Nebula Health Services Notice of Privacy Practices

Nebula Health Services Notice of Privacy Practices

Introduction

We are committed to treating and using protected health information about you responsibly. This Notice of Privacy Practices describes the personal information we collect and how and when we use or disclose it. It also describes your rights as they relate to protected health information. This notice is effective 6/1/2008 and applies to all protected health information as defined by federal regulations.

Each time you visit, a record of your visit is made. This record may contain symptoms, examination results, diagnoses, treatment, and a plan for future care. This information serves as a:

• Basis for planning your care and treatment;
• Means of communication among any health professionals who contribute to your care;
• Legal document describing the care you received;
• Means by which you or a third party payer can verify that services billed were actually provided;
• A source of information for public health officials charged with improving the health of the state and the nation;
• A tool with which we can access and continually work to improve the care we render and the outcomes we achieve.

Understanding what is in your record and how your health information is used helps to ensure its accuracy, better understand who, what, when, where, and why others may access your health record, and make more informed decisions when authorizing disclosure to others.

Your health Information Rights

Although your health record is the physical property of Nebula Health Services, the information belongs to you. You have the right to:

• Inspect and copy your health record as provided for in 45 CFR 164.524;
• Amend your health record and obtain an accounting of disclosures of your health information as provided for in CFR 164.528;
• Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522 (we are not required to agree to such restrictions);
• Request reasonable confidential communication of your information by alternative means or to an alternative location;
• Obtain a copy of this notice by request;
• Revoke your authorization to use and disclose information except to the extent that action has already been taken.

Our Responsibilities

Nebula Health Services is required by law to:

• Maintain the privacy of your health information;
• Provide you with this notice as to our legal duties and privacy practices with respect to information we maintain about you;
• Abide by the terms of this notice.

We reserve the right to change our practices and to make new provisions effective for all protected health information we maintain. Should our information practices change, we will have updated copies available in our office.

We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue using or disclosing your health information based on an authorization after we have received a written revocation of the authorization.

For More Information or to Report a Problem

If you have any questions and would like additional information, you may contact our clinic Privacy Officer, Valerie Koski, at 612-800-7600.

If you believe your privacy rights have been violated, you can file a complaint with our Privacy Officer or with the Office for Civil Rights at the address below. There will be no retaliation for filing a complaint.

Office for Civil Rights

U.S. Department of Health and Human Services

200 Independence Avenue SW

Room 509F, HHH Building

Washington, D. C. 20201

Examples of Disclosures for Treatment, Payment, and Health Operations

Information obtained by a member of the healthcare team will be documented and used to determine the course of treatment that should work best for you. They will record the actions they took and their observations. In that way, we will know how you are responding to a treatment.

A bill may be sent to you or a third-party payer. This information on or accompanying the bill may include information that identifies you, as well as your diagnosis and procedures.

Members of the healthcare team may use information in your health record in an effort to continually improve the quality and effectiveness of the healthcare and service we provide you.

There are some services provided in our organization through contacts with business associates. Examples include our billing service. When our associates are contacted, we may disclose your health information to them so they may perform the job we’ve asked them to do and bill you for services rendered. To protect your health information, however, we require them to appropriately safeguard your information.

We may disclose information to notify or assist in notifying a family member or other person responsible for care if there is concern for you immediate safety.

Health professionals, using their best judgment, may disclose to a family member or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.

We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.

As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

We may disclose health information for law enforcement purposes as required by law or in response to a court order.

For some other disclosures of your health information we are required by laws of Minnesota to obtain a written consent from you, unless the disclosure is authorized by law.

Nebula Health Services

P.O. Box 97 * North Branch, MN 55056

Ph: 612-800-7600 * Fax: 612-800-7602