Nelson County Health System P O Box 367 McVille, ND 58254 701.322.4328
| NCHS Privacy Policies |
1. OUR RESPONSIBILITY
Nelson County Health System (NCHS) is required by law to maintain the privacy of your protected health information, and provide you a description
of our privacy practices. We will abide by the terms of this notice and notify you if we cannot agree to a requested restriction. We will accommodate
reasonable requests you may have to communicate health information by alternative means or at alternative locations.
How we may use and disclose medical information about you:
NCHS is permitted to use and disclose your protected health information for care and treatment in order to provide health care services to you. We
may also use your protected health information for payment of your health care bills and to support the operations of NCHS The following
categories describe and provide examples of the ways that we are permitted to use your medical information for treatment, payment, and health
care operations. These examples are not exhaustive, but are used to illustrate the use and disclosures of protected health information NCHS is
permitted to make.
For Treatment: NCHS may use medical information about you to provide your health care treatment or services. We may disclose medical
information about you to doctors, nurses, technicians, medical students, or other health care personnel who are involved in taking care of you at
NCHS. For example: a doctor treating you for an injury may need to know if you have diabetes, because diabetes may slow the healing process; or
if your doctor orders Physical Therapy, the nursing staff will need to discuss your care and treatment with the Physical Therapist. Different
departments of NCHS also may share medical information about you in order to coordinate the different things you may need, such as
prescriptions, lab work, meals, and x-rays. We may provide your physician or health care provider we have referred you to with copies of various
reports that will assist him or her in treating you, once you are discharged from NCHS.
For Payment: NCHS will use your protected health information as needed to obtain payment for your health care services from an insurance
company before it approves or pays for health care services that we recommend. For example, we may inform you health insurance plan or third
party about diagnostic testing that has been recommended as a result of a medical examination that has been completed. This will help determine
whether your insurance plan and/or third party will cover this diagnostic test. NCHS may also disclose medical information to other health care
providers for their payment purposes.
For Health Care Operations: We will use medical information about you as needed to support the business activities of NCHS. These operations
are necessary to run our health care facilities and make sure all of our patients receive quality care. Members of the medical staff and/or quality
improvement team may use information in your health record to assess the care and outcomes of your care and others like it. The results will then
be used to continually improve the quality of care for all patients/residents we serve. For example, we may combine medical information about
many patients/residents to evaluate the need for new services, treatment, or equipment. We may disclose information to doctors, nurses, and
other students for educational purposes. We may call you by name in the waiting room when we call you in for an appointment or laboratory test.
NCHS may also use and disclose medical information:
performs a function involving the use or disclosure of health information on behalf of the NCHS. When these services are contracted, we may
disclose your health information to our business associate, so they can perform the job we have asked them to do. Examples of a business
associate include auditors, attorneys, and consultants. To protect your health care information, however, we require the business associate to
protect and safeguard the information they receive.
Other activities for which we may use or disclose your medical information include, but are not limited to, training programs, auditing, business
management, planning, and administrative functions.
Other permitted uses and disclosures and your opportunity to object:
NCHS may also use and disclose your protected health information in the following instances. You may agree or object to the use or disclosure of
all or part of your protected health information for these purposes:
A Facility Directory: Because NCHS provides health care services at different locations, we use different methods to identify the patients/residents
we provide care to.
friend, or any other person you identify, which is involved in your medical care or who helps pay for your care. If you are unable to agree or object
to such a disclosure, we may disclose information as necessary if we determine that it is in your best interest based on our professional judgment.
In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort to notify or assist in notifying a family
member or someone responsible for your care about your general condition, status, and location.
For marketing, informational, and other communications: NCHS may communicate to you via newsletters, mailings, or other means
regarding health related information, disease management programs, wellness programs, or other community based initiatives, programs, or
activities Nelson County Health System is participating in.
Uses and disclosures we are allowed to make without your permission or the opportunity to object:
NCHS may use or disclose your protected health information in the following situations without your permission:
Required by law: NCHS may use or disclose your medical information when required by federal, state, or local law. The use or disclosure will be
limited to what is required by law.
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written
permission. If you provide us with written authorization to use or disclose information about you, you may revoke the authorization at any time, in
writing. NCHS will honor your revocation except for any use or disclosure we have already made, based on your previous written authorization as
required by law. If you wish to revoke a written authorization, please contact the NCHS Privacy Officer.
2. YOUR RIGHTS AND HOW TO EXERCISE THEM:
You have the following rights regarding medical information we maintain about you and you may exercise those rights. If you have any questions
about this notice, please contact the NCHS Privacy Officer at 701-322-4328.
