|
|
To make an appointment, call 952.831.TRIA (8742)
Monday - Friday 8 A.M. - 5 P.M.
|
|
|
|
|
|
At TRIA, we are very sensitive to privacy issues and respect your right to privacy.
|
Patient Rights
As a patient at TRIA, you have certain rights to help protect you and
promote your recovery and well-being.
View PDF: Minnesota Outpatient
Surgical Center Patients� Bill of Rights
TRIA Notice of Privacy Practices
Effective 2/17/2010
This notice describes how medical information about you may be used and disclosed,
and how you can get access to this information. Please review it carefully.
In this notice, the words "we," "us," "Park Nicollet" and "TRIA" mean any or all of the following:
- TRIA Orthopaedic Center - a Park Nicollet Clinic location
- TRIA Ambulatory Surgery Center
- TRIA Orthopaedic Center Research Institute
- Park Nicollet Methodist Hospital (including its medical staff)
- Park Nicollet Clinic
- Park Nicollet Institute (including International Diabetes Center at Park Nicollet)
- Park Nicollet Melrose Institute
- Park Nicollet Health Care Products
- Other parts of the Park Nicollet system that provide health care,
and independent providers or contractors who participate in our organized health care arrangement
"You" means anyone who receives health care services or products from us. "Health information" means any
information that we create or receive relating to your health or health care payment, whether oral, written
or recorded in any form.
How we may use and disclose your health information
Required disclosures permitted without your authorization
Your rights to your health information
Our legal rights and duties
Complaints
How we may use and disclose your health information
The law requires us to inform you that we use and disclose your health information for the following purposes:
TREATMENT
We will use your health information to provide you with health care services or products. We may share your health
information with doctors, nurses or other health care providers (such as X-ray, lab and pharmacy) who are involved
in your care and who are part of the entity providing your care. With your consent, we may disclose certain health
information specified by you to your family, others involved in your care or organizations outside of Park Nicollet
providing health care to you.
PAYMENT
We may use and disclose health information to bill:
- your insurer
- Medicare
- any other payer or programs
- your health plan
- Medical assistance
- you
If your insurer or health plan requires prior approval or other notice to determine whether they will pay for
those services or products, we may disclose parts of your health information to them, unless you have asked that
we not bill your insurer or plan.
HEALTHCARE OPERATIONS
We may use and disclose information about you within Park Nicollet to manage and improve our health care service.
This includes:
- quality assessment
- licensing and accreditation
- business planning and management
- evaluating health professionals
- legal and accounting services
We may provide services with the help of people who are not our employees, and companies that are not our affiliates.
This includes equipment technologists, computer hardware and software providers or maintenance personnel. We call
these people or companies our �business associates.� We may give our business associates some access to your health
information so they can perform their job duties. We minimize their access as much as possible. They are required to
safeguard your information.
APPOINTMENT REMINDERS, TREATMENT ALTERNATIVES
We may use and disclose your health information to provide you with:
- appointment reminders
- information about treatment options and services
- other health-related products or services
HOSPITAL DIRECTORY
If you are a patient of Park Nicollet Methodist Hospital or Melrose Institute, we may include the following
limited information about you in the hospital directory.
- Name
- Location
- General condition (fair, stable and others)
This information may be released to people who ask for you by name. You can request that your name or
health information be restricted.
PEOPLE INVOLVED IN YOUR CARE
Unless you object, we may release health information to a family member or friend. We also may disclose
your health information if you are incapacitated, or in an emergency, if we feel it is in your best interest.
We may disclose information about you to a disaster-relief organization if there is a disaster, so that your
family can be notified.
RESEARCH
Your health information may be useful to researchers looking for better ways to diagnose and treat illnesses.
For research conducted by a TRIA or Park Nicollet medical staff member or employee, we will not use or disclose
any of your health information for research purposes, unless you give written permission or a group of people that
reviews and approves research (Institutional Review Board - IRB) determines that your permission is not necessary.
For research conducted by anyone who is not a TRIA or Park Nicollet medical staff member or employee, we will you
give you a chance when you register with us, to object to any use or disclosure of your health information for
research purposes, and your decision will be respected in all situations.
