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 THIS NOTICE CAREFULLY.
If you have any questions about this Notice of Privacy Practices or Your Rights as described in this Notice Please contact our Privacy Officer by calling 320.253.1909 or 1.800.383.1908.
Your personal health and medical information is defined as Protected Health Information (PHI) by a federal law known as HIPAA. More specifically, PHI is information about you, including demographic information that may identify you and information that relates to your past, present, or future health or medical condition, physical or mental, and any related healthcare services.
This Notice of Privacy Practices (“Notice”) describes how Midwest EAP Solutions (commonly referred to in our documents and materials as “Midwest” or “Practice” or “We”) may use and disclose your PHI to provide treatment, obtain payment or carry out healthcare operations and for other purposes permitted or required by law. This Notice also describes your rights as a patient to access and control your health information.
Midwest is required to abide by the terms of this Notice. We may change the terms of our Notice, at any time. If We change this Notice, then We will change our practice of handling PHI to comply with the revised Notice as of its effective date. You may request a revised Notice by calling our Privacy Officer or by visiting our office and requesting that a revised copy be sent to you.
PERMITTED USES AND DISCLOSURES
The following describes ways that Midwest may use and disclose your PHI by various categories. Not every use or disclosure will be listed within these categories. However, all of the ways Midwest is permitted to use and disclose your PHI falls within one of these categories. Examples of the uses and disclosures that We may make under each section are as follows:
Treatment. We may use your PHI to provide you with healthcare treatment and/or services. We may disclose your health information to physicians, nurses, technicians, health career students, therapists, or any other personnel who are involved in taking care of you. For example, we may disclose your PHI, as necessary to a physician who may be treating you for your health needs. We may also disclose your PHI for purposes of consultation or to enable the preparation of prescriptions or for any other treatment purpose. For example, we may need to disclose your PHI to a hospital that provides care to you or to another type of health care professional that requires information to appropriately diagnose your condition and to provide effective care and treatment to you.
We may disclose your PHI by calling you by name for an appointment or visit with a healthcare professional. We may use or disclose your PHI, as necessary, to contact you and to remind you of your appointment.
Payment. Midwest will use your PHI to obtain payment for your healthcare services. For example, we may need to give your health plan or coverage program information about your care and treatment so that We will be paid or for you to be reimbursed for the charges related to the services we provided. In addition, we may share your PHI with your health plan or coverage program to obtain prior approval or to determine whether or not your health plan or coverage program will cover the services or treatment being planned or considered.
Healthcare Operations. Midwest may use or disclose your PHI to support necessary business activities. These business activities include quality assurance programs, employee review scenarios and/or training of staff. We may use your PHI to review our treatment and services and to evaluate our performance in caring for you. For example, we may use PHI to aggregate data and information to determine whether We should provide new or additional services, if certain services should be discontinued, whether certain treatment protocols are effective, or to periodically assess the need for any focused improvement efforts.
Business Associates: We will share your PHI with certain contractors, defined under the Privacy Rule as Business Associates, to perform activities necessary to treatment, payment and/or healthcare operations. We will maintain a written agreement with such Business Associates to protect your PHI from unlawful uses or disclosures.
Required by Law. We may use or disclose your PHI to the extent that federal, state or local law requires the use or disclosure. The use or disclosure will be made in compliance with law and will be limited to the relevant requirements. You will be notified of any such uses or disclosures when the law requires such notification.
Minnesota Department of Health. We may disclose your PHI for certain public health programs to a public health authority that is permitted by law to collect or receive your health information. This disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your PHI, if directed by the appropriate public health authority, to a foreign government agency that is working with a public health authority.
Communicable Diseases. We may disclose your PHI, if authorized by law, to individuals who may have been exposed to a communicable disease or who may be at risk of contracting or spreading the disease or condition.
Health Oversight. We may disclose your PHI to a health oversight agency for activities authorized by law, such as those related to investigations and inspections. Oversight agencies seeking this information include government agencies that oversee the healthcare system, government benefit programs, and other government regulatory programs and civil rights laws.
Abuse or Neglect. Midwest may disclose your PHI to a human services or law enforcement authority authorized by law to receive reports of child abuse or neglect. We may disclose your PHI if we believe in good faith that you have been a victim of abuse, neglect, or domestic violence and such disclosure is to a government agency authorized to receive such information. Such disclosure will comply with the requirements in federal and state laws.
Food and Drug Administration. We may disclose your PHI due to an incident related to, and as required by, the Food and Drug Administration to report adverse events, product defects or problems, biological produce deviation, to track FDA-regulated products, to enable product recalls, repairs or replacements, to conduct post-marketing surveillance and for look-back, i.e., to locate and notify persons having received products since withdrawn or recalled.
Legal Proceeding. We may disclose PHI in the course of judicial or administrative proceedings, in response to an order of a court or tribunal (to the extent expressly authorized), and in certain conditions in response to a subpoena, discovery request, or other lawful processes.
Law Enforcement. We may disclose your PHI when necessary for law enforcement purposes and when applicable legal standards and requirements have been met. These purposes include requests for information for (1) legal processes required by law; (2) identification and location purposes; (3) victims of a crime; (4) suspicions that death has occurred as a result of criminal behavior; (5) crimes that may have occurred on Midwest premises; and (6) if a medical emergency arises away from our premises and it is likely that a crime has occurred.
Research. If you are participating in a research program approved by an Institutional Review Board (IRB) and you have signed a research participation agreement and consent form that has been provided to Midwest, then we may disclose your PHI to designated researchers in conformance with the research collection protocols.
Criminal Activity. Where applicable federal and state laws indicate, Midwest may disclose your PHI if we believe the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose your PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.