NCHS is required to abide by the terms of the Notice of Privacy Practices. We may change the terms of this notice at any time. The new notice will
apply to all protected health information we maintain at that time. The Notice of Privacy Practices will be posted at each NCHS location on their
facility's informational bulletin board. You may also request a copy at any time by contacting any NCHS provider location.
4. COMPLAINTS:
If you believe your privacy rights have been violated, you may file a written complaint about NCHS by notifying the Privacy Officer at 701-322-
4328. You may also file a complaint with the Office for Civil Rights at 303-844-2024 or the Department of Human Services at 866-627-7748.
5. TO REQUEST YOUR HEALTH INFORMATION:
Contact NCHS-Medical Records for any protected health information related to your care. Medical Records is staffed Monday - Friday from 8:00
am to 4:30 pm at 701.322.4328. Requests received after hours, on weekends, and/or holidays will be forwarded to Medical Records during normal
operating hours.
PRIVACY OFFICER OFFICE FOR CIVIL RIGHTS DEPARTMENT OF HUMAN SERVICES
Catherine Swenson Denver Regional Office Denver Regional Office
% Nelson County Health System 1961 Stout Street - Room 1185 FOB 1900 Broadway, Suite 700
P O Box 367 Denver, CO 80284-3538 Denver, CO 80202
McVille, ND 58254-0367 Phone: 303-844-2024 Phone: 766-627-7748
Phone: 701-322-4328 Fax: 303-844-2025 Email: askhipaa@cms.hhs.gov
cswenson@gondtc.com03 Email: ocrprivacy@os.dhhs.gov www.cms.hhs.gov/hippa/
www.hhs.gov/ocr/hippa
Nelson County Health System (NCHS) is required by law to maintain the privacy of your protected health information, and provide you a description
of our privacy practices. We will abide by the terms of this notice and notify you if we cannot agree to a requested restriction. We will accommodate
reasonable requests you may have to communicate health information by alternative means or at alternative locations.
How we may use and disclose medical information about you:
NCHS is permitted to use and disclose your protected health information for care and treatment in order to provide health care services to you. We
may also use your protected health information for payment of your health care bills and to support the operations of NCHS The following
categories describe and provide examples of the ways that we are permitted to use your medical information for treatment, payment, and health
care operations. These examples are not exhaustive, but are used to illustrate the use and disclosures of protected health information NCHS is
permitted to make.
For Treatment: NCHS may use medical information about you to provide your health care treatment or services. We may disclose medical
information about you to doctors, nurses, technicians, medical students, or other health care personnel who are involved in taking care of you at
NCHS. For example: a doctor treating you for an injury may need to know if you have diabetes, because diabetes may slow the healing process; or
if your doctor orders Physical Therapy, the nursing staff will need to discuss your care and treatment with the Physical Therapist. Different
departments of NCHS also may share medical information about you in order to coordinate the different things you may need, such as
prescriptions, lab work, meals, and x-rays. We may provide your physician or health care provider we have referred you to with copies of various
reports that will assist him or her in treating you, once you are discharged from NCHS.
For Payment: NCHS will use your protected health information as needed to obtain payment for your health care services from an insurance
company before it approves or pays for health care services that we recommend. For example, we may inform you health insurance plan or third
party about diagnostic testing that has been recommended as a result of a medical examination that has been completed. This will help determine
whether your insurance plan and/or third party will cover this diagnostic test. NCHS may also disclose medical information to other health care
providers for their payment purposes.
For Health Care Operations: We will use medical information about you as needed to support the business activities of NCHS. These operations
are necessary to run our health care facilities and make sure all of our patients receive quality care. Members of the medical staff and/or quality
improvement team may use information in your health record to assess the care and outcomes of your care and others like it. The results will then
be used to continually improve the quality of care for all patients/residents we serve. For example, we may combine medical information about
many patients/residents to evaluate the need for new services, treatment, or equipment. We may disclose information to doctors, nurses, and
other students for educational purposes. We may call you by name in the waiting room when we call you in for an appointment or laboratory test.
NCHS may also use and disclose medical information:
- To remind you that you have an appointment for medical care.
- To assess your satisfaction with our services.
- To tell you about possible treatment alternatives.
- To tell you about other health related benefits or services.
- To contact you as a part of marketing or fund raising efforts.
- For population based activities relating to improving health or reducing health care costs.
- For a review of our treatment and services and evaluation of our staff.
performs a function involving the use or disclosure of health information on behalf of the NCHS. When these services are contracted, we may
disclose your health information to our business associate, so they can perform the job we have asked them to do. Examples of a business
associate include auditors, attorneys, and consultants. To protect your health care information, however, we require the business associate to
protect and safeguard the information they receive.
Other activities for which we may use or disclose your medical information include, but are not limited to, training programs, auditing, business
management, planning, and administrative functions.
