Southwestern District Health Unit
Notice of Privacy Practices

Southwestern District Health Unit uses health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of Southwestern District Health Unit.

How Southwestern District Health Unit May Use or Disclose Your Health Information

For Treatment. Southwestern District Health Unit may use your health information to provide, coordinate, or manage your health care treatment or services. We may use or disclose your health information to a physician or other provider providing treatment or services for you For example, if we refer you to a physician or other provider for a service that we cannot provide, your health information may be disclosed to that office. This information is necessary determine what treatment or services you should receive.

For Payment. Southwestern District Health Unit may use and disclose, as needed, your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payer, such as an insurance company, health plan, Medicare, or Medicaid. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.

For Health Care Operations. Southwestern District Health Unit may use and disclose, as needed, health information about you for operational purposes. For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and others to: evaluate the performance of our staff; assess the quality of care and outcomes in your cases and similar cases; learn how to improve our facilities and services; and determine how to continually improve the quality and effectiveness of the health care we provide.

Appointments. Southwestern District Health Unit may use your information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Required by law. Southwestern District Health Unit may use and disclose information about you as required by law. For example, Southwestern District Health Unit may disclose information for the following purposes: for judicial and administrative proceedings pursuant to legal authority; to report information related to victims of abuse, neglect or domestic violence; and to assist law enforcement officials in their law enforcement duties.

Public Health. Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.

Decedents. Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.

Organ/Tissue Donation. Your health information may be used or disclosed for cadaveric organ, eye or tissue donation purposes.

Research. Southwestern District Health Unit may use your health information for research purposes when an institutional review board or privacy board that has reviewed the research proposal, established protocols to ensure the privacy of your health information, and has approved the research.

Health and Safety. Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.

Government Functions. Your health information may be disclosed for specialized government functions such as protection of public officials or reporting to various branches of the armed services.

Workers’ Compensation. Your health information may be used or disclosed in order to comply with laws and regulations related to Workers’ Compensation.

Other uses. Other uses and disclosures will be made only with your written authorization, unless otherwise permitted or required by law and you may revoke the authorization, in writing, except to the extent Southwestern District Health Unit has taken action in reliance on such.

Opportunity to agree to or prohibit. Southwestern District Health Unit is permitted to use or disclose information about you without consent or authorization provided you are informed in advance and given the opportunity to agree to or prohibit the disclosure in the following circumstances. If you are not present or able to agree or object to the use or disclosure, then we may, using professional judgment, to determine whether the disclosure is in your best interest.

• The use of a directory of individuals served by Southwestern District Health Unit.
  
• To a family member, relative, or other identified person, the information relevant to such person’s involvement in your care or payment for care.

Your Health Information Rights

You have the right to:

• request a restriction on certain uses and disclosures or your information as provided by 45 C.F.R. §164.522; however, Southwestern District Health Unit is not required to agree to a requested restriction;
  
• obtain a paper copy of the notice of information practices upon request;
  
• inspect and obtain a copy of your health record as provided for in 45 C.F.R. §164.524;
  
• request that your health record be amended as provided in 45 C.F.R. §164.526;
  
• request communications of your health information by alternative means or at alternative locations; and
  
• receive an accounting of disclosures made of your health information as provided by 45 C.F.R. §164.528.
  

Complaints

You may complain to Southwestern District Health Unit and to the Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.

Obligations of Southwestern District Health Unit

Southwestern District Health Unit is required by law to:

• maintain the privacy of protected health information;
  
• provide you with this notice of its legal duties and privacy practices with respect to your health information;
  
• abide by the terms of this notice;
• notify you if we are unable to agree to a requested restriction on how your information is used or disclosed;
• accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations; and

Southwestern District Health Unit reserves the right to change its information practices and to make the new provisions effective for all protected health information it maintains. Revised notices will be made available to you.

Contact Information

If you have any questions or complaints, please contact:

Carlotta F. Ehlis, Privacy Officer
2869 3rd Avenue West
Dickinson, ND 58601
Phone: 701-483-0171

SWDHU 4-14-2003