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

Understanding Your Health Record/Information

Each time you visit a hospital, physician, nursing home or other healthcare provider, a record of your visit is made.  Typically, this record contains your symptoms, examination and test results, diagnoses, treatment and a plan for ongoing and future care or treatment.  This information, often referred to as your health or medical record, serves as a:

• Basis for planning your care and treatment

• Means of communication among the health professionals who contribute to your care

• Legal document describing the care you received

• Means by which you or a third-party (insurance company) can verify that services billed were actually provided

• A tool in educating health professionals

• A source of data for facility planning and marketing

• A tool with which we can assess and continually work to improve the services we provide

Your Health Information Rights

Although your health record is the physical property of the La Crosse County Health Department, the information belongs to you.  You have the right to:

• Request Restrictions:  You may request restrictions on certain uses and disclosures of your health information.  You have the right to request a limit on La Crosse County’s disclosure of your health information to someone who is involved in your care or the payment of your care.  However, we are not required to agree to your request.  If you wish to make a request for restrictions, please contact the Privacy Officer for the Health Department.

• Obtain a Paper Copy of this Notice:  You or your representative has a right to a separate paper copy of this Notice at any time even if you or your representative has received this Notice previously.  To obtain a separate paper copy please contact the Privacy Officer for the Health Department at 785-9872

• Inspect and Obtain a copy of your Health Information:  With a few exceptions, you have the right to inspect and copy your health information, including billing records.  A request to inspect and your health information may be made to the Privacy Officer of the Health Department. An Authorization for Disclosure of Confidential Information form will be completed to obtain that information.  The Health Department may charge a reasonable fee for copying of this information.

• Request to Correct Health Information You Believe to be Incorrect or Incomplete:  You or your representative have the right to request for correction of health information if you believe there is incorrect or incomplete information contained in your record. 

La Crosse County Health Department requires that any requests for amendment of protected health information be made using the Amendment form available through the Health Department. This request is to be sent to the Privacy Officer of the La Crosse County Health Department, 300 4^th Street North, La Crosse, WI  54601-3299.  Your request will be reviewed.  If the change is not made, you will be told in writing why and how you can disagree.

• Obtain an Accounting of Disclosures of your Health Information:  You or your representatives have the right to request an accounting of disclosures of your health information made by the Health Department for any reason other than for treatment, payment or health operations. Your request for information will be made in writing.  Information given to you will include the release date, name of the person or organization disclosed to and reason for disclosure.  The list will not include dated before April 14, 2003, or go back more than six years and is subject to certain exceptions under 45 CFR 164.28.  We will provide one list per year free of charge.  There may be charges for additional lists.

• Request That You Be Informed About Your Health in a Way or at a Location That Will Keep Your Information Private:  You have the right to request how and where we contact you about your health information.  After completed a request form, your request will be evaluated and we will let you know if it can be done.

La Crosse County Health Department Responsibilities

• Maintain the privacy of your health information.  In the Home setting, there may be times when particular forms may be left in your home to provide accessibility and continuity for staff documentation of your cares.  Every effort shall be exercised to maintain confidentiality while these forms are in the home setting.

• Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you

• Abide by the terms of this notice or any amendments

• Notify you if we are unable to agree to a requested restriction

• Accommodate reasonable request you may have to communicate health information by alternative means or at alternative locations

We reserve the right to change our practices and to make new provisions effective for all protected health information we maintain.  Should our information practices change, we will post a revised notice within the facility, make revised notices available upon request and post revised notices to our web site at www.co.la-crosse.wi.us/health                                              

For More Information or to Report a Problem

If you have questions and would like additional information, you may contact the Privacy Officer for the Health Department at 608-785-9872.

 If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer or with the State Secretary of Health and Human Services.  There will be no retaliation for filing a complaint.

Uses & Disclosures That May Be Made Without Your Written Authorization

La Crosse County Health Department is permitted by law to use and disclose protected health information in the following ways:

• Treatment:  La Crosse County Health Department may use your health information to provide, coordinate or manage your health care.  We will share your health information with others from your healthcare team including but not limited to, physicians, lab, hospital and emergency providers, rehabilitation therapy, pharmacy and others that may be involved in the delivery of care to you.

·        Payment of Claims:  We will use your health information in order to bill and collect payment for your health care services from your current payment source. 

• Carry out Healthcare Operations:  We will use your health information for regular health operations.  For example:  La Crosse County Health Department members of quality improvement teams, other committees, and outside agencies may use information in your health record to assess the care and outcomes in your case and others like it.  This information will then be used in an effort to continually improve the quality and effectiveness of the health care and the services we provide.  Other examples include computer software companies and contracted consultants.

Other Circumstances of Use/Disclosure: 

·        Response to federal or state law or to a valid subpoena

·        Necessary for public health activities to prevent or control disease, injury or disability

·        Disclosure as it relates to victims of abuse, neglect or domestic violence

·        Related to health oversight activities for the purpose of monitoring, investigating, inspecting, or disciplining those who work in the health care system

·        Information to medical examiners, coroners and funeral directors for identification, determination of the cause of death, or for funeral preparations.

·        To avert serious threat to health or safety to you or the public

·        Disclosure as it relates to military, national security and other governmental functions

·        Compliance with worker’s compensation programs

·        Disclosures that relate to correctional institutions and other law enforcement custodial situations

·        Information for disaster relief services such as to the American Red Cross

Required Authorization for Disclosure

Any uses and disclosures of your health information other than generally described above will only be made with your individual written authorization.  If you sign an Authorization, you can later cancel it in writing at any time and we will not disclose any further protected health information.  If you wish to withdraw authorization contact the Privacy Officer for the Health Department.

Effective Date of Notice:  April 14, 2003