Notice of privacy practices

Effective April 15, 2003
Revised September 23, 2019

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.

While you receive healthcare from Welia Health, doctors, nurses, and other providers will gather and record medical information about your past and current health. This notice describes your rights and certain obligations we have regarding the use and disclosure of your medical information

Your medical information may be used for the following purposes:

Treatment. We will use your medical information to provide, coordinate, and manage your medical treatment or services. For example, a hospital doctor may share your medical information with another doctor for a referral.

Payment. We may use and disclose your medical information so that the treatment and services you receive at the hospital may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about a surgery you received at the hospital so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

Health Care Operations. We may use and disclose your medical information for hospital operations. These uses and disclosures are necessary to run the hospital and make sure that all of our patients receive quality care. For example, we may use your medical information to review our treatment and services and evaluate the performance of our staff in caring for you.

Medical Emergencies. We may use or disclose your medical information to help you in a medical emergency.

Appointment Reminders. We may use your medical information to contact you as a reminder that you have an appointment for treatment or medical care at the hospital or to remind you about prescription refills.

Hospital Directory. We may include certain limited information about you in the hospital directory while you are a patient at the hospital unless you tell us not to do so. This information may include your name, location in the hospital, your general condition (example, fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don’t ask for you by name. This is so your family, friends, and clergy can visit you in the hospital and generally know how you are doing.

Individuals Involved in Your Care or Payment for Your Care. We may disclose limited medical information to people involved in your care, such as a family member or emergency contact. We may allow people involved in your care to pick up your prescriptions or medical supplies. If you do not want this information given out, you can request that it not be shared.

Required By Other Laws. We will disclose your medical information when required to do so by Federal, State or local law. For example, we may disclose health information to the U.S. Department of Health and Human Services, under workers’ compensation or similar laws, or to social service or other agencies allowed to receive information about certain injuries or health conditions

To Avert a Serious Threat to Health or Safety. We may use and disclose your medical information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Research. We may use and disclose your medical information for research purposes as allowed by law or if you have given permission. You may ask us how to contact a researcher who received your health information for research purposes and the date on which it was disclosed.

Support of Fundraising Efforts. Occasionally, Welia Health or one of its business associates, or its foundation, may use certain information about you to let you know about fundraising or other charitable events. You have the right to opt-out of receiving such communications by contacting the Privacy Officer at the phone number on this notice. Opting out will have no impact on your treatment or payment for your treatment.

Pursuant to Your Written Authorization. We may use and disclose your medical information pursuant to your written authorization. Welia Health has authorization forms available. A completed form must state the parties to whom the information is to be disclosed, which medical information is to be disclosed, and the duration/purpose of the authorization.

Special situations: Uses and disclosures

Death; Organ and Tissue Donation. We may disclose certain health information about a deceased person to the next of kin. We may also disclose this information to a funeral director, coroner, medical examiner, or law enforcement official. If you are an organ donor, we may release your medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank as necessary to facilitate organ or tissue donation and transplantation.

Military Authorities/National Security. We may release medical information to authorized people from the U.S. Military, foreign military, and U.S. national security or protective services.

Worker’s Compensation. We may release medical information for worker’s compensation or similar programs as authorized or required by law. These programs provide benefits for work-related injuries or illnesses.

Public Health Risks. We may disclose your medical information as required by law to support public health activities. These activities may include:

• To prevent or control disease (such as cancer or tuberculosis), injury or disability;
• To report vital events such as births and deaths;
• To notify people of recalls of products they may be using;
• To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
• To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
• To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
• To make other reports as requested or authorized by applicable law;

Abuse, Neglect or Threat. We may disclose medical information to the proper government authorities about possible abuse or neglect of a child or vulnerable adult. If there is a serious threat to a person’s health or safety, we may disclose information to that person or to law enforcement.

Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.

Legal Process. We may disclose your medical information in response to a court or administrative order. We may also disclose medical information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute.

Law Enforcement. We may release certain medical information to law enforcement. This could be:

• In response to a court order, subpoena, warrant, summons or similar process, or
• about a missing child, or
• when there may have been a crime at our facilities, or
• when there is a serious threat to the health or safety of another person or people

Correctional Facility. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your medical information to the correctional institution or law enforcement official as authorized by law.

