PATIENT PRIVACY

Notice Of Privacy Practices

Twin Cities Medical Clinic Notice of Privacy Practices

This notice describes how the medical information about you may be used and disclosed.

Twin Cities Medical Clinic (TCMC) will attempt to abide by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which is a federal program requiring all medical insurance records and other identifiable health information used or disclosed by TCMC, in any form, to be kept confidential.  TCMC is required to follow Minnesota State Statutes regarding patient privacy.  TCMC has a notice of the Minnesota Department of Health’s ‘ACCESS TO HEALTH RECORDS NOTICE OF RIGHTS’ (based on Minnesota Statutes, Section 144.335, Subd. 5a) clearly displayed in the reception area of TCMC.  Please understand that if you would like additional information, or links to specific laws, you can visit www.health.state.mn.us and search for “access to health records” or call the Minnesota Department of Health at (651)282-6314.  TCMC can change its privacy practices and terms of this notice at any time, effective for all medical records (new and old).

The following is a summary of how TCMC intends to maintain the privacy of your health information and how we may use and disclose this information.  Before any important change in our privacy practices, this notice will be updated and made available.

We may use and disclose your medical records (Protected Healthcare Information-PHI) for the following purposes-  Treatment, Payment, and Healthcare Operations:

• Treatment may require that your information be disclosed to other healthcare professionals that are involved in your care such as specialist physicians, your primary physician, or the health department.

• Payment includes obtaining money due for services by TCMC.

• Healthcare Operations include the business aspects of running our practice, such as internal quality review, auditing function and cost management analysis.

Use and Disclosure of your PHI under Special Circumstances:

• Federal and State laws require TCMC to report communicable diseases and other public health risks to the local Department of Health or appropriate agency.

• Immigration I-693 Medical Exams and Refugee Immunization Updates require us to test for certain diseases, confirm immunization status, and report all our findings to the U.S. Department of Homeland Security, Citizenship and Immigration Services.  Please refer to Section I ‘Instructions for Aliens Applying for Adjustment of Status, Medical Examination and Health Information’, page 1 of Form I-693 Instructions (OMB No. 1615-0033).

• TCMC will provide your PHI to Law Enforcement officials in response to a warrant, summons, court order or subpoena.

• TCMC may release PHI to a coroner or medical examiner to identify the cause of death.

• Please see Minnesota Department of Health’s ‘ACCESS TO HEALTH RECORDS NOTICE OF RIGHTS’ (based on Minnesota Statutes, Section 144.335, Subd. 5a).

TCMC may contact you to provide appointment reminders or information regarding your treatment options.  Any other use and disclosure of your health information will be made only with your written authorization.

You have the following rights with respect to your protected health information (PHI):

• The right to reasonable requests to receive confidential communication of your PHI.

• The right to inspect or copy your PHI.  A written request is required.  You can only be charged the maximum amount set by Minnesota law for copying your records.

• The right to receive an accounting of disclosures of your PHI, if other than for treatment, payment and operations.

• The right to request an amendment of your PHI. Submit your request in writing and provide a reason that supports your request for amending your PHI. TCMC has the right to deny your request for amendment. If this occurs, you will be notified of the reason for the denial.

• The right to request a restriction or limitation on the medical information that TCMC may use or disclose about your treatment, payment or healthcare operations.  You also have the right to request a limit on the medical information that TCMC discloses about you to others involved in your care or payment of your care.  TCMC is not required to agree to your request.

This Notice of Privacy is effective August 1, 2007, and TCMC is required to abide by the terms as they apply to Minnesota Statutes (Section 144.335, Subd. 5a).  If you believe your privacy rights have been violated, you may file a complaint with our clinic, or with the Secretary of the Department of Human Services and the Minnesota Department of Health.

To file a complaint with TCMC, send to:

TCMC Attn:  Privacy Officer/CMO

4601 Excelsior Blvd, Suite 407

St. Louis Park, MN 55416