Other permitted uses and disclosures and your opportunity to object:
NCHS may also use and disclose your protected health information in the following instances. You may agree or object to the use or disclosure of
all or part of your protected health information for these purposes:
A Facility Directory: Because NCHS provides health care services at different locations, we use different methods to identify the patients/residents
we provide care to.
- Nelson County Health System - Hospital: NCHS will use certain limited information about you in the Hospital directory maintained at our
business office, unless you object. This information may include your name, location in the hospital, your condition (in general terms), and
your religious affiliation. You will be given the opportunity to decide which information you agree to use or disclose in the facility directory
when you are admitted. This information may also be released to people who ask for you by name. In case of an emergency, or if you are
incapacitated, we may use this information in our facility directory, we will provide you, or your legal representative, with an opportunity to
object, when it is practical to do so. - Nelson County Health System - Care Center and/or Swing Bed: On admission, we will also provide you with an opportunity to review how
NCHS uses limited information, including but not limited to, posting your name and room number in the Care Center's Resident Directory, or
posting your name on the door of your Swing Bed room at the Hospital. You can agree or object to the use or disclosure of all or part of
your protected health information any time during your stay.
friend, or any other person you identify, which is involved in your medical care or who helps pay for your care. If you are unable to agree or object
to such a disclosure, we may disclose information as necessary if we determine that it is in your best interest based on our professional judgment.
In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort to notify or assist in notifying a family
member or someone responsible for your care about your general condition, status, and location.
For marketing, informational, and other communications: NCHS may communicate to you via newsletters, mailings, or other means
regarding health related information, disease management programs, wellness programs, or other community based initiatives, programs, or
activities Nelson County Health System is participating in.
Uses and disclosures we are allowed to make without your permission or the opportunity to object:
NCHS may use or disclose your protected health information in the following situations without your permission:
Required by law: NCHS may use or disclose your medical information when required by federal, state, or local law. The use or disclosure will be
limited to what is required by law.
- Public Health: NCHS may use or disclose your protected health information for public health activities, such as a public health authority,
other government authority allowed to receive this information, or to persons who report to the FDA with respect to food, supplements, or
medications. In addition, this reporting could include vital statistics, communicable diseases, or information about product recalls. - Abuse, neglect, or domestic violence: NCHS may disclose your protected health information to a public health authority that is
authorized to receive reports of child abuse or neglect. In addition, we may disclose information to an authorized agency if we believe you
have been a victim of abuse, neglect, or domestic violence. Disclosure will be consistent with state and federal laws. - Health oversight: NCHS may disclose your protected health information to a health oversight agency for activities authorized by law such
as inspections, audits, and investigations. These activities are necessary for the government to monitor the health care system, government
programs, and civil rights laws. - Legal proceedings: NCHS may disclose your protected health information in a judicial or administrative proceeding, in a response to a
court order, and in certain cases in a response to a subpoena, discovery request, or other lawful process. - Law enforcement: NCHS may disclose your protected health information under certain conditions to saw enforcement in response to court
orders or other legal processes; to identify or locate a suspect, fugitive, missing person, or witness; concerning crime victims; about a
suspicious death that may have resulted from a crime; about criminal conduct on our premises; and to report a crime in a medical
emergency. - Coroners, funeral directors, and organ donation: NCHS may disclose your protected health information to a coroner or a funeral
director for purposes allowed by law such as identification or determining the cause of death. We may also disclose information to funeral
directors to allow them to carry out their duties. We may disclose information for organ, eye, or tissue donation purposes. - Research: NCHS 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 requirement for protection of this information. - Serious threat to health or safety: If NCHS believes the use or disclosure of protected health information is necessary to prevent or
reduce a serious threat to the health or the safety of a person or the public, we will disclose it consistent with applicable laws. We may also
disclose protected health information, if necessary, for law enforcement to identify or apprehend an individual. - Military activity and national security: Under certain conditions, NCHS may use or disclose protected health information of individuals in
the Armed Forces, veterans, or foreign military personnel, for purposes of determining benefits, or if necessary, for a military mission. We
may also use or disclose protected health information for national security and intelligence activities. - Inmates: NCHS may disclose protected health information about an inmate to a correctional institution or law enforcement officer as
authorized by law. - Workers compensation: Nelson County Health System may disclose your protected health information to comply with Workers
Compensation and laws and other similar programs established by law.
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written
permission. If you provide us with written authorization to use or disclose information about you, you may revoke the authorization at any time, in
writing. NCHS will honor your revocation except for any use or disclosure we have already made, based on your previous written authorization as
required by law. If you wish to revoke a written authorization, please contact the NCHS Privacy Officer.
2. YOUR RIGHTS AND HOW TO EXERCISE THEM:
You have the following rights regarding medical information we maintain about you and you may exercise those rights. If you have any questions
about this notice, please contact the NCHS Privacy Officer at 701-322-4328.
