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 IT CAREFULLY.”  

April 2003

I.  Understanding Your Health Record/Information

Each time you visit the Red Cliff Community Health Center, Ambulance service, AODA service, and Pharmacy services, a record of your visit is made. Typically, this record contains your symptoms, examination, test results, diagnoses, treatment, and a plan for future care. This information, often referred to as your health record, serves as a:

• Plan for your care and treatment
• Communication source between the health care professionals
• Tools with which we can check result and continually work to improve the care we provide
• Means by which Medicare, Medicaid or private insurance payers can verify the services billed.
• Tool for education of health care professionals
• Source of information for public health authorities charged with improving the health of the people
• Source of data for medical research, facility planning and marketing
• Legal document that describes the care you receive

Understanding what is in your health record and how the information is used helps you to:

• Ensure its accuracy
• Better understand why others may review your health information
• Make an informed decision when authorizing disclosures

II.  Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy Responsibilities 

The Red Cliff Community Health Center, Ambulance, AODA, and Pharmacy is required by law to:

• Maintain the privacy of your health information
• Inform you about our privacy practices regarding health information we collect and maintain about you
• Honor terms of this notice

Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy reserves the right to change its privacy practices and to make the new provisions effective for all protected health information it maintains.

Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy will post any revised Notice of Privacy Practices at public places in each physical facility on or after the effective date of the revision and you may request a copy of the notice.

Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy understands that health information about you is personal and is committed to protecting your health information.

Red Cliff Community Health Center, Ambulance, AODA, and Pharmacy will not use or disclose your health information without your permission, except as described in this notice and as permitted by the HIPAA Privacy Regulations.

III.  How Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy may use and disclose health information about you. 

The following categories describe how we may use and disclose health information about you.

We will use and disclose your health information to provide your treatment.

For example: We may disclose your personal health information to health care providers (doctors, dentists, pharmacies, hospitals and other caregivers) who request it to aid in your treatment.

If Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy staff sends you to another health care facility using Contract Health Service (CHS), Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy will exchange your health information with that health care provider for treatment decisions.

We will use and disclose your health information for payment.

For example: In order to administer the programs and receive payment for services, the Red Cliff Health Center, Ambulance, AODA, and Pharmacy must use and disclose your health information to determine:

• Eligibility for Programs
• Payment for Services 

If the Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy sends you to another health care facility using Contract Health Service (CHS), Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy will exchange your health information with that provider for health care payment decisions.

We will use your health information for health care operations.

For example: We may use your health information to evaluate your care and outcomes. This information will be used to continually improve the quality and effectiveness of the services we provide. This includes health care services provided under Contract Health Services (CHS).

Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy may use and disclose health information about you without your consent or authorization for the following purposes:

Required by Law: We may use or disclose your personal health information, as we are required to do so by federal, state, or local law.

Communication with Family: The Red Cliff Community Health Center, Ambulance, AODA, and Pharmacy providers may disclose your health information to others as directed by you. For example, we may inform your family members, relatives, close personal friends or any other person you identify. This disclosure of health information is relevant to that person’s involvement in providing care or payment for services.

Research:  Under certain circumstances, and only after a special approval process, we may use and disclose your health information to help conduct research. Such research might try to find out whether a certain treatment is effective in curing an illness and/or identifying of presence of disease within the community.

Death: We may disclose your health information to coroners and medical examiners so they can carry out their duties related to your death, such as identifying the body, determining the cause of death.

Organ Procurement Organizations: Consistent with applicable laws, the Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Service Reminders: Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy may contact you to provide information about other types of health-related benefits and services that may be of interest to you. Example: We may contact you about the availability of new services for diabetes.

Appointment Reminders: The Red Cliff Community Health Center and AODA staff, for example, may contact you with a reminder that you have an appointment for medical care at our facilities. 

Treatment Alternatives: The Red Cliff Community Health Center and AODA staff, may recommend possible treatment alternatives and options that may be of interest to you, using your health information.

Food and Drug Administration (FDA): The Red Cliff Community Health Center, Ambulance, AODA, and Pharmacy may disclose to the FDA your health information, if you have experienced adverse events with food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Public Health: The Red Cliff Community Health Center, Ambulance, AODA, and Pharmacy will disclose, as required by law, your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability, charged with receiving reports of child abuse or neglect, and charged with receiving information of abuse, neglect, or domestic violence. The Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy may disclose your health information to an individual who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition. We may have to report certain work-related instances and injuries, to your employer so your workplace can be monitored for safety.