FUNDRAISING ACTIVITIES
We may use your health information and disclose your contact information to Park Nicollet Foundation so it can
contact you about raising money for one or more nonprofit parts of Park Nicollet. The information we would disclose
is limited to your name, address and telephone number, plus the dates you received services from us. We do not
sell your information. Any fundraising communication addressed to you will contain instructions describing how you
may "opt out" from receiving further similar communications. If you do not wish to be contacted, please write to:
Park Nicollet Foundation, 6500 Excelsior Blvd.,
St. Louis Park, MN 55426
Required disclosures permitted without your authorization
We will release health information about you as required for workers' compensation or similar programs to comply
with related laws. Plus, we may need to use or disclose your health information without your authorization:
- to the government for public health activities as permitted or required by law to
report disease exposures and statistics, births and deaths, abuse or neglect, reactions to medication and
problems with products
- to a health oversight agency for audits, investigations, inspections and licensure
activities
- to prevent a serious and imminent threat to the health or safety of a person or the
public, or to help the police apprehend a person involved with a violent crime that may have seriously harmed
someone
- to organ donation organizations to assist with organ or tissue donation and transplantation,
consistent with applicable law
- to a law enforcement official in response to a court or administrative order, subpoena,
warrant, summons or similar process; to identify or locate a suspect, witness or missing person; to identify a victim
of crime if, under certain limited circumstances, we are unable to obtain the victim�s agreement; or in emergency
circumstances to report the location and perpetrator of a crime
- to a private party in litigation in response to a valid court order or administrative
order
- to a coroner or funeral director as permitted or required by law to identify a deceased
person, determine the cause of death or to carry out their necessary duties
- to a correctional institution if you are an inmate, as necessary for your health and
the health and safety of other people
- or military, national security or lawful intelligence activities
- otherwise as permitted or required by law
Other uses and disclosures of your health information will be made only with your written authorization. You may revoke
that authorization at any time for future uses and disclosures by writing to Park Nicollet Health Information
Management/Release of Information at the address at the end of this notice.
Your rights to your health information
You have the following rights regarding the health information we maintain about
you:
RIGHTS TO INSPECT AND COPY
With some exceptions, you have the right to see and request a copy of records that include your health information
and are maintained or used by us (the designated record set). To request a copy, write to Park Nicollet Health
Information Management/Release of Information at the address listed at the end of this notice. You may request
an electronic copy, if preferred. We charge a fee for copying or mailing costs. In some cases, we may deny your
request. If you are denied access to records, you may request that another licensed health care professional
chosen by us review the denial. We will comply with the outcome of the review.
RIGHT TO REQUEST AN AMENDMENT
You may ask us to amend a record containing your health information if you feel it is incorrect or incomplete.
Your request must be submitted in writing to Park Nicollet Health Information Management/Release of Information
at the address listed at the end of this notice. You must provide a reason for your request. We may deny your
request if, among other reasons, the information was not created by us; is not included in your medical, billing
or other records; or is otherwise accurate and complete.
RIGHT TO AN ACCOUNTING OF DISCLOSURES
You have the right to request a written report of where we sent your health information for up to a six-year period.
This does not include disclosures to or authorized by you or disclosures for treatment, payment and health
care operations as described in this notice. You must submit your request in writing to Park Nicollet Health
Information Management/Release of Information at the address listed at the end of this notice. Your request
must state a time period of six years or less, and may not include dates before April 14, 2003. The first report
you request within a 12-month period will be free. After that, we may charge you for the cost of providing the report.
RIGHT TO REQUEST RESTRICTIONS
You may request that we restrict or limit the health information we use or disclose about you for treatment,
payment or health care operations. We may not be able to comply with your request. If we agree to comply,
we will honor your request unless the information is needed to provide emergency treatment. You must make
your request in writing to Park Nicollet Health Information Management/Release of Information at the address
listed at the end of this notice. In your request, you must tell us: 1) what information you want to limit; 2)
how you want to limit our use or disclosure; and 3) to whom you want the limits to apply. If you pay for
services out of pocket, in full, you have the right to request we do not disclose your information in connection
with those services to your health plan. To facilitate this restriction, you must make your request at the
time of your visit or when services are provided. You will be required at the registration check-in desk to
fill out a Request for Confidential/Alternate Billing for Today�s Visit form (15279). Follow instructions on
the form.
RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS
You have the right to request that we communicate your health information with you in a certain method or
place (such as at work or by mail). You must make your request in writing when you register with us, or to
Park Nicollet Health Information Management/Release of Information at the address listed at the end of this
notice. We will try to meet all reasonable requests.
Our legal duties and rights
The law requires us to protect the privacy of your health information and to provide this notice of our practices.
We reserve the right to change our health information practices and the terms of this notice. We reserve the right
to make the changed notice effective for health information we already have about you and for new information. The
notice will contain an effective date on the first page. The notice will be placed in a prominent place at each of
our patient care sites, and it will be posted on our Web sites, www.parknicollet.com or www.tria.com. We will replace
the notice on our Web site with updated notices as they become available. In addition, you may request a paper copy
of this notice by contacting Patient Relations at the address at the end of this notice. Notices will be available
whenever we provide you with health care.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with Park Nicollet Health Services
Patient Relations at the address shown below. You also may file a complaint with Region V, Office for Civil Rights,
by mail to U.S. Department of Health and Human Services, 233 N. Michigan Ave., Suite 240, Chicago, IL 60601, or by
fax to 312-886-1807. All complaints must be made in writing. You will not be penalized for filing a complaint.
If you have any questions, contact:
Park Nicollet Health Services
Patient Relations
P.O. Box 650
Minneapolis, MN 55440
Park Nicollet Clinic: 952-993-3014
Park Nicollet Methodist Hospital: 952-993-5541
|
|
|