- RIGHT TO INSPECT AND COPY: You have the right to inspect and copy your protected health information. This means you may inspect
and obtain a copy of protected health information about you that is contained in NCHS' designated record set for as long as we maintain the
protected information. This information includes medical and billing records and other records that NCHS uses for making health related
discussions about you. You are not allowed to inspect or copy psychotherapy notes, certain information compiled for or in anticipation of
civil, criminal, or administrative proceedings, and information subject to a law that prohibits you access to it. In some circumstances, you may
have a right to have this decision reviewed. - RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS BY ALTERNATIVE MEANS OR AT AN ALTERNATIVE LOCATION: You have
the right to request that NCHS communicates 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 at a certain phone number, or mail information to you at a specific address. We will not request an
explanation from you about the reason for your request. We will accommodate reasonable requests. We may condition the accommodation
by asking you for information about how payment will be handled, or ask you to specify an alternative address or other method of contact.
Please make any request for alternate communications in writing to the NCHS Privacy Officer. - RIGHT TO REQUEST A RESTRICTION: You have a right to request a restriction or limitation on medical information Nelson County Health
System uses or discloses about you for treatment, payment, or health care operations. You also have a right to request a limit on the
medical information NCHS discloses about you to someone involved in your care or the payment of your care, or for notification purposes,
such as a family member, relative, or friend. Nelson County Health System is not required to agree to your request. If NCHS does
agree, we will comply with your request unless the information needed is to provide emergency treatment to you. We encourage you to
discuss any restriction(s) you wish to request about your protected health information with your physician. To request a restriction, your
request must be made in writing to our Privacy Officer. Please contact the NCHS Privacy Officer for the information you will need to include
in your restriction request. - RIGHT TO AMEND: If you believe that medical information NCHS has about you is incorrect or incomplete, you may ask us to amend the
information. You may ask for an amendment to information contained in NCHS' designated medical record set for as long as we maintain the
information. You must request an amendment in writing to the NCHS Privacy Officer, and you must provide a reason to support your
request. In certain cases, NCHS may deny your request for an amendment. For example, if the information was not created by NCHS and
the provider who created it is no longer available to make the amendment, or if the information we have is accurate and complete. - RIGHT TO AN ACCOUNTING: You have a right to receive an accounting of certain disclosures NCHS has made of your protected health
information. This does not include the use or disclosure for treatment, payment, or health care operations, for our directory, to person
involved in your care for notification purposes, for national security and intelligence purposes, or for certain disclosures to correctional
institutions and law enforcement. It does not include uses and disclosures for which you gave NCHS written authorization to disclose. You
have a right to receive specific information about disclosures that were made after April 14, 2003. As included in this Notice of Privacy
Practices, your right to receive this information is subject to certain restrictions and limitations. - RIGHT TO A PAPER COPY OF THIS NOTICE: You have a right to a copy of this notice. You may ask us to give you a copy of this notice at
any time. To obtain a paper copy, please contact the NCHS Business Office or Privacy Officer at 701-322-4328.
NCHS is required to abide by the terms of the Notice of Privacy Practices. We may change the terms of this notice at any time. The new notice will
apply to all protected health information we maintain at that time. The Notice of Privacy Practices will be posted at each NCHS location on their
facility's informational bulletin board. You may also request a copy at any time by contacting any NCHS provider location.
4. COMPLAINTS:
If you believe your privacy rights have been violated, you may file a written complaint about NCHS by notifying the Privacy Officer at 701-322-
4328. You may also file a complaint with the Office for Civil Rights at 303-844-2024 or the Department of Human Services at 866-627-7748.
5. TO REQUEST YOUR HEALTH INFORMATION:
Contact NCHS-Medical Records for any protected health information related to your care. Medical Records is staffed Monday - Friday from 8:00
am to 4:30 pm at 701.322.4328. Requests received after hours, on weekends, and/or holidays will be forwarded to Medical Records during normal
operating hours.
PRIVACY OFFICER OFFICE FOR CIVIL RIGHTS DEPARTMENT OF HUMAN SERVICES
Catherine Swenson Denver Regional Office Denver Regional Office
% Nelson County Health System 1961 Stout Street - Room 1185 FOB 1900 Broadway, Suite 700
P O Box 367 Denver, CO 80284-3538 Denver, CO 80202
McVille, ND 58254-0367 Phone: 303-844-2024 Phone: 766-627-7748
Phone: 701-322-4328 Fax: 303-844-2025 Email: askhipaa@cms.hhs.gov
cswenson@gondtc.com03 Email: ocrprivacy@os.dhhs.gov www.cms.hhs.gov/hippa/
www.hhs.gov/ocr/hippa
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