Notice: Patient Privacy

THE FOLLOWING NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THE INFORMATION CAREFULLY.

Your confidential healthcare information may be released to other healthcare professionals within the facility for the purpose of providing you with quality healthcare.

Your confidential healthcare information may be released to your insurance provider for the purpose of Lakeland Health Services receiving payment for providing you with needed healthcare services.

Your confidential healthcare information may be released to public or law enforcement officials in the event of an investigation in which you are a victim of abuse, a crime or domestic violence.

Your confidential healthcare information may be released to other healthcare providers in the event you need emergency care.

Your confidential healthcare information may be released to a pubic health organization or federal organization in the event of a communicable disease or to report a defective device or untoward event to a biological product (food or medication).

Your confidential healthcare information may not be released for any other purpose than that which is identified in this notice.

Your confidential healthcare information may be released only after receiving written authorization from you. You may revoke your permission to release confidential healthcare information at any time.

You may be contacted by Lakeland Health Services to remind you of any appointments, healthcare treatment options or other health services that may be of interest to you.

You may be contacted by Lakeland Health Services for the purposes of raising funds to support Lakeland Health Service’s operations.

You have the right to restrict the use of your confidential healthcare information. However, Lakeland Health Services may chose to refuse your restriction if it is in conflict of providing you with quality healthcare or in the event of an emergency situation.

You have the right to receive confidential communication about your health status.

You have the right to review and photocopy any/all portions of your healthcare information.

You have the right to make changes to your healthcare information.

You have the right to know who has accessed your confidential healthcare information and for what purpose.

You have the right to possess a copy of this Privacy Notice upon request. This copy can be in the form of an electronic transmission or on paper.

Lakeland Health Services is required by law to protect the privacy of its patients. It will keep confidential any and all patient healthcare information and will provide patients with a list of duties or practices that protect confidential healthcare information.

Lakeland Health Services will abide by the terms of this notice. Lakeland Health Services reserves the right to make changes to this notice and continue to maintain the confidentiality of all healthcare information. Patients will receive a mailed copy of any changes to this notice within 60 days of making the changes.

You have the right to complain to Lakeland Health Services if you believe your rights to privacy have been violated. If you feel your privacy rights have been violated, please mail your complaint to Lakeland Health Services:

ATTN: Ted Wawrzyniak
Lakeland Health Services
9211 Plymouth Ave N
Golden Valley, MN 55427

All complaints will be investigated. No personal issue will be raised for filing a complaint with Lakeland Health Services.

For further information about this Privacy Notice, please contact:

Ted Wawrzyniak
Administrator, Lakeland Health Services
763-512-1551

This notice is effective as of 4/16/03.

Reference #1027 HIPAA © Medical Consultants Network Inc. (800) 538-6264
Reference #1027 HIPAA © Medical Consultants Network Inc. (800) 538-6264