Other uses of medical information

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 authorization, including the use and disclosures of psychotherapy notes, use and disclosure for marketing purposes, or disclosures that are considered the sale of medical information. Certain types of medical information may have additional protection under federal or state law. For example, medical information about HIV/AIDS and genetic testing results may be treated differently under certain state laws. Additionally, federally assisted alcohol and drug abuse programs are subject to certain special restrictions on the use and disclosure of alcohol and drug treatment information. To the extent required, Welia Health would need to get your written permission before disclosing that information to others in most circumstances.

Who will follow this notice

This Notice describes Welia Health’s practices and the practices of:

• Any health care professionals authorized to enter information into your medical and billing records;
• All medical students and other trainees affiliated with the hospital;
• Any member of the Volunteer/Auxiliary that may help you while you receive services at Welia Health;
• All departments, units, employees, staff and other Welia Health personnel;
• All credentialed medical staff, including physicians and other allied health professionals, unless these other health care providers give you their own notice of privacy practices.

Your medical information rights

Right to Inspect and Copy Your Medical Information. In most cases, you have the right to inspect and obtain a copy of your health care information when you submit a written request. You have the right to request that the copy be provided in an electronic form or format (e.g., PDF saved onto CD). If the form and format are not readily producible, then the organization will work with you to provide it in a reasonable electronic form or format. Written requests should be sent to Welia Health’s Privacy Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. If we deny your request or obtain a copy, you may submit a written request for a review of that decision.

Right to Amend. If you feel that the medical information we have about you is incorrect or incomplete, you may ask us to amend the information by submitting a request in writing that provides your reason for requesting the amendment. We may deny your request for an amendment f the information was not created by us; if it is not part of the medical information maintained by us; or if we determine that the record is accurate. You may appeal, in writing, a decision by us not to amend a record.

Right to an Accounting of Disclosures. You have the right to request a list (an “accounting”) of the disclosures we made of your medical information, except for uses and disclosures made for treatment, payment, and health care operations. Your request must be in writing and be submitted to Welia Health’s Privacy Officer. Your request must state a time period for which you wish to have a list, and which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the cost of copying, mailing or other supplies associated with your request. We will inform you of the fee before you incur any costs.

Right to Request Restrictions. You may request, in writing, a restriction or limitation on the medical information we use or disclose about you for treatment, payment or healthcare operations. If you pay out-of-pocket in full for any item or service, then you may request that we not disclose information pertaining solely to such item or service to your health plan for purposes of payment or health care operations. We are required to agree with such a request unless you request a restriction on the information we disclose to a health maintenance organization (“HMO”), and the law prohibits us from accepting payment from you above the cost-sharing amount for the item or services that is the subject of the requested restriction.

You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had to a specific family member. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you must make your request in writing to Welia Health’s Privacy Officer. In your request, you must tell us (1) what information you want to limit, and (2) to whom you want the limits to apply; for example, disclosures to specific individuals.

Right to Request Confidential/Alternative Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location by notifying us in writing. For example, you can ask that we only contact you at work or by mail. We will not ask you the reason for your request. We will accommodate all reasonable requests. To request specific confidential communications, you must make your request in writing to Welia Health, Attention Privacy Officer (address below). Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a paper copy at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy. You may obtain a copy of this Notice at our website, WeliaHealth.org/resources/rights-and-policies/notice-of-privacy-practices.

Changes to this notice

The effective date of this Notice is September 3, 2019. We reserve the right to change the Notice and make the revised Notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in the hospital and on the Welia Health website at WeliaHealth.org/resources/rights-and-policies/notice-of-privacy-practices and will promptly make any revision available upon request.

Questions and complaints

If you have questions or concerns regarding our privacy practices, please contact Welia Health’s Privacy Officer at the address provided below. If you believe your privacy rights have been violated, you may file a written complaint with the hospital. To file a complaint with the hospital, contact Welia Health’s Quality Officer. All complaints must be submitted in writing. Finally, you may send a written complaint to the Secretary of the Department of Health and Human Services (HHS). We will provide you with the DHHS contact information upon request. We support your right to the privacy of your medical information and will not retaliate in any way if you choose to file a complaint with us or with HHS.

Please address all written correspondence to:

Welia Health
Attention Privacy Officer
301 Highway 65 S
Mora MN 55051