NOTICE OF INFORMATION PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY!

The following notice describes the privacy practices of St. Andrew's Health Center and St. Andrew's Bottineau Clinic, LLC including:

All of these entities, sites and locations may share Protected Health Information (PHI) with each other when necessary for the purpose of treatment, payment or healthcare operations as described in this notice.

OUR PLEDGE TO YOU: We understand that information about you and your health is personal and we are committed to protecting privacy while providing quality care. This Notice of Information Privacy Practices applies to all of the records of your care generated by St. Andrew's Health Center and St. Andrew's Bottineau Clinic, LLC. These facilities are required by law to:

Understanding Your Health Record/Information

Each time you visit a hospital, doctor, or other healthcare provider, a record of your visit is made. We need this record to provide you with quality care and to comply with certain legal requirements. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and plan for future care or treatment. This information, often referred to as your health record or medical record, serves as a:

Understanding what is in your record and how your Protected Health Information (PHI) is used helps you to:

Your Health Information Rights

Although your Protected Health Information (PHI) is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have a right to:

For More Information or to Report a Problem

If you have questions and/or would like additional information regarding any rights included in this Notice of Information Privacy Practices, you may contact St. Andrew's Privacy Officer at 701-228-9300 .

If you believe your privacy rights have been violated, you may file a complaint with St. Andrew's Privacy Officer by dialing 701-228-9300 , or writing to: St. Andrew's Health Center, Attention: Privacy Officer, 316 Ohmer Street, Bottineau, ND 58318 . You may also contact the United States Department of Health and Human Services Office for Civil Rights by dialing 1-303-844-2024 or (TDD) 1-303-844-3439 , by e-mailing OCRComplaint@hhs.gov , or by writing to: Region VIII, Office for Civil Rights, US Department of Health and Human Services, 1961 Stout Street, Room 1185 FOB, Denver, CO 80294-3538. There will be no retaliation for filing a complaint .

How We May Use and Disclose Medical Information About You

The following categories describe different ways that we use and disclose Protected Health Information (PHI). Not every use or disclosure in a category can be listed. However, examples are provided to explain some of the categories. All of the ways we are permitted to use and disclose information will fall within one of the categories.

For example: A doctor treating you for a broken leg 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. We also may disclose PHI about you to people outside our healthcare facilities who may be involved in your medical care after you leave the hospital, such as family members. We will also provide your doctor or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you once you are discharged from our healthcare facilities.

For example: We may need to give your health plan specific health documentation regarding physical therapy visits so that your health plan will pay us for the services you received. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine if your plan will cover the treatment. A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures and supplies used.

For Example: We may use PHI to review our treatment and services and to evaluate the performance of our staff in caring for you. We may combine PHI about many facility patients to decide what additional services our healthcare facilities should offer, what services are not needed, and whether certain treatments are effective.

For Example: If you select the option to not be included on our facility directory, flowers can not be sent to your room, phone calls can not be routed to your room, etc.

Changes to the Notice of Information Privacy Practices

We reserve the right to change our Notice of Information Privacy Practices and to make the new provisions effective for all Protected Health Information (PHI) we already have about you as well as any information we receive in the future. Should there be a significant change to our Notice of Information Privacy Practices, we will post a copy of the updated notice in St. Andrew's Health Center and St. Andrew's Bottineau Clinic, LLC, provide you with the revised copy upon your next visit for treatment/services, and obtain a new signature of acknowledgement for the revised copy. In addition, each time you register at the hospital/clinic for treatment or services, you have the right to request a copy of the current notice in effect.

We will not disclose your Protected Health Information (PHI) without your written authorization, except as described in this notice. If you provide us with authorization to use or disclose PHI about you, you may revoke that authorization, in writing, at any time. You understand that we are unable to take back any disclosures we have already made with your permission.