•  Your confidential healthcare information may be released to other healthcare professionals within the hospital for the purpose of providing you with quality healthcare.
  For example: All information obtained by a nurse, physician, or other member of the healthcare team will be documented in your record and used to communicate with other members of the healthcare team involved in your care.
•  Your confidential healthcare information may be released to your insurance provider for the purpose of the hospital receiving payment for providing you with needed healthcare services.
  For example: A bill may be sent to you or your health care insurance company. Information on the bill includes identifying information along with a diagnosis and procedures rendered.
• Your confidential healthcare information may be released for routine healthcare facility operations.
  For example: Your health information will be reviewed by medical staff and other professionals in an effort to continually improve the quality of healthcare and services we provide. Storing the information involves entering some of the data into databases as well as filing and storing the paper documents in your chart. These functions may be handled by a number of different employees in the facility.
• Your confidential healthcare information may be released for any of the following reasons, without your prior authorization:
• mandatory public health reporting of certain diseases, products, and injuries,
• required reporting about victims of abuse, neglect or domestic violence,
• for health oversight activities, such as audits and investigations,
• for judicial and administrative proceedings in response to a court order, subpoena or discovery request,
• for certain law enforcement purposes, for example, to identify or locate a suspect, fugitive, material witness, or missing person,
• to coroners, medical examiners and funeral directors, for purposes of determining cause of death, or performing duties related to the departed,
• for organ, eye, or tissue donation purposes,
• under certain circumstances, for research,
• when necessary to prevent or lessen a serious threat to the health or safety of the individual or the public,
• and, specialized government functions such as national security activities and medical suitability determinations.
• Your confidential healthcare information may be released to other healthcare providers in the event you need emergency care.
• Your confidential healthcare information may be released for workers’ compensation or similar programs.
• Your confidential healthcare information may not be released without your written authorization for any purpose other than that stated above.
• You may revoke your permission to release confidential healthcare information at any time, except for what’s already been done while the authorization was in effect. If you wish to revoke your authorization, please do so in writing and submit to:

  Cuyuna Regional Medical Center
  Health Information Services Department
  320 East Main
  Crosby, MN 56441

• You may be contacted by the hospital to remind you of any appointments, healthcare treatment options or other health services that may be of interest to you.
• Detailed messages regarding any appointments will be left on your answering machine unless you contact the hospital. Please refer to the Right to Request Confidential Communications section if you do not want messages left on your answering machine.
• You may be contacted by the hospital for the purposes of raising funds to support the hospital’s operations. If you do not want the healthcare center to contact you for fundraising efforts, you must notify the healthcare center at (218) 546-7000.

You have specific rights regarding confidential information about you created by us or kept here in either your medical records or your billing records.

You have the right to request restrictions on the use of your confidential healthcare information. However, the hospital may choose to refuse your restriction if it is in conflict with providing you with quality healthcare or in the event you have an emergency situation.

To request restrictions, you must make your request in writing to:

Cuyuna Regional Medical Center
Health Information Services Department
320 East Main
Crosby, MN 56441

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.

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 ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted and must be in writing.

You have the right to review, inspect, and receive a photocopy of any/all portions of your healthcare information. This includes medical and billing records.

To inspect and/or receive a photocopy of your healthcare information you must submit your request in writing to:

Cuyuna Regional Medical Center
Health Information Services Department
320 East Main
Crosby, MN 56441

If you request a copy of the information, 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 medical information, you may request that the denial be reviewed. Another licensed healthcare 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.

You have the right to request changes to your healthcare information. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information.

To request an amendment, your request must be made in writing and submitted to the following address. In addition, you must provide a reason that supports your request.

Cuyuna Regional Medical Center
Health Information Services Department
320 East Main
Crosby, MN 56441

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;
• Is not part of the medical information kept by or for the healthcare center;
• Is not part of the information which you would be permitted to inspect and copy; or
• Is accurate and complete.

You have the right to know who has accessed your confidential healthcare information and for what purpose.

To request an accounting of disclosures, you must submit your request in writing to:

Cuyuna Regional Medical Center
Health Information Services Department
320 East Main
Crosby, MN 56441

Your request for an accounting of disclosures must state a time period which may not be longer than six (6) years and may not include dates before April 15, 2003.

You have a right to possess a copy of this Privacy Notice upon request. You may ask us to give you a copy of this notice at any time.

To obtain a paper copy of this notice, please contact the Health Information Services Department at (218) 546-7000.

We reserve the right to change this notice and make the new terms effective for all confidential health information we maintain. We will post a current copy of this notice in the healthcare center. The notice will contain, on the bottom of each page, the last revision date.

The health care center is required by law to protect the privacy of its patients. It will keep confidential any and all patient healthcare information and will provide the patient with a copy of this Notice of Privacy Practices. The health care center is required to abide by the terms of this notice.

The medical staff are independent healthcare professionals and are not under the control of the Healthcare Center.

You have the right to complain to the health care center or to the Secretary of the Department of Health and Human Services if you believe your rights to privacy have been violated. To file a complaint with the healthcare center, contact the Human Resources Department at (218) 546-7000.

• All complaints must be submitted in writing.
• All complaints will be investigated.
• You will not be penalized for filing a complaint.

For further information about this Privacy Notice, please contact:

Health Information Services Director/Privacy Officer
Phone: 218-546-2313

This notice is effective as of April 14, 2003.

Last Revision: 10/06