HAV-IT Services Notice of Privacy Practices
Effective Date: May 23, 2003
Approved By: HAV-IT Services Board of Directors
If you have any questions about this notice, please contact the Facility Privacy Officer by dialing (701)-324-4636.
State law and standards of accreditation and certification have stood as the basis of HAV-IT Services policy regarding confidentiality and privacy. HAV-IT Services is now
considered a “covered entity” by additional federal regulations as required by the Health Insurance Portability and Accountability Act, commonly called HIPAA.
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.
How we may use and disclose medical information about you.
Uses and Disclosures
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 you treatment or services. We may disclose medical information about you to doctors, nurses,
technicians, medical students, or other hospital/long term care personnel who are involved in taking care of you at HAV-IT Services. For example: a doctor treating you
for an injury may need to know if you have diabetes, because diabetes may slow the healing process, or if your Doctor orders Physical Therapy, the nursing staff will need to discuss your care and treatment with the Physical Therapist. Different departments of HAV-IT Services also may share medical information about you in order to coordinate the different things you may need, such as prescriptions, lab work, meals, and x-rays. We may also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you once you are discharged from HAV-IT Services.
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. 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 health plan about treatment you are going to receive to determine whether your plan will cover it. For Health Care Operations: Members of HAV-IT Services involved in your direct care and/or Individual Life Plan team may use information in your health record to assess the care and outcomes in your case and others like it. The results will then be used to continually improve the quality of care for all people we serve. For example, we may combine medical information about many individuals/residents to evaluate the need for new services, treatment, or equipment. We many disclose information to doctors, nurses, and other students for educational purposes.
We may also use and disclose medical information:
- To business associates we have contracted with to perform the agreed upon service and billing for it;
- 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;
- To contact you as part of fund raising efforts;
- For conducting ILP/care plan activities;
- To assure access to benefits and financial resources;
- For Population based activities relating to improving health or reducing health care costs;
- For conducting training programs and reviewing competence of health care professionals, HAV-IT Service staff, etc..
Business Associates: There are some services provided in our organization through contracts with business associates. Examples may include psychologists, ambulance
service, school systems, physician services in the emergency department and radiology, certain outside laboratories, or a copy service, a computer service,
accreditation agencies, etc.. 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 and bill you or your third party for services rendered. To protect your health information, however, we require the business associate to appropriately
safeguard your information.
Directory: We may include certain limited information about you in the HAV-IT Telephone Directory while you are here. The information may include your name,
address, phone number and the name of your Service Coordinator. This information is provided to HAV-IT employees so they know where you live and how they can contact you. If you would like to opt out of being in the HAV-IT Telephone Directory, please request the form “Notice of Amendment to Personal Health Information” from your Service Coordinator or HAV-IT’s Privacy Officer.
Individuals Involved in Your Care or Payment for Your Care: We may release medical information about you to a friend or family member who is involved in your medical care or who helps pay for your care. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
Fundraising Activities/Brochure: We may disclose your health information to a foundation, other entities to assist in fundraising efforts or our brochure. We would only release information such as your name, address and phone number and the dates that you received treatment or services from us. If you do not want us to contact you for fundraising efforts, you must notify your Service Coordinator or HAV-IT’s Privacy Officer to state (either orally or verbally) that you do not want to receive the information.
Research: We may disclose information to researchers when a HAV-IT Services review committee has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved their research.
Future Communications: We may communicate to you via newsletters, mail outs, or other means regarding treatment options, health related information, disease-management programs, wellness programs, or other community based initiatives or activities our facility is participating in.
Organized Health Care Arrangement: HAV-IT and its staff members have organized and are presenting you this document as a joint notice. Information will be shared as necessary to carry out treatment, payment, and health care operations. HAV-IT staff and caregivers may have access to protected health information in their offices to assist in reviewing past treatment as it may affect treatment at the time.
Affiliated Covered Entity: Protected health information will be made available to your physician as necessary to carry out treatment, payment, and health care operations.
As Required by Law:
- Funeral Directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.
- Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
- Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects or post marketing surveillance information to enable product recalls, repairs or replacement.
- Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
- Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.
- Correctional Institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof, health information necessary for your health, and the health and safety of other individuals.
- Judicial or Administrative: We may disclose health information in response to a court or administrative order, a discovery request, civil or criminal proceedings, a valid subpoena or other lawful process.
- Law Enforcement: We may disclose health information to law enforcement official for law enforcement purposes as required by law,
- in response to a court order, subpoena, warrant, summons or similar legal process;
- regarding a victim or death of a victim of a crime in limited circumstances;
- in emergency circumstances to report a crime, the location of the person who committed the crime including crimes that may occur at facilities owned or operated by HAV-IT Services
- To avert a serious health threat to health or safety: We may disclose your health information when necessary to prevent a serious threat to your health and safety or the health.
- National Security: We may disclose your health information to a federal official(s) for national security activities and for the protection of the President and other Heads of State.
- Military & Veterans: If you are/were a member of the armed forces, we may release your health information as required by military command authorities.
- Other uses of your health information: Other uses and disclosures of your health information not covered by this notice or the laws that apply to us will be made only with your written authorization. If you provide us with authorization to use or disclose your health information, you may revoke that authorization in writing at any time. Upon receipt of your written revocation, we will no longer use or disclose your health information for the purposes of the authorization. However, we are unable to retrieve any disclosures already made based on your prior authorization.
Federal Law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a workforce member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.
Your Health Information Rights
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, you have the Right to:
- Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does include psychotherapy notes. We may deny your request to inspect and copy in certain very 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 the hospital 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 our facility. 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. This is a list of the disclosures we make of medical information about you.
- Request Restrictions: You have the right to request a restriction or limitations 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 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. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
- Request Confidential Communications: You have the right to request that we communicate 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.
- A Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
Should we obtain a website in the future, you may obtain a copy of this notice at our website.
To exercise any of your rights, please obtain the required forms from the Privacy Officer and submit your request in writing.
Changes to this notice
We reserve the right to change this notice and 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. The current notice will be posted at HAV-IT Services and include the effective date. In addition, each time you register at or are admitted to HAV-IT
Services for treatment or health care services, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with HAV-IT Services by contacting the main number and asking for the Facility Privacy Officer or with the Secretary of the Department of Health and Human Services. To file a complaint with HAV-IT Services, contact the Privacy Officer. All complaints must be
submitted in writing.
You will not be penalized for filing a complaint.
Name: Tim Huseth, Exec. Director of HAV-IT Services
Telephone Number: 701-324-4636
Please sign and return the last page to:
Tim Huseth, Executive Director
409 West Brewster St.
Harvey, ND 58341-1466
Click the link below to obtain a copy of the Notice of Privacy