Notice of Protected Health Information Privacy Practices

Purpose of this Notice:

Tamber Health (Tamber) is required by law to maintain the privacy of your protected health information (PHI). This notice applies to all records of the physical and mental health care and related services you receive at Tamber. This notice will tell you about the ways in which we may use and disclose your PHI. This notice also describes your rights and certain obligations we have regarding the use and disclosure of your PHI.

Who Will Follow this Notice:

This notice describes Tamber’s privacy practices, as well as the privacy practices of:

• any health care professional authorized to enter information into your Tamber medical record;
• all departments and offices of Tamber; and
• all employees, staff, business associates, and other Tamber personnel.

Understanding Your Health Record:

Each time you visit or are visited by a Tamber health care provider or a provider affiliated with Tamber, a record of the care and services you receive from us is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for care or treatment. This information, often referred to as your health or medical record, serves as a:

• basis for planning your care, treatment and any follow up care you may need;
• means of communication among the many health professionals who contribute to your care;
• legal document describing the care you received;
• means by which you or a third-party payor (for example, insurance carriers, Medicare, Medicaid) can verify that services billed were actually provided;
• tool in educating health professionals;
• source of information for medical research;
• source of information for public health officials charged with improving the health of the nation;
• source of information for facility planning; and
• tool that can be used to assess and continually improve the care rendered and the results achieved.

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

1. ensure its accuracy;
2. better understand who, what, when, where and why others may access your health information; and
3. make more informed decisions when authorizing disclosure to others.

Tamber’s Commitment:

We are required by law to:

• make sure that your PHI is kept private;
• give you this notice of our legal duties and privacy practices with respect to your PHI;
• follow the terms of this notice as long as it is currently in effect. If we revise this notice, we will follow the terms of the revised notice as long as it is currently in effect;
• train our personnel concerning privacy and confidentiality; and
• mitigate (lessen the harm of) any breach of privacy/confidentiality.

How We May Use and Disclose Information about You:

• The following categories (listed in bold-face print below) describe different ways that we use and disclose your PHI. For each category of uses or disclosures we will explain what we mean and give you some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information fall within the categories below.
  • For Treatment. We are permitted to use and disclose your PHI to doctors, psychologists, nurses, social workers, technicians, medical students or other personnel who are involved in taking care of you at Tamber or provide you with medical treatment or services. We also may disclose your PHI to health care providers outside Tamber who may be involved in your medical care, such as primary care physicians, specialty care providers, rehabilitation facilities, and inpatient facilities. For example, your primary care physician may need to know what medications a Tamber affiliated provider has prescribed to you in order to help prevent any cross-reactions with any medication(s) that he or she may prescribe to you.
  • For Payment. We are permitted to use and disclose your PHI so that the treatment and services you receive at Tamber may be billed to (and payment may be collected from) your insurance company or a third party. For example, we may need to give your health plan information about the doctor’s visit you received at Tamber so your health plan will pay us or reimburse you for the visit.
  • For Health Care Operations. We are permitted to use and disclose your PHI for our business operations. These uses and disclosures are necessary to run Tamber and to make sure that all of our patients receive quality care. For example, we may use PHI to review our treatment and services and to evaluate the performance of our staff in caring for you. We also may disclose information to Tamber personnel to conduct training programs. We also may combine certain PHI about several Tamber patients as part of a study to determine what additional services Tamber should offer, what services are not needed, and whether certain new treatments are effective. We also may remove all information that identifies you from a set of PHI so that others may use that information to study health care and health care delivery without learning who the specific patients are.
  • To Business Associates for Treatment, Payment and Health Care Operations. We are permitted to disclose your PHI to our business associates in order to carry out treatment, payment or health care operations. For example, we may disclose your PHI to a company we hire to bill insurance companies on our behalf to help us obtain payment for the health care services we provide.
  • Individuals Involved in Your Care or Payment for Your Care. We may release your PHI to a family member, other relative or close personal friend who is involved in your medical care if the PHI released is directly relevant to the person’s involvement with your care or payment for your care. In addition, we may disclose your PHI to a group assisting in a disaster relief effort so that your family can be notified about your location and general condition.
  • Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at Tamber.
  • Treatment Alternatives. We may use and disclose medical information to give you information about treatment options or alternatives that may be of interest to you.
  • Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

 

• Special Situations:

 

