Privacy Practices

Northern Star Therapy, Ltd. - Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

If you have any questions about this Notice of Privacy Practices or Your Rights as described in this Notice... Please contact our Privacy Officer by calling (320)259-5429 or (320)240-6955.

Your personal health and medical information is defined as Protected Health Information (PHI) by federal law. More specifically, PHI is information about you, including demographic information that may identify you and information that relates to your past, present, or future health or condition, physical or mental, and related healthcare services.

This Notice of Privacy Practices describes how we may use and disclose your PHI to provide treatment, obtain payment or carry out healthcare operations and for other purposes permitted or required by law. This Notice also describes your right as a patient to access and control your health information.

Northern Star Therapy (our "Practice" or "We" or "Northern Star Therapy") is required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our Notice, at any time. A new or revised Notice will be effective for all PHI that our Practice maintains beginning with the date that a revised Notice is made effective. You may request a revised Notice of Privacy Practices by calling or visiting our office and requesting a revised copy be sent to you, or by asking for a revised Notice of Privacy Practices at the time of your next appointment.

PERMITTTED USES AND DISCLOSURES

The following categories describe different ways that our Practice may use and disclose your PHI. Not every use or disclosure will be listed within these categories. However, all of the ways that we are permitted to use and disclose your PHI will fall within one of these categories. Examples of uses and disclosures that our Practice may make under each section are as follows:

Treatment. We may use your PHI to provide you with healthcare treatment and/or services. We may disclose your health information to physicians, nurses, technicians, health career students, physical therapists, occupational therapists or any other personnel who are involved in taking care of you. For example, we may disclose your PHI, as necessary to a physician who may be treating you for your health needs. We may also disclose your PHI for purposes of consultation, to obtain x-rays, or for any other treatment purpose. For example, we may need to disclose your PHI to a home health agency that provides care to you or to emergency personnel so that he/she has the necessary information to appropriately diagnose your condition and to provide care and treatment for you.

We may disclose your PHI by calling you by name in the waiting room when you are ready to be seen for your office visit. We may use or disclose your health information, as necessary, to contact you and to remind you of your appointment.

Payment. Our Practice will use your PHI, as needed, to obtain payment for you healthcare services. For example, we may need to provide your health plan or coverage program with information about your care and treatment so that our Practice will be paid or for you to be reimbursed for the cost of the services we provided. In addition, we may share PHI with your health plan or coverage program regarding a treatment you are planning to receive in order to obtain prior approval or to determine your eligibility for coverage.

Healthcare Operations. Our Practice may use or disclose, as needed, your PHI to support necessary business activities. These business activities include quality assurance programs, employee review scenarios and/or training of staff. For example, we may also use your PHI to review our treatment and services and to evaluate our performance in caring for you. We may use PHI to aggregate data and information to determine whether we should provide new or additional services, if certain services should be discontinued, whether certain procedures or protocols are effective, or to periodically assess the need for any focused improvement efforts.

Business Associates. We at Northern Star Therapy will share your health information with contractors and others, also known as "Business Associates," that support or assist our Practice by performing various activities necessary for treatment, payment and/or healthcare operations. Whenever an agreement between our Practice and a Business Associate involves your PHI, we will maintain a written contract with the Business Associate to protect your PHI from unlawful uses or disclosures.

Required by Law. Our Practice may use or disclose your PHI to the extent that federal, state or local law requires the use or disclosure. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements. You will be notified, as required by law, of any such uses or disclosures.

Minnesota Department of Health. We may disclose your PHI for certain public health programs and purposes to a public health authority that is permitted by law to collect or receive your health information. This disclosure will be made for the general purpose of controlling disease, injury or disability. We may also disclose your PHI if directed by the appropriate public health authority, to a foreign government agency that is working with a public health authority.

Communicable Diseases. Our Practice may disclose your PHI, if authorized by law, to an individual who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight. Our Practice may disclose your PHI to a health oversight agency for activities authorized by law, such as those related to, investigations and inspections. Oversight agencies seeking this information include government agencies that oversee the healthcare system, government benefit programs, government regulatory programs and civil rights laws.

Abuse or Neglect. We may disclose your PHI to a human services or law enforcement authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your PHI if we believe that you have been a victim of abuse, neglect or domestic violence to the government entity or agency authorized to receive such information. In this case the disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration. Our Practice may disclose your PHI due to an incident related to and required by the Food and Drug Administration to report adverse events, product defects or problems, biological produce deviation, to track FDA-regulated products, to enable products recalls, repairs or replacement, to conduct post-marketing surveillance and for look back, i.e., to locate and notify persons having received any products since withdrawn or recalled.

Legal Proceeding. We may disclose PHI in the course of any judicial or administrative proceedings, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request, or other lawful processes.

Law Enforcement. We may disclose your PHI where applicable legal requirements are met for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law; (2) limited information request for identification and location purposes; (3) pertaining to victims of a crime; (4) suspicion that death has occurred as a result of criminal behavior; (5) crimes that may have occurred on our Practice premises; and (6) if a medical emergency arises away from our Practice premises and it is likely that a crime has occurred.

Criminal Activity. Where applicable Federal and State laws indicate, our Practice may disclose your PHI if we feel the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose your PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.

Research. If you are participating in a clinical research program approved by an Institutional Review Board (IRB) and if you have signed a specific research participation agreement and consent form that has been provided to our Practice then we may disclose your PHI to the designated researchers in conformance with the established research collection protocols.

Military Activity and National Security. In certain situations, our Practice may use or disclose your PHI if you are deemed an Armed Forces personnel in the following situations: (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veteran Affairs of your eligibility for benefits; or (3) to foreign military authority if you are a member of that foreign military service. We may also disclose PHI to authorized officials conducting national security and intelligence activities, including for the provision of protective services to the President or others as authorized by law.

