Privacy Statement

ST. JOHN LUTHERAN HOME & VISTA RIDGE
201 SOUTH COUNTY ROAD 5
SPRINGFIELD, MN 56087
507-723-3200

The Maples at St. John
301 South County Road 5
Springfield MN 56087
507-723-3250

 

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.

If you have any questions about this notice, please contact:

Patricia Schulte, RHIT
Privacy Officer
507-723-3200

WHO WILL FOLLOW THIS NOTICE:

This notice describes our nursing home practices and that of:

  1. Any healthcare professional authorized to enter information into your chart.
  2. All departments and units of the nursing home.
  3. Any member of a volunteer group we allow to help while you are in the nursing home.
  4. All employees, staff and other nursing home personnel.

OUR PLEDGE REGARDING MEDICAL INFORMATION:

We understand that medical information about you and your health is personal. We are committed to protecting medical/health information about you. We create a record of the care and services you receive at the nursing home. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the nursing home, whether made by nursing home staff or consulting staff.

We are required by law to:

  1. make sure that health information that identifies you is kept private;
  2. give you this notice of our legal duties and privacy practices with respect to health information about you; and
  3. follow the terms of the notice that is currently in effect.

I. HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS

For Treatment: We may use and disclose health information about you to provide you with medical treatment or services. We may disclose health information about you to facility and non-facility personnel such as doctors, nurses and technicians who are involved in taking care of you at St. John Lutheran Home. 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. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of the facility also may share health information about you in order to coordinate the different things you need, such as Physical therapy, lab work and medications. We also may disclose health information about you to people outside the facility who may be involved in your medical care.

For Payment: We may use and disclose your personal health information so that we can bill and receive payment for the treatment and services you receive at this facility. For billing and payment purposes, we may disclose your personal health information to your representative, an insurance or managed care company, Medicare, Medicaid or another third party payor. For example, we may contact Medicare or your health plan to confirm your coverage or to request prior approval for a proposed treatment or service. We may also disclose health information about you to allow another health care provider to be paid for services they provide to you. We can refuse to provide services to you if you do not authorize us to disclose health information in order to receive payment for our services.

For Health Care Operations: We may use and disclose your personal health information for facility operations. These uses and disclosures are necessary to manage the facility and to monitor our quality of care. For example, we may use personal health information to evaluate our facility’s services, including the performance of our staff.

II. HOW WE MAY USE AND DISCLOSE PERSONAL HEALTH INFORMATION ABOUT YOU FOR OTHER SPECIFIC PURPOSES

Facility Directory: Unless you object, we will include certain limited information about you in our facility directory. You have the right to request that your name not be included in the “Facility Directory”, however, then no information will be given to visitors, florists, etc. This information may include your name, your location in the facility, and your general condition (which is good, fair, poor) and your religious affiliation. Our directory does not include specific health information about you. We may release information in our directory, except for your religious affiliation, to people who ask for you by name. We may provide the directory information, including your religious affiliation, to any member of the clergy.

Individuals Involved in Your Care or Payment for Your Care: Unless you object, we may release health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care.

Disaster Relief: We may disclose your personal health information to an organization assisting in a disaster relief effort (such as a tornado).

As Required By Law: We will disclose health information about you when required to do so by federal, state or local law. For example, all of our beds are Medicare and Medicaid certified so we will electronically submit, as an example, billing data, via a secure line as required by Federal law.

Public Health Activities: We may disclose health information about you for public health activities. These activities generally include the following:

to report reactions to medications or problems with products;

to notify people of recalls of products they may be using;

reporting to a public health or other government authority for preventing or controlling disease, injury or disability;

to notify a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition or

for certain purposes involving workplace illness or injuries.

Reporting Victims of Abuse, Neglect or Domestic Violence: If we believe that you have been a victim of abuse, neglect or domestic violence, we may use and disclose your personal health information to notify a government authority if required or authorized by law, or if you agree to the report.

Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. An example would be the required yearly surveys performed by the Minnesota Department of Health or random Medicare audits.

Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order or agreement protecting the information requested.

Law Enforcement: We may disclose your personal health information for certain law enforcement purposes, including:

As required by law to comply with report requirements;

To comply with a court order, subpoena, warrant, summons, investigative demand or similar process;

To identify or locate a suspect, fugitive, material witness, or missing person;

When information is requested about the victim of a crime if the individual agrees or under other limited circumstances;

To report information about a suspicious death;

To provide information about criminal conduct occurring at the nursing home;

To report information in emergency circumstances about a crime; or

Where necessary to identify or apprehend an individual in relation to a violent crime or an escape from lawful custody.

Research: We may allow personal health information of residents from our own facility to be used or disclosed for research purposes provided that the researcher adheres to certain privacy protections, unless you object. If you object, your personal health information will not be disclosed. Your personal health information may be used for research purposes only if a proposed research project has been reviewed and approved through a special research approval process and/or St. John Lutheran Home Administration. We will use reasonable efforts to obtain your specific permission if the research will have access to your name, address or other information that reveals who you are, or will be involved in your care at the facility.

