Fairview Providers

Effective date: January 1, 2008

FAIRVIEW

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

What is this notice for?

The Notice of Privacy Practices tells you about your rights under a federal law called the Health Insurance Portability and Accountability Act—or HIPAA for short. This law protects your health information and sets rules about who can see and get your health information. (“Health information” includes any information about your mental or physical health, your health care, payment for your health care, and any demographic information.) The notice also tells you about Fairview’s policies for protecting, using, and sharing your health information.

Why am I getting this notice?
Your privacy is important to us. The law requires that you be given a copy of this notice so that you can
• know your rights
• use your rights
• ask questions about your rights
• file a complaint if you think your rights may have been violated

What are my rights over my health information?

You have the right to
• see and get a copy of your health records. To see or get a copy of your health records, write us at the address listed on the form you signed when you got this notice or to the place where your records are kept. You may have to pay for the cost of copying and mailing your records. If harm to yourself or others may result from you seeing your health records, a licensed healthcare provider may decide that we should not give you all of your information. If this happens, you have the right to ask again for the information. We will then ask a different licensed health care professional to review your request. We will comply with whatever the second reviewer decides.

• make changes to your health information. If you feel that the health information we have about you is incorrect or incomplete, you can ask us to change it. To ask for a change, write to us at the address listed on the form you signed when you got this notice or to the place where your records are kept. You must tell us why you want to change your records. We may not make the change if you do not ask for the change in writing or you do not tell us why you want to make the change. And we may not make the change if the health information you want to change
- was not created by us (unless the person or place that created the information is no longer able to make changes);
- is not part of the health information kept by or for us;
- is not part of the information that you would be allowed to see or copy; or
- is accurate and complete. We will tell you in writing if we are not going to make the change.
If this happens, you have the right to write back to us explaining why you think we were wrong not to make the change. We will put your explanation with your health information.

• know how your health information is used or shared with others. Mostly we use health information for treatment and payment. (For more information, see “How will you use and share my health information?” below.) Sometimes we must also share information with others, usually because we are required by law to do so. For example, we must report births, deaths, abuse, and certain diseases. To find out with whom, if anyone, we have shared your information, write to us at the address listed on the form you signed when you got this notice or to the place where your records are kept. Tell us what period of time you want to know about. This period of time may not be longer than six years and may not include any time before April 14, 2003. You can get your report for free once a year. If you want more reports, we may charge you for the cost of making them. But we will let you know what this cost will be before we send you more reports.

• ask us to restrict how your health information is used or shared with others. To ask us to restrict your health information, write to us at the address listed on the form you signed when you got this notice or to the place where your records are kept. Tell us
- what information you want to restrict;
- whether you want to restrict how we use the information or how we share it, or both; and
- to whom you want to restrict the information.
If you do not want us to give information to your insurer, you need to tell us how you will pay for your treatment. Be aware that the law says we do not always have to agree to your request. Even if we do agree to your request, we will not restrict your health information if it is needed to provide you with emergency treatment.

• ask us to reach you in a certain way or place. For example, you can ask that we contact you at work rather than at home or by mail rather than by phone. To make a request, write to us at the address listed on the form you signed when you got this notice or to the place where your records are kept. Tell us exactly how and where you wish to be reached. We will allow all reasonable requests, and we will not ask you why you are making the request.

• have a copy of this notice. You may ask for a copy of this notice at any time. You can download a copy from our website (www.fairview.org). Or, if you would rather have a paper copy mailed to you, you can e-mail us at privacy1@Fairview.org or write to us at Fairview Privacy Office, 400 Stinson Blvd. N.E., Minneapolis, MN 55413.

How will Fairview protect my health information?
Fairview works hard to protect your health information. We use computer systems to store your health information. We have policies, processes and protections in place to keep your information from being seen by anyone that should not see it.

While our computer systems are protected from access by unauthorized people, e-mails are not. We will not communicate with you using e-mail unless you want us to. Sometimes we need to hire other companies such as consultants and accountants to help us with our health care operations. If we do, we only give them health information when it is needed and only after they have signed an agreement to follow this Notice of Privacy Practices and the law.

