obtain a copy of your PHI, please send a written request to the Privacy Officer. If you request a copy of your PHI, AWH may charge a fee for the cost of copying and mailing the information.
AWH may, for certain limited reasons, deny your request to inspect or obtain a copy of your PHI. If AWH denies your request, you may be entitled to a review of that denial. If you are entitled to a review and you wish to have AWH’s decision reviewed, please contact the Privacy Officer. The Privacy Officer will designate a licensed health care professional to review your request. This reviewing health care professional will not have participated in the original decision to deny your request. AWH will comply with the decision of the reviewing health care professional.
4. Amending PHI. You have the right to request that AWH amend your PHI in a designated record set for so long as that information exists in a designated record set. To request that an amendment be made to your PHI, please send a written request to the Privacy Officer. Your written request must provide a reason that supports the requested amendment.
AWH may deny your request if it does not contain a reason that supports the requested amendment. Additionally, AWH may deny your request to have your PHI amended if AWH determines that (1) the information was not created by AWH, unless the person or entity that created the information is no longer available to make the amendment; (2) the information is not part of a designated record set; (3) the information is not available for your inspection; or (4) the information is accurate and complete.
5. Accounting of Disclosures of Your PHI. You have the right to request a listing of certain disclosures of your PHI made by AWH during the period of up to six (6) years prior to the date on which you make your request. Any accounting you request will not include (1) disclosures made to carry out treatment, payment or health care operations; (2) disclosures made to you; (3) disclosures made pursuant to an authorization given by you; (4) disclosure’s made to other people involved in your care or made for notification purposes; (5) disclosures made for national security or intelligence purposes; (6) disclosures made to correctional institutions or law enforcement officials; or, (7) disclosures made prior to April 14, 2003. The right to receive an accounting is subject to certain other exceptions, restrictions and limitations set forth in applicable statutes and regulations.
To request an accounting of the disclosures of your PHI made by AWH, please send a written request to the Privacy Officer. Your written request must set forth the format in which you want the accounting (i.e. hard copy, electronically) and the period for which you wish to receive an accounting. AWH will provide one free accounting during each twelve (12) month period. If you request additional accountings during the same twelve (12) month period, you will be charged for all costs AWH incurs in preparing and providing that accounting. AWH will inform you of the fee for each accounting in advance and will allow you to modify or withdraw your request in order to reduce or avoid the fee.
6. Obtaining a Copy of this Notice. You have the right to request and receive a paper copy of this Notice of Privacy Practices from AWH any time.
If you believe that your privacy rights have been violated, you may file a complaint with AWH or with the Secretary of Health and Human Services. To file a complaint with the Secretary of Health and Human services. Please contact:
Office for Civil Rights
U.S. Department of Health and Human Services
222 N. Michigan Ave., Suite 240
Chicago, IL 60601
To file a complaint with AWH, please contact Privacy Officer Bronagh MacCafferty at 952.806.0011 or
Associates in Women’s Health
6517 Drew Ave South
Edina, MN 55435
All complaints must be submitted in writing. AWH will not retaliate against you for filing a complaint.
If you have any questions or concerns regarding the information contained in this notice, please contact Privacy Officer Bronagh MacCafferty 952.806.0011.