Coroners, Medical Examiners and Funeral Directors: We may release your personal health information to a coroner, medical examiner, funeral director or, if you are an organ donor, to an organization involved in the donation of organs and tissue. This may be necessary, for example, to identify a deceased person or determine the cause of death.

To Avert a Serious Threat to Health or Safety: We may use and disclose your personal health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. An example might be a Diabetic resident with impaired memory who has wandered out of the facility and police and searchers are involved in the search and return.

Military and Veterans: If you are a member of the armed forces, we may use and disclose your personal health information about you as required by military command authorities. We may also use and disclose personal health information about foreign military personnel as required by the appropriate foreign military authority.

Worker’s Compensation: We may use or disclose your personal health information to comply with laws relating to workers’ compensation or similar programs.

National Security and Intelligence Activities: Protective Services for the President and Others: We may disclose personal health information to authorized federal officials conducting national security and intelligence activities or as needed to provide protection to the President of the United States, certain other persons or foreign heads of states or to conduct certain special investigations.

Fundraising Activities: We may disclose your name, address and phone number and those names identified on the admission intake form in fundraising efforts for St. John Lutheran Home and/or Foundation. We would only release contact information, such as your name, address and telephone number and the dates you received treatment or services from us. We will not give or sell this information to any other parties. You have the right to request that no fundraising requests be sent to you by contacting the Privacy Officer, St. John Lutheran home, 201 S. County Road 5, Springfield, MN 56087.

III. YOUR AUTHORIZATION IS REQUIRED FOR OTHER USES OF PERSONAL HEALTH INFORMATION

We will use and disclose personal health information (other than as described in this Notice or required by law) only with your written Authorization. You may revoke your Authorization to use or disclose personal health information in writing, at any time. If you revoke your Authorization, we will no longer use or disclose your personal health information for the purposes covered by the Authorization, except where we have already relied on the Authorization. (Example: you revoke your Authorization to send copies of your health record to your insurance company).

IV. YOUR RIGHTS REGARDING YOUR PERSONAL HEALTH INFORMATION

You have the following rights regarding health information we maintain about you:

Right to Request Restrictions. You have the right to request a restriction or limitation on the health 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 health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.

We are not required to agree to your request and we will inform you of this decision. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you must make your request in writing to Health Information Services. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

Right of Access to Inspect and Copy Personal Health Information: You have the right to inspect and obtain a copy of your health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.

To inspect and copy health information that may be used to make decisions about you, you must submit your request to Health Information Services. We must allow you to inspect your records within 24 hours of your request. If you request a copy of the information to review your current health care, we must provide you with copies within 2 business days of that request without cost. For other requests, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, we will provide it to an appropriate third party or to another provider, and that other provider or third party may release the information. You may also request that the denial be reviewed. Another licensed health care professional, chosen by the nursing home, 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.

Right to Amend. If you feel that health 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 or for the nursing home.

To request an amendment, your request must be made in writing and submitted to Health Information Services. In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;

Is not part of the health information kept by or for the nursing home;

Is not part of the information which you would be permitted to inspect and copy; or

Is already accurate and complete as determined by the facility.

If we deny your request for amendment, we will give you a written denial including the reasons for the denial and the right to submit a written statement disagreeing with the denial.

Right to an Accounting of Disclosures: You have the right to request an “accounting ” of our disclosures of your personal health information. This is a listing of certain disclosures of your personal health information made by the facility or by others on our behalf, but does not include disclosures for treatment, payment and health care operations or certain other exceptions.

To request an accounting of disclosures, you must submit a request in writing, stating a time period beginning after April 13, 2003 that is within six years from the date of your request. Send the request to the Privacy Officer, St. John Lutheran Home, 201 S. County Road 5, Springfield, MN 56087. An accounting will include, if requested: the disclosure date; the name of the person or entity that received the information and address, if known; a brief description of the information disclosed; a brief statement of the purpose of the disclosure or a copy of the authorization or request; or certain summary information concerning multiple similar disclosures. The first accounting provided within a 12-month period will be free; for further requests, we may charge you our costs.

V. COMPLAINTS

If you believe that your privacy rights have been violated, you may file a complaint in writing with St. John Lutheran Home or with the Office of Civil Rights in the U.S. Department of Health and Human Services. To file a complaint with the facility, contact Patricia Schulte, RHIT, Privacy Officer at 507-723-3200 or St. John Lutheran Home, 201 S. County Road 5, Springfield, MN 56087.

We will not retaliate against you if you file a complaint.

VI. CHANGES TO THIS NOTICE

We will promptly revise and distribute this Notice whenever there is a material change to the uses or disclosures, your individual rights, our legal duties, or other privacy practices stated in this Notice. We reserve the right to change this Notice and to make the revised or new Notice provisions effective for all personal health information already received and maintained by the facility as well as for all personal health information we receive in the future. We will post a copy of the current Notice in the facility, in the Survey & Compliance Book located by the Dining Room. In addition, we will provide a copy of the revised Notice to all residents.

VII. FOR FURTHER INFORMATION

If you have any questions about this Notice or would like further information concerning your privacy rights please contact Patricia Schulte, RHIT, Privacy Officer at 507-723-3200 or St. John Lutheran Home, 201 S. County Road 5, Springfield, MN 56087.