Inmates. We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
Military Activity and National Security. In certain situations, Midwest may use or disclose your PHI if you are deemed to be Armed Forces personnel in the following situations: (1) for activities deemed necessary by appropriate military command authorities; (2) for a determination by the Department of Veteran Affairs of your eligibility for benefits; or (3) to a foreign military authority if you are a member of that foreign military service. We may also disclose your PHI to authorized officials conducting national security or intelligence activities including the provision of protective services to the President or others as authorized by law.
Workers Compensation. Midwest may disclose your PHI to comply with worker compensation laws and other similar programs established by law.
Required Use and Disclosures. The Privacy Rule mandates that we make disclosures when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the Privacy Rule and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Specifically, the requirements of Section 164.500 et seq.
Health-Related Services and Treatment Alternatives. We may use your PHI to inform you about health-related services, options, or alternatives that may be helpful to you.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
Midwest understands that your PHI and matters related to your health are personal. We are committed to protecting your PHI and to informing you about your rights in respect to your PHI. The following statements relate to your rights, your PHI, and how you may exercise your rights.
If you have questions about this Notice of Privacy Practices or Your Rights as described below, please contact our Privacy Officer by calling 320.253.1909 or 1.800.383.1908. If you have special requests, restrictions, or directions for us to consider or coordinate in respect to your PHI, this Notice, or Your Rights, you must communicate with us in a writing that is signed, dated and addressed to:
Attention: Privacy Officer
Midwest EAP Solutions
1015 W. St. Germain, Ste. 440
St. Cloud, MN 56301
Right to Request Restrictions on Uses and Disclosures. You have the right to ask Midwest not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations. You also have the right to request Midwest to restrict the use or disclosure of PHI to family members or personal representatives. However, We are not required to agree to any restriction you may request. But, if We do agree to your requested restriction and believe it to be in your best interest, We may not violate your requested restriction except as necessary to the delivery of emergency medical care. Request by writing to our Privacy Officer.
Right to Access Your PHI. In most cases, you have the right to inspect and obtain a copy of PHI that We maintain about you. To receive a copy of your PHI, We may charge you the cost of copying, mailing and supplies associated with your request. Certain types of PHI will not be available for inspection and copying. This includes PHI collected by us in connection with or in reasonable anticipation of legal claims or proceedings. In limited circumstances We may deny your request to inspect and obtain a copy of your PHI. If We deny your request to inspect and copy, you may request that the denial be reviewed. An individual chosen by Midwest who is not involved in the original decision to deny your request will conduct the review. Midwest will comply with the outcome of that review. In these matters, Write to our Privacy Officer.
Right to Amend Your PHI. You have the right to request that your PHI be amended if you believe your PHI maintained by Midwest is incorrect or that an important part of your PHI is missing. We may deny your request if your request is not in writing or does not include a reason that supports your request. If your request to amend your PHI is declined, you have the right to prepare a statement of disagreement to be included with your PHI. At our discretion, We have the right to include a rebuttal to your statement with your PHI; however, We will provide you with a copy. In regard to your right to amend your PHI, Write to our Privacy Officer.
Right to Receive an Accounting of Disclosure. You have a right to request an accounting of the disclosures of your PHI that Midwest has made, if any, for reasons other than disclosures for treatment, payment, healthcare operations or disclosures that have been made pursuant to proper authorization by you. Your right to an accounting of Midwest disclosures of your PHI applies only to your PHI created after April 14, 2003 and cannot exceed a period of six years prior to the date of your request. The initial accounting you request within a twelve-month period will be free. However, We may charge you for any additional accounting requests. We will notify you of the cost involved and you may choose to withdraw or modify your request before any costs are incurred. Regarding these requests, Write to our Privacy Officer.
Right to Receive Confidential Communication. You have the right to request communications involving your PHI be provided to you at an alternative location or by an alternative means of communication. Midwest is required to accommodate any reasonable request if the normal method of disclosure may endanger you. Write to our Privacy Officer with this request and briefly describe the reason for your request.
Right to File a Complaint. You have a right to file a complaint with Midwest or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. All complaints must be submitted in writing. You will not be penalized or retaliated against in any way for filing a complaint. If you have questions on filing a complaint, please contact our Privacy Officer by calling 320.253.1909 or 1.800.383.1908. Submit complaints in writing to our Privacy Officer.
Right to Receive a Paper Copy of This Notice. Upon request, even if you have previously agreed to accept this Notice electronically, you have a right to request a paper copy of this Notice. Make such request in writing addressed to our Privacy Officer.
Effective Date of Notice. This Notice was published and made effective April 14, 2003.
Additional Information or Change to this Notice. We reserve the right to add information or change the terms of this Notice at any time. The effective date of this Notice and any revised Notice may be found on the last page at the bottom right hand corner of the Notice. You may request a copy of a revised Notice by mail or email, but we will only deliver the Notice by email if email delivery is offered by Midwest and if you have agreed to such delivery. A copy of our Notice is also available in the Midwest lobby area. Write to our Privacy Officer for a copy.
Further Information. You may have other rights under various but related laws. You may always request information on our policies and practices by writing to our Privacy Officer.
Patient Acknowledgment of Receiving Notice of Privacy Practices & Midwest Documentation
You will be requested to acknowledge your receipt of this Notice of Privacy Practices by signature on a form designed for that purpose. Midwest will retain that form, once signed by you, within the medical record established for you by Midwest. If you refuse or are unable to sign the acknowledgment form that we provided you with this Notice, we will document your records accordingly as part of our good faith effort to promote your review and understanding of this Notice of Privacy Practices.
Effective Date: 4/14/03