GoldPine Home Bemidji, Inc.

Notice of Privacy Practices

Effective April 14, 2003

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.  Please read it carefully.

If you have any questions regarding this notice, please contact GoldPine Homes Privacy Officer,

Janee Hill at 218-444-4346.

Protected Health Information (PHI) is information about you that may identify you and that relates to your past and present or future physical or mental health or condition, your treatment, or payment for your healthcare.  We are required by law to maintain the privacy of your PHI and to provide you with this Notice of our Privacy Practices and our duties to you.

GoldPine Home is committed to treating and using PHI about you responsibly.  This Notice of Health Information Practices describes information we collect, and how and when we use or disclose that information.  It also describes your rights as they relate to your PHI.  This notice applies to all PHI as defined by Federal Regulations.  If you have any questions regarding this notice please contact GoldPine Homes Privacy Officer, Janee Hill at 218-444-4346.

1. Right to a paper copy of this notice: You have a right to a paper copy of this notice.  You can obtain this by contacting the privacy officer at 218-444-4346.
2. Right to inspect and copy: You have the right to inspect and copy your PHI.  This means you may inspect and obtain a copy of PHI about you that is contained in a designated record set as for as long as we maintain the PHI.  This information includes medical and billing records that GoldPine Home uses for making decisions about you.  You are not allowed to inspect or copy psychotherapy notes, certain information compiled for or in anticipation of civil, criminal or administrative proceedings, and information subject to a law that prohibits your access to it.  In some circumstances you may have a right to have the decision reviewed.
3. Right to amend: If you believe the medical information you have is incorrect or incomplete, you may ask us to amend the information.  You may ask for an amendment to the information in a designated record set for as long as we maintain the information. You must request an amendment in writing to our privacy officer, and you must provide a reason to support your request for an amendment.
4. Right to request confidential communications by alternative means or at an alternative location: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.  For example, you can ask that we only contact you at work or by mail. We will not request an explanation from you about the reason for your request.  We will accommodate reasonable requests. Please make any requests for alternative communications in writing to our privacy officer.
5. Right to request a restriction: You have the right to request a restriction or limitation on medical information that we use or disclose about your treatment, payment or healthcare operations. You also have the right to request limit on the medical information we disclose about someone involved in your care or the payment for your care, or for notification purposes, such as a family member or friend. We are not required to agree to your request.   If we do agree, we will comply with the request unless the information is needed to provide emergency treatment to you.  We encourage you to discuss any restrictions with your physician. To request restrictions, your request must be in writing to our privacy officer.  It must state the information you want to limit, whether you want to limit use or disclosure or both, and whom you want the restriction to apply. 

Uses and Disclosures of PHI:

How we may use and disclose medical information about you:

      We are permitted to use and disclose your PHI for care and treatment in order to provide healthcare services to you. We may also use PHI for payment of   your healthcare.  The following are examples of the ways that we are permitted to use your medical information healthcare, treatment and payment.   

1.   Treatment:

      We will use and disclose your PHI to provide you with medical treatment and services.  We may disclose medical information to doctors, nurses, and our direct care team.  We will also use your medical information to coordinate and manage your healthcare with other outside departments such as pharmacy, lab work, Social Services, Veterans Administration, Dental, Audiology, and Optometry, who may become involved with your healthcare.

2.   Payment:

      We will use your PHI as needed to obtain payment for your healthcare services from the Minnesota Department of Health and Beltrami County Social Services.  We may also disclose medical information to other healthcare  providers for their payment purposes.

Other permitted uses and disclosures:

Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your PHI that relates to that person’s involvement in your healthcare.  If you are unable to agree or object to such a disclosure, we may disclose information as necessary if we determine that it is in your best interest based on our professional judgment.  We may also use or disclose PHI to notify a family member or someone responsible for your care about your general condition or death.

Uses and disclosures we are allowed to make without your permission or opportunity to object:

      We may use or disclose your PHI in the following situations without your permission.

1. Required by law: We may use or disclose your medical information when required by federal, state, or local law.  The use or disclosure will be limited to what is required by law.
2. Public Health: We may use or disclose your PHI for public health activities, such as to public health authority, other government authority allowed to receive this information, or to persons who report to the FDA.  For example, we may report communicable diseases or vital statistics.
3. Abuse, neglect: We may disclose your PHI to a public authority that is authorized to receive reports of abuse or neglect.  In addition, we may disclose information to an  authorized agency if we believe you have been a victim of abuse, or neglect. Disclosure will be consistent with state and federal laws.
4. Health oversight: We may disclose your PHI to a health oversight agency for activities  authorized by law such as inspections, audits and investigations. These activities are necessary for the government to monitor the healthcare system, government programs, and civil rights laws.
5. Legal proceedings: We may disclose your PHI in a judicial or administrative proceeding, in response to court order, and in certain cases in response to a subpoena, discovery request, or other lawful process.
6. Law enforcement: We may disclose PHI under certain conditions to law enforcement in response to court orders or other legal process; to identify or locate a suspect, missing person, about a suspicious death that may have resulted from a crime; about criminal conduct on our premises; and to report a crime in a medical emergency.
7. Coroners and funeral directors: We may disclose PHI to a coroner or funeral director for purposes allowed by law such as determining cause of death.  We may also disclose formation to funeral directors to allow them to carry out their duties, and this information may be provided in reasonable anticipation of death.

Changes to this notice:

We are required to abide by the terms of this Notice of Privacy Practices.  We may change the terms of this notice at any time.  The new notice will apply to all PHI we maintain at the time.  When there are updates you will be given a copy of the new updates.  Or you may request a copy by contacting the privacy officer at 218-444-4346.

Complaints:

If you believe your privacy rights have been violated, you may file a complaint with us by notifying our privacy officer.  All complaints must be submitted in writing to the privacy officer.  You may also file a complaint with the secretary of the Department of Health and Human Services.  We will not retaliate against you filing a complaint.  If you have questions about this notice, please contact GoldPine Homes Privacy Officer, Janee Hill at 218-444-4346.