Whom
Does This Notice Apply?
This notice has been published by the
University
of
North Dakota TRIO
Programs. It applies to everyone who works for TRIO,
including all employees, contractors, information technology service workers,
work-study students and volunteers.
Why
Do We Publish This Notice?
We understand that information about you and
your health is sensitive and personal. We are also required by law to maintain the privacy of information that
we gather and use about you, and all of the students we serve. We also will
provide you with notices of our legal duties and privacy practices with respect
to your information.
We are committed to the privacy of our
student’s information. However, in order
to serve you, we need to obtain, secure, and utilize your records. We need to
share health information with healthcare, insurance, and billing
providers.
This notice is also to inform you about
certain legal rights you have with respect to the information we secure. You have the right to review and copy information
in your records. You may also request that we amend these records, and may ask
us to account for certain disclosures.
When
Does This Notice Become Effective?
We are required to comply with the terms of
this notice while it is in effect. We reserve the right to change the terms of
this notice and to make the new terms effective for all information to which
this notice applies. This notice will be
in effect from
April 14,
2003
, until the date we publish an amended notice. If we do publish an amended notice, we will
notify you of the amendment. We will
also publish this information on our website at
http://www.und.nodak.edu/dept/trio, or a copy may be requested by contacting us
at the above telephone number or address.
What
Information Does This Notice Cover?
This notice covers all information in our
written or electronic records which concerns you, your healthcare, and payment
for services we provide for your care. This notice also covers information we may have shared with other
organizations to help us provide care to you, get reimbursed for services
provided to you, or to manage our administrative operations.
Uses
and Disclosures of Protected Health Information. How We May Use and Disclose
Medical Information About You:
In order for us to provide you healthcare, we
are permitted to use or disclose your health information for the following
purposes:
1.
Treatment. We may use or disclose information about you
for treatment purposes. This information may be communicated to doctors,
nurses, technicians, medical students, or other individuals who are involved in
providing you healthcare. We may also
disclose information about you to organizations and individuals involved in
your care, such as consulting physicians, laboratories, social workers, and
other persons in the medical profession. For example, if you are referred to a
physician or a hospital for specialty services, we will provide all clinical
information which might be necessary or helpful to assist in your care. Or, if it is necessary to send a sample of
your blood to a laboratory for analysis, we will provide the laboratory with
the information they need to analyze your blood correctly.
2.
Payment. We may use or disclose information about you
for payment purposes to your health plan or other third party financially
responsible for your care, or to claims and billing services if necessary. For
example, if you are covered by a health plan payment cannot be made for the
services provided to you unless a claim is submitted. This may include diagnosis and treatment
information. This is only an example.
There may be other ways we may use or disclose information about you in
connection with reimbursement for your care.
3.
Health Care
Operations. We may use or disclose information about you
in connection with the operation of our practice. These activities may include; practice
quality improvement, training of medical students, insurance underwriting,
medical or legal review, and business planning or administration of our
practice. For example, we may audit our management practices so we can become
more efficient. These are only examples, and we may use or disclose information
about your for healthcare operations in many other ways.
Other
Permitted Disclosures.
We may also disclose information about you
without your consent for the following purposes:
1.
We
may use or disclose your protected health information to public health or other
government agencies that are allowed to receive this information, or to persons
who report to the FDA. We may disclose vital statistics, communicable diseases,
or information about product recalls.
2.
We
may disclose your protected health information to authorized agencies in the
event of suspected child abuse, neglect, or domestic violence. Disclosure will
be consistent with state and federal laws.
3.
We
may disclose your protected health information to authorized agencies in other
cases of suspected abuse, neglect, or domestic violence, under the following
circumstances, with your agreement; if required by law, if you are
incapacitated, a minor, or it appears necessary to prevent serious harm to you
or others.
4.
We
may disclose your protected health information to a health oversight agency for
activities authorized by regulatory, licensing, and other legal purposes that
are necessary for healthcare system government programs, and civil rights laws.
5.
We
may disclose protected health information in judicial or administrative
proceedings, in response to a court order, and in certain cases in response to
a subpoena, discovery request, or other legal purpose.
6.
We
may disclose protected health information under certain conditions to law
enforcement agencies, subject to applicable legal requirements and limitations.
7.
We
may disclose protected health information to your authorized superiors or other
authorized federal officials, if you are in the
United States
military, national
security, intelligence, or Foreign Service.
8.
We
may disclose protected health information to coroners, funeral directors, and
organ donation organizations, for purposes allowed by law, such as
identification or determining cause of death.
9.
We
may disclose your protected health information to researchers when their
research has been approved by an institutional review board or privacy board,
and the board has determined that the research meets certain requirements for
protection of that information.
10.
We may disclose your
protected health information to comply with workers’ compensation laws and
other similar programs established by law.
Pharmacy.
In order to provide optimum care to our
students, Student Health Pharmacy routinely receives the entire student medical
record when an order to fill prescriptions has been received by one of our
providers. The Student Health Pharmacy is committed to protecting your personal
health information and is required to abide by the terms of this notice.
Reminders,
Marketing and Research.
We may send you information to support your
healthcare, including appointment reminders, information about alternative treatments,
and health related services which may be of interest to you. Please
advise us if you do not wish to receive such communications and we will not
use or disclose your information for such purposes. If you do not wish to receive this type of
communication, you must advise us in writing.
What
Legal Rights Do You Have in Connection to Your Health Information?
By law, you are entitled to:
1. Request a restriction. Ask us to
further restrict our use and disclosure of information about you. We are not required to grant such a request,
but if we do grant your request, we must abide by it.
2. Confidential communications. You
have a right to request that we communicate with you about medical matters in a
certain way or at a certain location.
3. Review your medical record. You
have a right to review your personal medical records.
4. Obtain a copy of your medical record.
You have a right to obtain a copy of all or any part of your medical
information. We may charge you a
reasonable fee for copying materials.
5. Request an amendment. You have a
right to request an amendment to your medical records. If you believe that the
medical information about you is incorrect or incomplete, you may request an
amendment in writing and provide a reason to support your request. We are not
required to make such an amendment. You are entitled to request in writing a
written statement of disagreement, which will be included in your medical
record. If you choose to make such a
statement, we are entitled to submit a statement of explanation, or response to
your appeal, which will be placed in your medical record.
6. Right to obtain accounting of
disclosures. You have a right to receive an accounting of disclosures we
have made and to obtain an accounting of disclosures. You have a right to receive specific
information about disclosures that were made after
April 14, 2003
. This does not include disclosures for
purposes of treatment, payment, or healthcare operations.
7. Right to revoke consent for
treatment/payment and healthcare operations. If you have provided us
with an authorization for any purpose, you may revoke it at any time. You may revoke an authorization by giving us
written notice at our contact address mentioned above. You revocation will be effective as of the
time we receive it, and will not apply to any uses or disclosures which occur
before we have received such a request.
8. Right to file a complaint. If you
believe we have violated your privacy rights, you may forward a written
complaint to us. You may also file a complaint with the Secretary of the United
States Department of Health and Human Services. If you do file a complaint, we are legally prohibited from retaliating
against you.
Complaints can be submitted to:
Region VIII
Office for Civil Rights
U.S.
Dept of Health & Human Services
1961
Stout Street
, Room 1185 FOB
Denver
,
CO
80294-3538
Phone:
(303) 844-2025
Fax:
(303) 844.2025
TDD
(303) 844.3439
