Gateway Family Health Clinic Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE TERM ‘GFHC” SHALL BE USED THROUGHOUT THIS NOTICE TO REFER COLLECTIVELY TO ALL GATEWAY FAMILY HEALTH CLINIC PROVIDERS AND STAFF AT ALL CLINIC LOCATIONS.
Our Health Information Responsibilities:
- We have a duty to protect the privacy of your health information and to provide you with the most current Notice one time as of age 18.
- We are required by law to maintain the privacy of your health information and to provide you with this notice about ways we may use and disclose health information about you, as relate to our legal obligations and your privacy rights.
- We are required to notify you if there is a breach of your health information.
Your Health Information Rights:
Restrictions on Use or Disclosure: this Notice describes some restrictions on how we can use and disclose your health information. You may ask us for extra limits on how we use or to whom we disclose the information. You need to make that request in writing. We are not required to agree to your request. If we do agree, we will follow the restriction except in the following instances:
– in an emergency where the information is needed for your treatment
– if you give us written permission to use or disclose your information
– if you decide to end the restriction
– or as otherwise required by law.
– If you request that we place restrictions on our use or disclosure of your health information for treatment, payment or health care operations we will agree to that restriction if you pay in full at time of service
Your access to your health information:
You may request to look at or get copies of your health information. You need to make that request in writing. If you ask for copies of your health information in a format other than paper copies, we will give you that other format, if practical. If you ask for copies, we will charge photocopying fees, the cost of making copies of x-rays or other images and postage costs. If your request is denied, we will send the denial in writing, and include the reason and describe any rights you may have to a review of the denial.
You may ask us to change certain health information. You need to make such a request in writing. You must explain why the information should be changed. If we agree to make the change, we will try to inform prior recipients of the change. If your request is denied, we will send the denial in writing. This denial will include the reason and describe any steps you may take in response.
You may receive a list of disclosures of your health information – with some exceptions – made by us or our business associates. The list will not include disclosures made for treatment, payment or health care options, disclosures made before April 14, 2003, and other disclosures as allowed by law. You need to make your request in writing. If you ask for a list more than once in a 12 month period, we will charge you a fee for each list. Your request must state a time period which may not be longer than six years. You may withdraw or change your request to reduce or eliminate the charge.
Uses and Disclosures of Health Information:
GFHC safeguards your health information whenever it is used or disclosed. We make all uses and disclosures according to our privacy policies and the law. We may use and disclose your health information as follows:
– For your treatment (includes working with another provider related to your care).
– For obtaining payment (such as billing for services provided or to obtain prior approval or determine your health plan coverage).
– Our health care operations. This is defined as activities related to quality assessment and improvement, or to engage in care coordination or case management, or to otherwise manage our business.
– In a medical emergency.
– To people involved in your care. If you request a family member or emergency contact to obtain limited information, such as appointment dates, prescription lists, we will ask you to sign a “Protected Health Information” (PHI) form listing that individual’s name and what sort of information we may share.
– For research if allowed by law or if you have given permission.
– Death; organ donation – we may disclose certain health information about a deceased person to the appropriate next of kin. We may also disclose this information to a funeral director, coroner, medical examiner, law enforcement official or organ donation agency.
– Law enforcement. We may disclose certain health information to law enforcement, examples including when there may have been a crime at the facility or when there is a serious threat to the health or safety of another person or people.
– Correctional Facility. We may disclose the health information of an inmate or other person in custody to law enforcement or a correctional institution. (CONTINUED)—–
– Abuse, neglect or threat. We may disclose health information to the proper authorities about possible abuse or neglect of a child or vulnerable adult. If there is a serious threat to a person’s health or safety, we may disclose information to the person or to law enforcement.
– Food and Drug Administration. We may disclose health information to entities regulated by the FDA to measure the quality, safety and effectiveness of their products.
– Military Authorities/National Security. We may disclose health information to authorized people from the US military, foreign military and US national security or protective services.
– Public Health Risks. We may disclose health information about you for public health purposes such as preventing or controlling disease, injury or disability; reporting births and deaths; notifying people of recalls of products they may be using; notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
– Health Oversight Activities. We may disclose health information to government, licensing, auditing and accrediting agencies for actions allowed or required by law.
– As required by other laws.
– Legal process. We may disclose health information in response to a state or federal court order, legal orders, subpoenas or other legal documents.
– To Business Associates. GFHC contracts with various business associates to provide some services. Examples include attorneys, consultants, laboratories and collection agencies. To protect the information that is disclosed, each business associate is required to sign an agreement to appropriately safeguard the information and not to redisclose the information unless specifically permitted by law.
Your authorization to release or disclose health information.
GFHC may use or disclose health information only with your written permission, except as described above. If you give written permission, you may withdraw it at any time by notifying us in writing. Authorization forms are available at any GFHC location. That Authorization requires you to specifically approve release of any information regarding chemical dependency, mental health/psychotherapy, alcohol/drug abuse or HIV/STD treatment if such information is included in your records. Your specific authorization is required to use or disclose your protected health information for marketing purposes or fundraising opportunities.
Who must follow the terms of this Privacy Notice:
All medical staff, employees, medical students or residents will comply with this Notice. If you receive services at GFHC from a health provider who is not a GFHC staff member, that health care provider will still be required to follow the terms of this notice with regards to those services.
Questions or Complaints: If you have questions about our privacy practices, please contact us as listed below:
Clinic Manager/Privacy Officer – 1-218-485-2001 or Clinic Administrator 1-218-485-2000
Gateway Family Health Clinic, Ltd., 4570 County Highway 61, Moose Lake, MN 55767
You may also send a written complaint to the US Department of Health and Human Services. We will provide you with that address upon request. Please know you will not be penalized for filing a complaint. If you have a question about obtaining your health information, please contact our Health Information department at the clinic of your choice.
Changes to this Notice.
GFHC is required by law to maintain the privacy of protected health information in accordance with applicable federal and state laws and to provide individuals with this notice of its legal duties and privacy practices with respect to health information. The effective date of this Notice is April 14, 2003 and has been updated as of September 23, 2013. Revised Notices are available and posted at all clinic locations and on our website at www.gatewayclinic.com