How will Fairview use and share my health information?
We may use or share your information for the following reasons:

• Treatment. We use your health information to give you medical treatment. To treat you properly, we may need to share your health information with doctors, nurses, and other staff taking care of you. For continuity of care you may receive in the future, we will share information in paper form or sometimes in electronic form, with your regular doctor. Also for continuity of care, Fairview is implementing an electronic medical record with certain physician groups that practice at Fairview hospitals but are not a Fairview-owned clinic. We have policies and procedures in place to protect the confidentiality of your health information as it is shared with these physician groups.

• Payment. We use and share your health information so that we can bill you or whoever is responsible for paying for your care.

• Health care operations. We may use and share your health information to help run our facility and make sure that all of our patients are getting quality care. For example, we may use health information to review our services and the staff caring for you. We may also combine health information about many patients to see if new treatments are effective.

• Appointment reminders. We may use and share your health information to remind you of an appointment.

• Treatment alternatives. We may use and share your health information to tell you about treatment options that you may be interested in.

• Health-related benefits and services. We may use and share your health information to tell you about health-related benefits or services that you may be interested in.

• Fundraising. We may use some of your information to contact you to raise money for Fairview. We may share information with Fairview Foundation, which is part of the Fairview system, so that the Fairview Foundation may ask you for a donation. We will only share “contact information”—your name, address and phone number and the dates you were treated. If you are contacted for a donation, you can choose not to be contacted again. Simply write to Fairview Foundation at 2450 Riverside Ave, Minneapolis, MN 55454.

If your doctor is employed by University of Minnesota Physicians, University of Minnesota Physicians may give your contact information to the University of Minnesota Medical School or the Minnesota Medical Foundation to ask you for a donation. If you do not want to be contacted, write to University of Minnesota Physicians Privacy Administration, 720 Washington Ave S.E., Suite 300, Minneapolis, MN 55414.

In some cases, your doctor may work for a tax-exempt entity and may use your contact information to ask you for a donation for this entity. If you have questions or do not want to be contacted, contact your doctor’s office.

• Patient directory.
While you are a patient at Fairview, friends, family and others may call to ask about you. If someone calls and asks for you by name, we will tell them your location so that they may call or visit you. If they ask, we will also tell them in general terms how you are doing (doing well, serious condition, etc.). If you ask us to list your faith community (or religious affiliation) in the directory, we will also share this information with a leader from your faith community (priest, minister, rabbi, or other spiritual advisor) if they ask. If you do not want us to tell anyone that you are here, ask for this restriction when you are registered.

• People involved in your care or payment for your care.
With your permission, we may share your health information with a family member or friend involved in your health care while you are a patient at Fairview. If you are not able to give your permission, we will decide what, if any, information to share. We may also share information with a person or persons helping to pay for your care. In each of these cases, you may limit what health information we share. In the event of a disaster, we may share your health information with those helping with disaster relief so that your family can know what has a happened to you and where you are.

• Research.
Your health information may be used for research to learn new or better ways to diagnose and treat illnesses. Fairview employees, medical and allied health staff and University of Minnesota Academic Health Center faculty are considered internal researchers. All others are considered external researchers and Fairview will not give your health information to external researchers unless you give us permission to do so in writing. The use of your health information for research will be reviewed and approved by a research review board. We will not use your health information for research unless you give us permission in writing or the research review board decides that your permission is not necessary. Before the review board will decide that your permission is not necessary, the researchers must prove that the project is important enough and show they have a plan to protect your information.

If you disagree with the use of your health information to be used for research purposes, you may notify us in writing.

• As Required By Law
We will share your health information when required to do so by federal, state or local law.

