Privacy Notice

Notice of Privacy Practices

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Bethel Lutheran Home is dedicated to maintaining the confidentiality of your health information. We are required by law to maintain the privacy of your health information and provide you a description of our privacy practices. We will abide by the terms of this notice and notify you if we cannot agree to a requested restriction. We will accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

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.

Use and Disclosures of Medical Information about you:

The following categories describe examples of the way we use and disclose medical information:

For Treatment:  We may use medical information about you to provide treatment or services to you. We may disclose medical information about you to doctors, nurses, and other facility personnel who are involved in taking care of you.  For example:   A) Different departments to coordinate different things you may need such as adaptive equipment, therapy, lab  work, meals.  B) Provide your physician or other health care provider with copies of reports to assist in treating you.

For Payment:  We may use and disclose medical information about your treatment and services to bill and collect payment from you, your insurance company or a third-party payer (Medicare/Medicaid).  For example:  A) Provide State and Federal agencies with your assessment information to determine the rate you will be charged for care provided at our facility.  B)  Give insurance company information to determine coverage.

For Health Care Operations:  Members of the staff may use information in your record to assess the quality of care we provide and outcomes in your case and others like it. The results will then be used to continually improve the quality of care for all residents we serve.  For example:  A) Quality assessment studies to compare ourselves with other facilities.  B)  Information used for in-service/education training for our staff.

Other Uses and Disclosures:

• To survey your satisfaction with our services.

• To tell you about health related benefits and services.

• To contact you as part of fund-raising efforts

• As required by state or federal law )i.e. funeral directors, state data-surveyor information)

• For conducting training programs or reviewing competence of health care workers.

We will remove personal identification to the extent possible to protect your privacy.

Business Associates:  There are some services provided in our organization through contracts with business associates. We may use and disclose medical information with these business associates contracted to perform agreed upon services.  For example:  A) Transcription services and B) Specialized medical Equipment Suppliers.

Whenever you health information is disclosed to a Business Associate, we will have a written contract with them to protect the privacy of your information.

Directory:  If you agree, we will include in our facility directory your name, location in facility, religious affiliation. This information will be provided to members of the clergy (be religious affiliation) and, except for religious affiliation, to people that ask for you by name. If you do not wish to be in the facility directory, please request the Media/Publication Form from the Admissions Coordinator or the Social Service Office.

Individuals Involved in Your Care or Payment for Your Care: 

• Family, friend who is involved in your medical care or helps pay for your care (ie, POA, Guardian, or other Responsible Party).

• An entity assisting in disaster relief effort

• Research

• Future communications (newsletters, health related information, disease management programs)

• Affiliated covered entity (information available to your physicians as necessary, etc.)

Required by Law:

Examples:  Public Health, Workers Compensation, Funeral Directors, Medical Director, Health Oversight Agencies

• Law enforcement/legal proceedings - only as required by law or in response to a valid subpoena.

• State specific requirements

Your Health Information Rights

Although your health record is the physical property of Bethel Lutheran Home you have the right to:

A)  Inspect and Copy

• Includes medical and billing records as well as psychotherapy notes

• We may deny your request to inspect and copy in certain very limited circumstances

• You may request a review of the denial and we will comply with that outcome

• Contact Privacy Officer with questions

B)  Amend

• If you feel medical information is incorrect or incomplete

• If we deny your request, you will be notified

• Contact Privacy Officer for request form

C)  Request An Accounting of Disclosures

• We will maintain a list of disclosures we make about your protected health information

D)  Request Restrictions

• On medical information we use or disclose for treatment, payment or operations

• On medical information disclosed to person involved in your care or payment for care

• We are not required to agree to your request

•  Obtain a restriction by contacting the Admission Coordinator or Social Services Office

If we do agree, we will comply with restriction requests unless information is necessary to provide you treatment in an emergency situation.

E)  Request Confidential Communications

• We will agree to share confidential information at alternative locations or by alternative means upon reasonable request (For example, using an alternative address for billing services).

• We will not request an explanation

• Notify Privacy Officer to make this request

F)  To Request a Paper Copy of This Notice at any time and as often as desired.

If you want to exercise any of these rights, please submit your request in writing to our Privacy Officer: 

      Jeanne Buschta

      Bethel Lutheran Home

      PO Box 1828

      Williston, ND 58802-1828

We reserve the right to make changes to this notice at any time. A new notice will be posted with the effective date and you may request a revised copy from the Admission Coordinator or Social Service Office.

Complaints

If you believe any of your privacy rights have been violated you can file a complaint by:

• Contacting our Privacy Office. In addition all complaints must be submitted in writing.

• If you are not satisfied, you many also contact the Secretary of the Department of Health and Human Services

• You will not be penalized for filing a complaint

Use and Disclosures with Written Consent

• Other uses and disclosures not covered by this notice or required by law must have written authorization from you or responsible party.

• The written authorization may be revoked at any time.

• We cannot take back disclosures made with your permission.

This policy is effective:      4/14/2003

If you have any questions contact Privacy Officer:   Jeanne Buschta, 701-572-6766

  Admissions

  Adult Day/Respite Care

  Basic Care

  Child Care

  Independent Living Apt.

  Pastoral Care

  Rehabilitation

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