Workers Compensation: The Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy will disclose health information for workers compensation or similar programs as required by law.

Correctional Institution: Should you be an inmate of a correctional institution, The Red Cliff Community Health Center, Ambulance, AODA, and Pharmacy may disclose to the institution, health information necessary for your health and the health and safety of other individuals.

Law Enforcement: The Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy may disclose health information for law enforcement purposes as required by law or in response to a court order.

Members of the Military: If you are a member of the military services or U.S. Public Health Service Commissioned Corps, The Red Cliff Community Health Center, Ambulance, AODA, and Pharmacy may disclose your health information to your military command authorities. 

Health Oversight Authorities: The Red Cliff Community Health Center, Ambulance, AODA, and Pharmacy may disclose health information to health oversight authorities for activities authorized by law. These oversight activities include investigations, audits, inspections, and other actions. These are necessary for the government to monitor the health care system, government programs, and monitor compliance with civil rights laws. 

To avoid a serious threat to health or safety: We may disclose your health information to the extent necessary to avoid a serious and imminent threat to your health or safety or to the health or safety of others.

Non Violation of this Notice: Red Cliff Community Health Center, Ambulance, AODA, And Pharmacy is not in violation of this Notice or the HIPAA Privacy Rule if any of its employees, business associates or contractors discloses information under the following circumstances: disclosures by whistleblowers and disclosures by workforce member crime victims.

Note:  Except for the situations listed above, we must obtain your specific written authorization for any other release of your health information. An authorization is different than consent. One primary difference is that unlike with consents a provider must treat you even if you do not wish to sign an authorization for. If you sign an authorization form, you may withdraw your authorization at any time, as long as your withdrawal is in writing. If you wish to withdraw your authorization, please submit your written withdrawal to the Medical Records Department.

IV. Your Health Information Rights

Although your health record is the physical property of the Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy, the information belongs to you. All requests in connection with the following rights must be in writing. You have the right to:  

• Inspect and copy your health information. With a few exceptions, you have the right to inspect and obtain a copy of your health information. The Health Center , Ambulance, AODA, and Pharmacy have the right to grant access in whole, in part or to deny access. If a denial is based on revisable grounds, the client has the right to request a review. The copying fee is 10 cents per page after the first 10 pages.
• Request a restriction on certain uses and disclosures of your health information. The Red Cliff Community Health Center , Ambulance, AODA, and Pharmacy are not required to agree to any requested restriction.
• Request an amendment to your health record if you believe your health information is incorrect or incomplete; you may ask us to amend the information.              
• Request confidential communications about your health information. You may request confidential communications by an alternate means or at an alternate location. The Health Center , Ambulance, AODA, and Pharmacy will accommodate all reasonable requests
• Receive an accounting of disclosures of your health information.  You have the right to ask for an accounting of disclosures of your health information we have made during the previous six years, but the request cannot include those dated before April 14, 2003. The accounting of disclosures must include the date of each disclosure, who received the disclosed health information, a brief description of the health information disclosed, and why the disclosure was made. The Health Center , Ambulance, AODA, and Pharmacy may not charge you for the list, unless you request such list more than once per year. In addition, we will not include in the list disclosures made to you, or for purposes of treatment, payment, health care operations, national security, law enforcement/corrections, and certain health oversight activities.
• Obtain a paper copy of the Red Cliff Community Health Center, Ambulance, AODA, and Pharmacy Notice of Privacy Practices upon request

To exercise your rights under this Notice, to ask for more information, or to report a problem you may contact the Privacy Officer at:

Privacy Officer Pauline Grooms
(715) 779-3707
Red Cliff Community Health Center
88455 Pike Road, P.O. Box 529
Bayfield, WI 54814

If you believe your privacy rights have been violated, you may file a written complaint with the above individual or the Secretary of Health and Human Services, U.S. Department of Health and Human Services, Washington, DC 20201. There will be no retaliation for filing a complaint. You may file a complaint at either entity.

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