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Patient Privacy
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.


Lakes Regional Healthcare is committed to protecting the privacy and security of our patientsˇ¦ confidential health information. We are required by law to maintain the privacy of your health information and to provide you with notice of our legal duties and privacy practices with respect to your personal health information. If you have any questions about any part of this notice, or if you want more information about the privacy practices at Lakes Regional Healthcare, please feel free to contact the HIPAA Privacy Officer at (712) 336-8786 or by email to chansman@lakeshealth.org. This notice provides you with the following important information:

• How we use and disclose your health information
• Your privacy rights with regard to your protected health information
• Our obligations to you concerning the use and disclosure of your protected health information

Effective Date of This Notice: [September 23, 2013] The terms of this notice apply to all designated Lakes Regional Healthcare records containing your protected health information that are created and maintained by our organization. We reserve the right to revise or amend our Notice of Privacy Practices. Any revisions or amendments to the Notice will be effective for all of your records created or maintained in the past as well as any records we create or maintain in the future. We will post a copy of the most current Notice in a prominent location on site. We will also post the most current Notice to our organizational website. Lakes Regional Healthcare will abide by the terms of the notice currently in effect. At any time, you may request a copy of our most current Notice. You will be asked to acknowledge receipt of the Notice of Privacy Practices in writing during an admission encounter.

Who Will Follow Our Privacy Practices: Lakes Regional Healthcare provides care to our patients, residents, and clients in partnership with physicians and other professionals and organizations. Our privacy practices will be followed by:

• Any health care professional who cares for you at any one of our locations or sites
• All locations, departments and units that are a part of our organization, regardless of geographical location
• All members of our workforce including employees, medical staff members, students, and volunteers

How Lakes Regional Healthcare Will Use and Disclose Your Protected Health Information: We are committed to ensuring that your health information is used responsibly by our organization. We collect health information about you and store it in paper records and computer files. We may use and disclose information about you for the following purposes:

1. Treatment Purposes: We may use or disclose your health information for treatment purposes. While a patient at our organization, we may find it necessary to share your health information with physicians, nurses, lab and radiology technicians, and others involved in your care. We may also share your health information with other healthcare organizations that may participate in your care and treatment such as a hospital where you may be transferred.
2. Payment Purposes: Your health information may be used or disclosed with your consent for payment purposes. It may be necessary for us to disclose your health information so that treatment and services that we have provided may be billed and collected from you, your insurance company, or other party responsible for payment.
3. Health Care Operations: Your health information may be used for our organizational operations that are necessary to ensure that we provide the highest quality of care. For example, your health information may be used for performance improvement purposes.
4. Information Provided to You: We may use your health information to assist us in communicating with you regarding appointment reminders, test results, and treatment information. Our communications to you may be by phone or by mail.
5. Facility/Patient Directory: We will list your name, where you are located in the facility, and your religious affiliation in our directory. If you do not want us to list this information in our directory and provide it to clergy and others, you must tell us that you do not want your name listed. The directory information, except for the religious affiliation, will be provided to persons who ask for your information by name. The directory information with the religious affiliation will be provided to local clergy persons who ask for your information by religious affiliation.
6. Notification and Communication With Family and Friends: Your health information may be disclosed to notify a family member, your personal representative or other responsible person for your care about your location, your general condition, or in the event of your death. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communicating with your family and others.
7. Required by Law: As required by law, we may use and disclose your health information to law enforcement agencies for purposes such as identifying or locating a suspect, fugitive, material witness or missing person.
8. Correctional Institutions: If you are an inmate of a correctional institution, we may disclose to the institution your health information necessary for your health and the health and safety of others.
9. Public Health: As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child or elder abuse or neglect, reporting domestic violence; reporting to the Food and Drug Administration (FDA) problems with products and reactions to medications; and reporting disease or infection exposure.
10. Health Oversight Activities: We may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings authorized by law.
11. Judicial and Administrative Proceedings: We may disclose your health information in the course of any administrative or judicial proceedings. If you are involved in a lawsuit or other administrative proceeding, we may release your health information in response to a court or administrative order.
12. Deceased Person Information: We may disclose your health information to coroners, medical examiners, and funeral directors. Unless your wishes were previously noted, we may also release patient information regarding the circumstances that led to your death to family members or those involved with your care. This does not include past, unrelated medical problems.
13. Organ Donation: We may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues.
14. Research: We may disclose your health information to researchers conducting research that has been approved by hospital administration.
15. Public Safety: We may disclose your health information to governmental agencies in order to prevent or to assist when there is a serious threat to the health or safety of others or the general public.
16. Specialized Government Functions: We may disclose your health information for specialized government purposes which include: military and veterans activities, national security and intelligence activities, protective service of the President/others, medical suitability determinations for Department of State officials, correctional institutions and law enforcement custody situations, or provision of public benefits.
17. Workers Compensation: We may disclose your health information in compliance with Worker's Compensation laws.
18. Marketing: We may use your health information to give to you information about other treatments or health-related benefits and services that we provide and that may be of interest to you.
19. Fundraising: We may use certain information (name, address, telephone number, dates of service, age, and gender) to contact you in the future to raise money for Lakes Regional Healthcare. We may also provide this name to our institutionally related foundation, for the same purpose. The money raised will be used to expand and improve the services and programs we provide the community. You will be given the opportunity to 'opt' out with each fund raising campaign.