Workers Compensation. Our Practice may disclose your PHI if so authorized and to comply with workers compensation laws and other similar programs established by law.

Inmates. We may use or disclose your PHI if you are an inmate of a correctional facility and our Practice created or received your PHI in the course of providing care to you.

Required Use and Disclosures. The federal law Privacy Rule mandates we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Specifically, the requirements of Section 164.600 et seq.

Health-Related Services and Treatment Alternatives. We may use your PHI to inform you about health-related services, options, or alternatives that may be helpful to you.

YOUR RIGHTS REGARDING YOUR PERSONAL HEALTH INFORMATION

Our Practice understands that your PHI and healthcare is a personal matter. We are committed to protecting your PHI and to informing you about your rights in respect to your PHI. The following statements relate to your rights, your PHI, and how you may exercise these rights.

If you have questions about this Notice of Privacy Practices or Your Rights as described below, please contact our Privacy Officer by calling our Downtown ("Dntn") Location at (320)259-5429 or the Northwest ("NW") Location at (320)240-6955. If you have special requests, restrictions, or directions for us to consider or coordinate in respect to your PHI, this Notice, or Your Rights, you must communicate with us in a writing this is signed, dated, and addressed to:

Attention: Privacy Officer
Northern Star Therapy, Ltd.
1411 St. Germain St. West
St. Cloud, MN 56301

or at

Attention: Privacy Officer
Northern Star Therapy, Ltd.
4544 County Road 134, Suite A
St. Cloud, MN 56303

Right to Request Restrictions on Uses and Disclosures. You have the right to ask our Practice not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations. You also have the right to request our Practice to restrict the use or disclosure of your PHI to family members or personal representatives. However, we are not required to agree to any restriction you may request. But if we do agree to your requested restriction and believe it to be in your best interest, we may not violate your requested restriction except as necessary to the delivery of emergency medical care. Request by writing to our Privacy Officer.

Right to Access Your PHI. In most cases, you have the right to inspect and obtain a copy of your PHI we maintain about you. To receive a copy of your PHI, you may be charged the cost of copying, mailing or other supplies associated with your request. Certain types of PHI will not be available for inspection and copying. This includes PHI collected by us in connection with or in reasonable anticipation of legal claims or proceedings. In limited circumstances we may deny your request to inspect and obtain a copy of your PHI. If we deny your request to inspect and copy, you may request that the denial be reviewed. An individual chosen by our Practice who is not involved in the original decision to deny your request will conduct the review. We will comply with the outcome of that review. In these matters, Write to our Privacy Officer.

Right to Amend Your PHI. You have the right to request your PHI be amended if you feel your PHI maintained by our Practice is incorrect or that an important part of your PHI is missing. We may deny your request if your request is not in writing or does not include a reason that supports your request. If your request to amend your PHI is declined, you have the right to prepare a statement of disagreement included within your PHI. Our Practice retains the right to include a rebuttal to your statement, a copy of which will be provided to you. In regard to your right to amend your PHI, Write to our Privacy Officer.

Right to Receive an Accounting of Disclosures. You have a right to request an accounting of the disclosures of your PHI that our Practice has made, if any, for reasons other than disclosures for treatment, payment, healthcare operations or disclosures that have been made pursuant to proper authorization by you. Your right to an accounting of our disclosures of your PHI applies only to your PHI created after April 14, 2003 and cannot exceed a period of six years prior to the date of your request. The initial accounting you request within a twelve-month period will be free. However, we may charge you for any additional accounting requests. We will notify you of the cost involved and you may choose to withdraw or modify your request before any costs are incurred. Request by Writing our Privacy Officer.

Right to Receive Confidential Communication. You have the right to request that communications involving your PHI be provided to you at an alternative location or by an alternative means of communication. Our Practice is required to accommodate any reasonable request if the normal method of disclosure may endanger you. Write to our Privacy Officer with this request and briefly describe the reason for your request.

Right to File a Complaint. You have a right to file a complaint with our Practice or the Secretary of Health and Human Services if you believe your privacy rights have been violated. You will not be penalized or retaliated against by Northern Star Therapy in any way for filing a complaint. If you have questions on filing a complaint, contact our Privacy Officer at (320)259-5429 or (320)240-6955. Submit complaints in writing to our Privacy Officer.

Right to Receive a Paper Copy of This Notice. Upon request, even if you have previously agreed to accept this Notice electronically, you have a right to request a paper copy of this Notice. Make such requests in writing addressed to our Privacy Officer.

Effective Date of Notice. This Notice was published and made effective April 14, 2003.

Additional Information or Change to this Notice. We reserve the right to change the terms of this Notice at any time. The effective date of this Notice and any revised Notice may be found on the last page at the bottom right hand corner. You may request a copy of revised Notices from our Practice by mail or email, but we will only deliver a Notice by email if email delivery is offered by us and you have agreed to such delivery. A copy of our Notice is also available in the Lobby of our Practice offices. Write to our Privacy Officer for a copy.

Further Information. You may have other rights under various but related laws. You may always request information on our policies and practices by writing to our Privacy Officer.

Patient Acknowledgment of Receiving Notice of Privacy Practices and Practice Documentation.
You will be requested to acknowledge your receipt of this Notice of Privacy Practices by signature on a form designed for that purpose. Our Practice will retain that form, once signed by you, within the medical record established for you by our Practice. If you refuse or are unable to sign the acknowledgment form that we provided you with this Notice, we will document your medical record accordingly as part of our good faith effort to promote your review and understanding of this Notice of Privacy Practices.

Q & H Word Doc. #144845

Effective Date: 4/14/03