NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND GIVEN OUT AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
(download The Mat-Su Health Services Privacy Practices as a pdf file for printing).

PLEASE REVIEW IT CAREFULLY

Mat-Su Health Services respects your privacy. We understand that your personal health information is very sensitive. We will not give out your information to others unless you tell us to do so, or unless the law allows or requires us to do so.

The law protects the privacy of the health information we create and obtain in providing our care and services to you. Protected Health Information means any information that is identifiable to you as your personal information, including your symptoms, test results, diagnoses, treatment, health information from other providers, and billing and payment information relating to these services.

Use and Disclosures of Protected health Information for Treatment, Payment, and Health Care Operations

We may use or give out your protected health information for your treatment, payment for your treatment, and our health care operations. We are required to get your authorization to give out this information for payment purposes.

The following are examples of how we may use or give out information about you:

For treatment:

Information obtained by a nurse, physician, or other member of our health care team will be recorded in your medical record and used to help decide what care may be right for you.
We may also share information to others providing your care. This will help them stay informed about your care.

For payment:

We request payment form your health insurance plan. Health plans need information from us about your medical care. Information shared with health plans may include your diagnoses, procedures performed, or recommended care.

For health care operations:

We may use your medical records to measure quality and improve services.
We may use and give out information to review how well our health care providers take care of you. We may also use this information to train our health care providers and other staff.
We may remind you about appointments. We may also give you information about treatment options or other health-related benefits and services.
We may use and give out your information for:

Medical quality review by your health plan;
Accounting, legal, risk management, and insurance services;
Audit functions, including fraud and abuse detection and compliance programs.

Your Rights Regarding Your Protected Health Information

The health and billing records we create and store are the property of Mat-Su Health Services. The protected health information in it, however, generally belongs to you. You have a right to:

Receive, read, and ask questions about this Notice.
Ask us to limit certain uses and disclosures. You must make this request in writing to us. We are not required to grant the request.
Get a copy of your protected health information. The request must be in writing. We have a form available for this type of request. We may charge you a reasonable fee based on copying and other costs.
In certain situations, we may deny your request to look at or get a copy of your information. If we deny your request, we will notify you in writing. We will provide you with the right to have the denial reviewed.
Ask us, in writing, to amend your health information. If we deny your request, we will provide you a written explanation. You may write a statement of disagreement that will be stored in your medical record and included with any release of your records.
When you ask, we will give you a list of disclosures of your health information. The list will not include disclosures to third party payors. You may receive this information without charge once every 12 months. We will notify you of the cost involved if you ask for this information more than once in 12 months.
Ask that your health information be given to you in a different manner or at another location. Please sign, date, and give us your request in writing.
Cancel prior authorizations to use or give out health information by giving us a written cancellation. Canceling your authorization does not affect information that has already been released. It also does not affect any action taken before we have it. Sometimes, you cannot cancel an authorization if its purpose was to obtain insurance.
Ask for and receive from us a paper copy of the most current Notice of Privacy Practices for Protected health Information (“Notice”).

Our Responsibilities

We are required to:

Keep your protected health information private.
Give you this Notice.
Follow the terms of this Notice.

We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice. You may receive the most recent copy of this Notice by calling or visiting Mat-Su Health Services.

To Ask for Help or to Complain

If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact the Manager at Mat-Su Health Services.

You may also send questions or complaints to:
            Mat-Su Health Services
            Attn: Privacy Officer
            1363 W. Spruce Avenue
            Wasilla, AK 99654
            (907) 376-2411

If you believe your privacy rights have been violated, you may ask any staff member to direct you to the correct contact person. You may also deliver a written complaint to the Privacy Officer at Mat-Su Health Services at the address listed above. You may also file a complaint with the U.S. Secretary of Health and Human Services.

We respect your right to file a complaint with us or with the U.S. Secretary of Health and Human Services. If you complain, we will not take any action against you.

Other Disclosures and Uses of Protected health Information

We may use and give out your protected health information without your authorization as follows:

With medical researchers – If the research has been approved and has policies to protect the privacy of your health information. We may also share information with medical researchers preparing to conduct a research project.
To funeral directors/coroners consistent with the laws that allow them to carry out their duties.
To organ procurement organizations (tissue donation and transplant) or persons who obtain, store, or transplant organs.
To the Food and Drug Administration (FDA) relating to problems with food, supplements, and products.
To comply with workers’ compensation laws – if you make a workers’ compensation claim.
For public health and safety purposes as allowed or required by law:

To prevent or reduce a serious, immediate threat to the health or safety of a person or the public.
To public health or legal authorities

To protect public health and safety.
To prevent or control disease, injury, or disability.
To report vital statistics such as births or deaths.

To report suspected abuse or neglect to public authorities.
To correctional institutions if you are in jail or prison, as necessary for your health and the health and safety of others.
For law enforcement purposes such as when we receive a subpoena, court order, or other legal process, or you are the victim of a crime.
For health and safety oversight activities. For example, we may share health information with the Department of Health.
For disaster relief purposes. For example, we may share health information with disaster relief agencies to assist in letting family or others know of how you are.
For work-related conditions that could affect employee health. For example, an employer may ask us to measure health risks on a job site.
To the military authorities of U.S. and foreign military personnel. For example, the law may require us to provide information necessary to a military mission.
In the course of judicial/administrative proceedings at your request, or as directed by a subpoena or court order.
For specialized government functions. For example, we may share information for national security purposes.

Other Uses and Disclosures of Protected Health Information:

Uses and disclosures not in the Notice will be made only as allowed or required by law, or with your written authorization.

Confidentiality of Behavioral Health Records

The confidentiality of behavioral health records maintained by this agency is protected by Federal law and regulations. Generally, the agency may not say to a person outside the agency that a person attends the behavioral health program, or disclose identifying information a person as an alcohol or drug abuser, unless:
The individual consents in writing;
The disclosure is allowed by a court order; or
The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit or program evaluation.
Violation of the Federal law and regulations by a program is a crime. Suspected violations may be reported to appropriate authorities in accordance with Federal regulations.
Federal law and regulations do not protect any information about a crime committed by a person in care either at the agency or against any person who works for the agency or about any threats to commit such a crime.
Federal law and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities.

Effective Date: October 10, 2005
(Last updated: 10-10-05)