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:
- Any health
care professional authorized to enter information into your health
- All departments
and services of the hospital/clinic
- Any member
of a volunteer group we allow to help you while you are in the
- All employees,
medical staff and other facility personnel, including students
- All visiting
providers and specialists that have an Organized Healthcare
Arrangement with St. Andrew's Health Center and St. Andrew's
Bottineau Clinic, LLC
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
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:
the privacy of your Protected Health Information (PHI)
you with a notice as to our legal duties and privacy practices
with respect to information we collect and maintain about you
by the terms of this notice
you if we are unable to agree to a requested restriction
reasonable requests you may have to communicate PHI by alternative
means or at alternative locations.
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:
for planning your care and treatment
of communication among the many health professionals who contribute
to your care
document describing the care you received
by which you or a third-party payer can verify that services
billed were actually provided
- A tool
in educating health professionals
- A source
of data for medical research
source of information for public health officials charged with
improving the health of the nation
- A source
of data for facility planning and marketing
- A tool
with which we can assess and continually work to improve the
care we render and the outcomes we achieve
Understanding what is in your record and how your Protected Health
Information (PHI) is used helps you to:
understand who, what, when, where and why others may access your
- Make more
informed decisions when authorizing disclosure of PHI to others
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:
in writing, an amendment to your PHI if you feel that the information
we have about you is incorrect or incomplete. We are not required
to agree to your request, but if we do agree, we will comply
with your request.
in writing, a restriction or limitation on the PHI we use or
disclose about you for treatment, payment or healthcare operations.
We are not required to agree to your request. If we do agree,
we will comply with your request unless the information is needed
to provide you emergency treatment.
a paper copy of this Notice of Information Privacy Practices
in writing, to inspect and copy PHI that may be used to make
decisions about your care. Usually, this includes medical and
billing records, but does not include psychotherapy notes.
in writing, an accounting of disclosures of your PHI. This is
a list of the disclosures of PHI we made about you.
in writing, communications of your PHI by alternative means or
at alternative locations.
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 Treatment: Information
obtained by a nurse, doctor or other member of your healthcare
team will be recorded in your record and used to determine the
course of treatment that should work best for you. Your doctor
will document, in your record, his or her expectations of the
members of your healthcare team. Members of your healthcare team
will then record the actions they took and their observations.
In that way, the doctor will know how you are responding to treatment.
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 Payment: We may use and disclose PHI about
you so that the treatment and services you receive at our healthcare
facilities may be billed to and payment may be collected from you,
an insurance company, or a third party.
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
- For Healthcare Operations: We may use and disclose
PHI about you for St. Andrew's Health Center and St. Andrew's Bottineau
Clinic, LLC operations. These uses and disclosures are necessary
to run our healthcare facilities and insure that all of our patients
receive quality care.
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.
are some services provided in our healthcare facilities through
contracts with business associates. Examples: Doctor services
in the emergency department and radiology, certain laboratory
tests, and a release of information service we use to help us
organize the release of medical information. When these services
are contracted, we may disclose your PHI to our business associate
so they can perform the job we have asked them to do and bill
you or your third-party payer for services rendered. To protect
your PHI, however, we require the business associate to appropriately
safeguard your information.
- Directory: Unless
you notify us in writing that you object, we will use your
name and location in the facility for directory purposes
and also give this information to other people who ask for
you by name. Unless you notify us in writing that you object,
this information, as well as your general condition and religious
affiliation, may also be provided to members of the clergy and
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.
- As Required
by Law: We will disclose PHI about
you when required to do so by federal, state or local law
- Communication with Family: Health professionals,
using their best judgment, may disclose PHI to a family member, other
relative, close personal friend or any other person you identify
is involved in your medical care. We may also give information to
someone who helps pay for your care. We may also tell your family
or friends your condition and that you are in the hospital. In addition,
we may disclose medical information about you to an entity assisting
in a disaster relief effort so that your family can be notified about
your condition and location.
- Research: We
may disclose information to researchers when their research
has been approved by an institutional review board that has
reviewed the research proposal and established protocols to
ensure the privacy of your PHI.
- Funeral Directors,
Coroners, Medical Examiners: We
may disclose PHI to funeral directors, consistent with applicable
law, to carry out their duties. We may release PHI to a coroner
or medical examiner; this may be necessary to determine the
cause of death.
- Organ and Tissue
Donation: Consistent with
applicable law, we may disclose PHI to organ procurement organizations
or other entities engaged in the procurement, banking, or transplantation
of organs for the purpose of tissue donation and transplant.
- Appointment Reminders/Treatment
may contact you to provide appointment reminders or information
about treatment alternatives or other health-related benefits
and services that may be of interest to you.
- Fund Raising: We
may contact you as part of a fund-raising effort for St. Andrew's
Health Center and St. Andrew's Bottineau Clinic, LLC. We may
disclose information to a foundation related to our healthcare
facilities so that the foundation may contact you in raising
money for our healthcare facilities.
- Marketing: We
may disclose information or contact you for marketing purposes.
Patient authorization will be obtained by our healthcare facilities,
- Food and Drug
Administration (FDA): We
may disclose, to the FDA, Protected Health Information (PHI)
relative to adverse events with respect to food, supplements,
and product defects or post marketing surveillance information
to enable product recalls, repairs or replacement.
- Worker's Compensation: We
may disclose PHI about you for worker's compensation or similar
programs. These programs provide benefits for work-related
injuries or illnesses.
- Public Health: As
required by law, we may disclose your PHI to public health
or legal authorities charged with preventing or controlling
disease, injury or disability.
Institution: Should you be an
inmate of a correctional institution or under the custody of
a law enforcement official, we may disclose to the institution,
or agents thereof, PHI necessary for your health and the health
and safety of other individuals.
- Law Enforcement: We
may disclose PHI for law enforcement purposes as required by
law or in response to a valid subpoena.
- Military and
Veterans: If you are a member
of the armed forces, we may disclose PHI about you as required
by military command.
Oversight Activities: We
may disclose PHI to a health oversight agency for activities
authorized by law. These oversight activities may include audits,
investigations, inspections and licensure. These activities
are necessary for the government to monitor the healthcare
system, government programs, and compliance of civil rights
Security Activities: We
may release PHI about you to authorized federal officials for
intelligence, counterintelligence and other national security
activities authorized by law. We may disclose PHI about you
to authorized federal officials so they may provide protection
to the President, other authorized persons or foreign heads
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.
Other Uses of Health Information
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.
Version I Effective Date: April 14, 2003