• As Required By Law. We will disclose your PHI when required to do so by federal, state, or local law.
  1. Public Health Activities. We may disclose your PHI for public health activities. For example, public health activities generally include:
     1. preventing or controlling disease, injury or disability;
     2. reporting births and deaths;
     3. reporting child abuse or neglect;
     4. reporting reactions to medications or problems with products;
     5. notifying patients of recalls of products they may be using;
     6. notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; or
     7. notifying the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.
  2. We will only make this disclosure if you agree or when required or authorized by law.
  3. Health Oversight Activities. We may disclose PHI to a health oversight agency for activities authorized by law such as audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
  4. Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
  5. Law Enforcement. We may release PHI if asked to do so by a law enforcement official:
     1. in response to a court order, subpoena, warrant, summons or similar process;
     2. to identify or locate a suspect, fugitive, material witness or missing person—but only if limited information (e.g., name and address, date and place of birth, Social Security number, blood type and RH factor, type of injury, date and time of treatment, and date and time of death, if applicable) is disclosed;
     3. about the victim of a crime if, under certain limited circumstances, we are unable to obtain the victim’s agreement;
     4. about a death we believe may be the result of criminal conduct;
     5. about criminal conduct we believe occurred on Tamber’s premises; and
     6. in emergency circumstances to report a crime; or to determine the location of the crime, it’s victims, or the identity, description or location of the person who committed the crime.
  6. Coroners, Medical Examiners and Funeral Directors. We may release PHI about patients of Tamber to a coroner or medical examiner to identify a deceased person or to determine the cause of death. We may also release PHI about patients of Tamber to funeral directors as necessary to help them carry out their duties.
  7. Organ and Tissue Donation. We may release PHI to organizations that handle organ procurement; or organ, eye or tissue transplantation; or to an organ donation bank to facilitate organ or tissue donation and transplantation.
  8. To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to law enforcement in order to help prevent the threat.
  9. Research. Under certain circumstances, we may use and disclose your PHI for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another for the same condition. Most research projects, however, are subject to a special approval process. This process requires an evaluation of the proposed research project and its use of PHI, and balances these research needs with our patients’ need for privacy. Before we use or disclose PHI for research, the project will have been approved through this special approval process.
  10. Armed Forces and Foreign Military Personnel. If you are a member of the armed forces, we may release your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority.
  11. National Security and Intelligence Activities. We may release your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
  12. Protective Services for the President and Others. We may disclose your PHI to authorized federal officials so they may provide protection to the President of the United States; other authorized persons or foreign heads of state; or to conduct special investigations.
  13. Workers’ Compensation. We may release your PHI for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

When Your Authorization is Required:

• Uses or disclosures of your PHI for other purposes or activities not listed above will be made only with your written authorization (permission). If you provide us authorization to use or disclose your PHI, you may revoke your authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your PHI for the reasons covered by your written permission. However, we are unable to take back any disclosures we have already made with your permission.

Psychotherapy Notes Authorization:

• In addition to your standard PHI, Tamber may separately maintain certain written, electronic, video, and audio notes documenting or analyzing your private, group, or joint counseling sessions (your “Psychotherapy Notes”). Uses or disclosures of your Psychotherapy Notes will be made only with your separate written authorization (permission), except for the following, which do not require your authorization: internal treatment uses; certain limited, internal training, compliance, and oversight uses and disclosures; uses and disclosures related to Tamber’s own legal defense against you or your decedents; limited disclosures to a coroner or medical examiner; or uses or disclosures necessary to avert a serious threat to the health or safety of a person or the public. We abide by the psychotherapy notes authorization requirement of the HIPAA Privacy Rule, unless otherwise required by law.

Your Rights:

• You have the following rights regarding the PHI we maintain about you.
  • Right to Request Restrictions. You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. We are not required to agree with your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. Tamber will notify you in writing whether we agree or do not agree with your request. In your request, you must tell us:
    1. what information you want to limit;
    2. whether you want to limit Tamber’s use and/or disclosure of the information;
    3. to whom you want the limits to apply (for example, disclosures to your spouse); and
    4. your contact address.
  • Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by telephone at work or that we only contact you by mail at home. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
  • Right to Inspect and Receive a Copy. You have the right to inspect and receive a copy of PHI that may be used to make decisions about your care. Usually, this includes medical and billing records. Psychotherapy notes may not be inspected or copied. If you request a copy of your PHI, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect or receive a copy in certain very limited circumstances. If you are denied access to PHI, we will notify you in writing, and you may request that the denial be reviewed. Another licensed health care professional chosen by Tamber will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
  • Right to Amend. If you believe that PHI we have about you is incorrect or incomplete, you may ask your provider to amend the information. You have the right to request an amendment for as long as the information is kept by or for Tamber. You must include a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
    1. was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
    2. is not part of the PHI kept by or for Tamber;
    3. is not part of the information that you would be permitted to inspect and copy; or
    4. is accurate and complete.
  • Tamber will notify you in writing whether we agree or do not agree with your amendment request. Additionally, if we grant the request, we will make the correction and distribute it to all necessary recipients as well as those you ask to receive the corrected information. If we deny your request for an amendment, we will notify you how you may file a complaint with Tamber or the Department of Health and Human Services.
  • Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures” that have been made by Tamber in the past six (6) years. The accounting (or list) of disclosures will include:
    1. the date of the disclosure;
    2. the name of the entity or person who received the PHI and, if known, the address;
    3. a brief description of the PHI disclosed; and
    4. a brief statement of the purpose of the disclosure.
  • Your request must state a time period not longer than six (6) years prior to the date of the request. The first list you request within a twelve (12) month period will be free of charge. For additional lists, we will charge you for the costs of providing the list. We will also notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
  • 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 copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To obtain a paper copy of this notice, print this page or contact the Tamber Privacy Office at 855-4TAMBER (855-482-6237).

Contact Information for these Rights:

• If you have any requests, questions, or would like additional information on these rights, you may contact Tamber’s Privacy Officer at(612) 814-8012 or in writing to Tamber Health, P.O. Box 178, Crystal Bay, MN 55323. Additionally, if you believe your privacy rights have been violated, you may file a complaint with either the Tamber’s Privacy Officer or with the Office for Civil Rights, U.S. Department of Health and Human Services, work 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201. You will not be penalized in any way for filing a complaint.

Changes to this Notice:

• We reserve the right to change this notice. We reserve the right to make the revised or changed 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 on Tamber premises and on Tamber’s web site. The notice will contain on the first page, in the lower left-hand corner, the effective date. In addition, each time you register at, or are admitted to, Tamber for treatment purposes, you may request a copy of the current notice in effect.

Effective Date: 04/15/2014.