Other Uses of Your Health Information: In any other situations not covered by this Notice as noted above, we will ask for your written authorization before using or disclosing information about you. If you choose to authorize disclosure of information about you, you can later revoke that authorization at any time by notifying us in writing of your decision.

Your Rights Regarding Your Health Information: As a patient of Lakes Regional Healthcare you have certain rights with regard to the health information that is maintained by our organization. These rights are as follows:

1. You have the right to receive a paper copy of this Notice of Privacy Practices. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, you may contact the HIPAA Privacy Officer at (712) 336-8786.
2. With a few exceptions, you have the right to access, inspect and receive a copy of your health information. If you request copies of your health information, we may charge a fee for the cost of copying, mailing or other related supplies. If we deny your request to review or obtain a copy of your health information, you may submit a written request for a review of that decision.
3. You have the right to request an electronic copy of your information in the form and format you request.
4. You have the right to request in writing that your health information be amended if you feel it is incorrect or incomplete. Lakes Regional Healthcare will review the request and make a determination as to whether or not an amendment will be made. If we did not create the information that you feel is incorrect or incomplete, we may deny your request. Lakes Regional Healthcare will communicate to you in writing the final decision on your request as well as provide information to appeal a denial of your request should it occur.
5. You have the right to receive your health information through a reasonable alternative means or at an alternative location in a confidential manner such as sending mail to an address other than your home.
6. You have the right to request in writing restrictions on certain disclosures of your health information. We will consider your request and determine our ability to carry out your request while not compromising your care.
7. You have a right to receive a list or accounting of those disclosures, which Lakes Regional Healthcare has made regarding your health information for purposes other than treatment, payment or healthcare operations. Your request must state the time period desired for the accounting, which must be less than a 6-year period starting after April 14, 2003. The first accounting in a 12-month period is free; other requests may be charged according to our cost for producing the information.
8. If your information was impermissibly accessed and after a risk assessment is done, if it is determined to have been a breach, you will be notified.


If You Would Like to File a Complaint About How Your Health Information is Used and Disclosed: If you are concerned that your privacy rights may have been violated, or you disagree with a decision we made about your access to your health information, you may contact our Privacy Officer or Compliance Officer at Lakes Regional Healthcare P.O. Box AB, Spirit Lake, IA 51360 or call (712) 336-1230. Finally, you may send a written complaint to the Secretary of the U.S. Department of Health and Human Services Office of Civil Rights. Lakes Regional Healthcare cannot, and will not, require you to waive the right to file a complaint as a condition of receiving treatment or retaliate against you for filing a complaint with the Secretary of Health and Human Services.


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