Notice of Privacy Practices
Effective Date: 1/16/2023
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW THIS INFORMATION CAREFULLY.
If you have any questions about this notice, please contact the Northern Lakes Surgery Center Privacy Officer at 218.509.2063.
Each time you visit a hospital, physician or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and billing-related information. This notice applies to all of the records of your care generated by Northern Lakes, whether made by Northern Lakes personnel or agents of Northern Lakes.
We are required by law to keep your health information private and to provide you a description of our privacy practices. We will follow the terms of this notice and notify you if we cannot agree to a restriction you request. We will accommodate reasonable requests you make to communicate health information by alternative means or to alternative locations.
Uses and Disclosures
The following are examples of how we use and disclose your medical information.
For Treatment: We may use your medical information to give you appropriate treatment or services. This means your medical information may be shared with doctors, nurses, technicians, medical students or other Northern Lakes staff who are involved in taking care of you. 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. We may share your medical information to coordinate the care you may need, such as prescriptions, lab work, meals and X-rays. We may also provide your doctor or a subsequent healthcare provider with copies of various reports that will help them provide ongoing care to you.
For Payment: We may use and disclose information about your treatment and services to bill and collect payment from you, your insurance company or a third-party payer. For example, we may need to give your insurance company information about your surgery so they will pay us or reimburse you for the treatment. We may also tell your insurance provider about treatment you are going to receive to determine whether they will cover it. You have the right to request restrictions on information disclosures to your insurance provider for services paid out-of-pocket in full and disclosure is not otherwise required by law.
For Health Care Operations: We may use your health records to assess care and outcomes in your case and others like it. We do this to continually improve the quality of care for all patients we serve. For example, we may combine medical information about many patients to evaluate the need for new services or treatments. We may also disclose this information to doctors, nurses and students for educational purposes.
We may also use and disclose your medical information for the following:
- To remind you that you have an appointment for medical care;
- To assess your satisfaction with our services;
- To tell you about possible treatment alternatives;
- To tell you about health-related benefits or services;
- For health department or regulatory agency activities relating to improving health;
- For population-based monitoring and review.
Business Associates: There are some services provided in our organization through contracts with business associates. Examples include physician radiology services, certain laboratory tests and companies that we contract with for billing. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do. To protect your health information, however, we require that all of our business associates appropriately safeguard your information.
For Health Information Exchanges: We may participate in one or more electronic health information exchanges, record locators or patient information services. These allow us to exchange health information about you with other participating providers and their business associates. In order for us to do this, the provider must have a treatment relationship with you. For example, we may notify your primary care provider when you are admitted to the hospital, or we may give a doctor providing care to you access to our records so they can treat you. If you would like to opt out of the electronic health information exchange, please request the Health Information Exchange Authorization form from the admissions staff.
Individuals Involved in Your Care or Payment for Your Care: In certain circumstances, we may have to release medical information about you to a family member or friend who is involved in your medical care or to someone who helps pay for your care. In addition, if you are a victim of a disaster, we may disclose medical information about you to an outside entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
Research: Federal and state law permit the use and disclosure of health information for medical research purposes under certain circumstances. Your authorization will be obtained to use or disclose health information for research purposes, unless an exception to the authorization requirement applies. Exceptions include where the health information has been de-identified or where an Institutional Review Board has approved a waiver of authorization. In some situations, limited information may be used before approval of the research study to allow a researcher to determine whether enough patients exist to make a study scientifically valid. Northern Lakes does not disclose individually identifiable health information to external researchers without authorization, and we will only use such information for internal research purposes in accordance with applicable law.
Future Communications: We may communicate with you via newsletters, mailings or other means regarding treatment options, health-related information, disease management programs, fundraising, wellness programs, other community-based initiatives or activities our facility is participating in. You may contact Northern Lakes and ask not to be included in future communications, if you wish.
Law Enforcement/Legal Proceedings: We may disclose health information for law enforcement purposes as required by law or in response to a court order or search warrant.
As required by law, we may also use and disclose health information to the following types of entities, including but not limited to:
- Food and Drug Administration (FDA)
- Public Health or Legal Authorities charged with preventing or controlling disease, injury or disability
- Correctional Institutions
- Workers Compensation Agents
- Organ and Tissue Donation Organizations
- Health Oversight Agencies, such as Medicare or Medicaid
- Medical Examiners and Funeral Directors
- National Security and Intelligence Agencies
- Protective Services for the President and others
Your Health Information Rights
Although your health record is the physical property of the healthcare provider or facility that compiled it, you have the right to:
Inspect and Get Copies: You have the right to inspect and get paper or electronic copies of medical information that may be used to make decisions about your care. We may deny your request to inspect and get copies in certain limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by Northern Lakes will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Amend: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by Northern Lakes. We may deny your request for an amendment and if this occurs, you will be notified of the reason for the denial.
An Accounting of Disclosures: You have the right to request an accounting of disclosures that occurred in the six years prior to the date on which the accounting is requested. This is a list of the disclosures we made of medical information about you. The list will not include disclosures made for treatment, payment or healthcare operations.
Request Restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. All such requests must be in writing. 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, you give us written permission to use or disclose the restricted information, if you decide or we decide to end the restriction, or as otherwise required by law. In addition, you have the right to request a restriction on disclosure of your information to your health plan if you have paid for the service in full and disclosure is not otherwise required by law.
Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. We will agree to the request to the extent that it is reasonable for us to do so. For example, you can ask that we use an alternative address for billing purposes.
Privacy Breach Notification: You have the right to notification of a breach of unsecured protected health information.
To exercise any of your rights, please obtain the required forms from the Privacy Officer or from your physician or your physician’s office staff and submit your request in writing.
Changes to This Notice
We reserve the right to change this notice. The revised or changed notice will be effective for information we already have about you as well as any information we receive in the future. Copies of the current notice will be available for pick up and will be posted at all registration sites. In addition, each time you register at a Northern Lakes facility for treatment or healthcare services, a copy of the current notice in effect will be made available to you.
If you believe your privacy rights have been violated, you may file a complaint by contacting the Northern Lakes Privacy Officer at the telephone number or email address provided below or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Other Uses of Medical Information
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. We are unable to take back any disclosures we have already made with your permission.
Northern Lakes Surgery Center Privacy Officer