MINNESOTA CENTER FOR PSYCHOLOGY, LLC
NOTICE OF PRIVACY PRACTICES
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.
The law requires us to protect the privacy of your health information and to provide you with notice of our legal duties and privacy practices with respect to this health information. We are required to follow the terms of the Notice that is currently in effect. This Notice outlines our legal obligations regarding your health information and is effective as of February 2, 2010. We reserve the right to change the terms of this Notice and to make the new terms effective for all health information we possess. If this Notice is changed, we will post the revised Notice on our website and in our office, and we will give you a revised Notice upon request.
How We May Use or Disclose Your Health Information
The law allows us to use or disclose your health information for the following purposes:
1. For Treatment. We may use or disclose your health information to provide you with medical treatment or services. For example, a mental health practitioner may review your medical record and release medical information for a consultation or referral. We will get your written consent prior to making disclosures outside our practice for treatment purposes, except in emergency circumstances when it is not possible to get your consent.
2. For Payment. We may use and disclose your health information to receive payment for treatment that you receive. For example, we may send a bill to your health insurance company that describes the services we provided to you. We will get your written consent prior to making disclosures for payment purposes.
3. For Health Care Operations. We may use and disclose your health information for the operation of our practice. For example, we may share information with our staff or employees for training purposes or to assess the quality of care provided in our practice. We will get your written consent before making disclosures to others outside our practice for health care operations purposes.
4. Communication with Family and Friends Involved in Your Care or Paying Your Bills. If you are able to make your own health care decisions, we will ask your permission before sharing medical information about you. If you are unable to make health care decisions, our health care practitioners may disclose relevant information if they believe that doing so is in your best interests.
5. Appointment Reminders. We may use your information to send you reminders about future appointments.
6. Notification. We may disclose your health information to notify a family member, a personal representative, or other persons responsible for your care about your location or general condition.
7. Public Health Agencies. We may use or disclose your health information for public health activities such as assisting public health authorities in preventing or tracking disease. We may be permitted and/or required by law to report neglect, child abuse, or abuse of a vulnerable adult.
8. Health and Safety. Your health information may be disclosed to avert a serious threat to health or safety of you or any other person. Any disclosure would be only to someone able to help prevent the threat. Minnesota law imposes a duty to warn on certain mental health care providers if a person has communicated a specific, serious threat of physical violence against a specific person.
9. Law Enforcement. We will only release your medical information to law enforcement officials in response to a valid court order, a grand jury subpoena, or warrant, or with your written consent. We may release non-medical information about you to law enforcement if we are asked by law enforcement for the information, or as may be required by law. In addition, we may release non-medical information about you if you are suspected of committing a crime on the practice’s premises.
10. Research. We may use and disclose your information for research purposes, either with your written authorization or otherwise consistent with applicable law. Minnesota law may require consent before your information can be released to an outside researcher. We will make a good faith effort to obtain your consent or refusal, as required by law, prior to releasing any identifiable information about you to outside researchers.
11. Health Oversight. We may disclose your information to a health oversight agency for activities authorized by law, including audits and investigations, in order for the government to monitor health care programs and compliance with laws. Minnesota law requires that patient-identifying information be removed from most disclosures for these purposes, unless you have provided us with written consent.
12. Lawsuits/Disputes. If you are involved in a lawsuit or dispute, we may disclose information about you in response to a court order, a grand jury subpoena, a warrant, with your written consent, or as otherwise required by law.
13. National Security, Intelligence, and Protective Services for the President and Others. We will release medical information about you to authorized federal officials for intelligence, counter-intelligence, national security activities, and protective services for the President or other authorized persons or foreign heads of state only as required by law or with your written consent.
14. Decedents. Health information may be disclosed to funeral directors, coroners, or medical examiners in the case of certain types of death for the purpose of identifying a deceased person, determining a cause of death or other purpose, in accordance with applicable law.
15. Workers’ Compensation. Your information may be used or disclosed in order to comply with laws and regulations related to Worker’s Compensation. Minnesota law permits disclosure of your information to the parties involved in the claim, without specific written consent, if the information is related to a workers’ compensation claim.
16. Business Associates. We may disclose your information to a business associate to perform functions on our behalf, if the business associate has signed an agreement to protect the confidentiality of the information.
17. As Required by Law. We may use and disclose your health information as otherwise required by law.
Other uses and disclosures will be made only with your written authorization, which you may revoke, except to the extent we have already acted upon the authorization. We are required to retain records of care provided to you.
Your Rights Regarding Your Health Information
You have the following rights with respect to your health information. If you would like to exercise any of these rights or if you have questions regarding your rights, please contact:
Minnesota Center for Psychology
Phone: (651) 644-4100
1. You have the right to request that we limit our uses and disclosures of your health information. Requests must be in writing, and you must tell us what information you wish to limit; whether you want to limit our use, our disclosure, or both; and to whom you want the limits to apply. If you pay out-of-pocket in full for an item or service, then you may request that we not disclose information pertaining solely to such item or service to your health plan for purposes of payment or health care operations. We are required to agree with such a request. However, we are not required to agree to any other request.
2. You have the right to request that we communicate with you through alternative means or locations. We will respect any reasonable requests. Requests must be in writing, and you must specify how and where you wish to be contacted. We may require you to provide information about how payment will be handled.
3. You have the right to review and obtain a copy of your health information. We may charge you a fee for the cost of providing you with such a copy. Requests must be in writing. If we maintain your health information in an electronic health record, you have the right to receive a copy of your health information in electronic form. You may also direct us to provide such electronic health information directly to an entity or person clearly and specifically designated by you in writing. We may deny your request in limited circumstances, such as if the disclosure will be harmful to your health. In such cases, we may supply the information to a third party who may release the information to you. You may have a denial reviewed by another health care professional chosen by the practice, and we will comply with the outcome of that review.
4. You have the right to request that we amend your health information. Requests must be in writing, and we may deny your request if it does not include a reason to support the request. We may also deny a request if you ask us to amend information that: was not created by us; is not part of the medical information kept by us; is not information you would be permitted to inspect and copy; or is already accurate and complete.
5. You have the right to obtain an accounting of disclosures of your health information, except disclosures: for treatment, payment, or health care operations; authorized by you; for national security or intelligence; or to correctional institutions and law enforcement with custody of you. Requests must be in writing and may not go back more than six years. You may receive one free accounting in any 12-month period; we will charge you for additional requests.
6. You have the right to receive a paper copy of this Notice.
You may complain to us if you think we have violated your privacy rights. You will not be retaliated against for bringing a complaint. Direct complaints to:
Minnesota Center for Psychology
2324 University Ave W, Sutie 120
St. Paul, Minnesota 55114
Phone: (651) 644-4100
You can also file a complaint with the Department of Health and Human Services, Office for Civil Rights.