• Special Situations

- A serious threat to health or safety
  We may use or share your health information to prevent a serious threat to your health and safety or the health and safety of the public or another person. We would only give this information to someone that can prevent the threat.
- Organ and tissue donation
  If you are an organ donor, we may share your health information with organizations that handle organ or tissue donation and transplantation.
- Military and veterans
  If you are a member of the armed forces, we may share health information as required by military authorities. We may also share health information about foreign military personnel to foreign military authority.
- Workers' compensation
  If you are being treated for a work-related injury or condition, we may share your health information with workers' compensation or similar programs.
- Public health risks
  We may share your health information with public health or authorized government authorities
- - to prevent or control disease, injury or disability;
  - to report births and deaths;
  - to report child abuse or neglect;
  - to report problems with medicines and other products;
  - to tell people about recalls of products they may be using;
  - to let a person know if he or she may have been exposed to a disease or may be at risk for getting or spreading a disease or condition; or
  - if we believe you have been the victim of abuse, neglect or domestic violence. We will only share this information if you say we can or when required or authorized by law.
- Health oversight activities
  We may share health information for health oversight activities as authorized by law. Examples of oversight activities include audits, investigations, inspections and licensing. These activities are needed for the government to oversee the health care system.
- Lawsuits and disputes
  If you are involved in a dispute or lawsuit, we may share your health information if required by court order. We may also share your health information in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but usually only if you give us permission.
- Law enforcement If asked to do so by a law enforcement official, we may share health information
- - in response to a court order, grand jury subpoena, warrant, summons or similar process.
  - to identify someone who has died.
  - to locate a missing child under age 18.
  - about the victim of a crime if we are unable to obtain the person's agreement.
- - We may also share health information with a law enforcement official
    - about a death we believe may be the result of criminal conduct;
    - about criminal conduct at the health care facility;
    - in emergency situations to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime; and
    - in other situations as required by law.
- Coroners, medical examiners and funeral directors
  We may give health information to a coroner or medical examiner. We may need to this, for example, to identify someone who has died or to determine the cause of death. We may also give health information to funeral directors as needed to carry out their duties. o National security and intelligence activities We may give health information to authorized federal officials for activities authorized by law. We may share health information with authorized federal officials so they can protect the President and other authorized persons or foreign heads of state or conduct special investigations.
- Inmates
  If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your health information
  - so that the correctional institution can provide you with health care;
  - to protect your health and safety or the health and safety of others; or
  - for the safety and security of the correctional institution.
Other uses of health information
Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you have given us written permission to use or share your health information, you may take back that permission, in writing, at any time. If you take back your permission, we will no longer use or share your health information for the reasons listed on your written permission. Of course, we cannot take back any information we have already shared with your permission.

What do I do if I think my privacy rights may have been violated?
If you think your privacy rights may have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. You may call the Fairview Privacy Office at 612-672-5647 to talk about your complaint, ask questions or find out how to reach the Department of Health and Human Services. To file a complaint with us, write to the Fairview Privacy Office at 400 Stinson Blvd. N.E., 3rd Floor, Minneapolis, MN 55413. You will not be penalized for filing a complaint.

Who at Fairview must follow this notice?
Fairview provides a wide variety of health care services through a number of hospitals, clinics and other entities. In order to provide quality care, we share health information within Fairview as appropriate. For example, a patient may first be seen at a Fairview clinic, admitted to a Fairview hospital, discharged to a nursing home that is part of the system and then get home care services from a Fairview home care agency. All of Fairview’s entities, employees, volunteers and agents will follow this notice. The notice applies to all records of the care you got at Fairview.

When doctors and other health care providers not employed by Fairview are treating you at Fairview, they must follow the terms of this notice. However, they may use a different privacy notice in their office or clinic.

Here are all of the Fairview entities that follow this privacy notice:

Fairview Health Services
- Columbia Park Medical Group
- Fairview Counseling Centers
- Fairview Diagnostic Laboratories
- Fairview Home Medical Equipment
- Fairview Lakes Medical Center
- Fairview Northland Medical Center
- Fairview Pain Management Center
- Fairview Rehabilitation Services
- Fairview Ridges Hospital
- Fairview Southdale Hospital
- University of Minnesota Children’s Hospital, a division of Fairview
- University of Minnesota Medical Center, a division of Fairview
- Fairview Urgent Care Centers
- Institute for Athletic Medicine
Fairview Red Wing Health Services
Fairview Seminary Home
Fairview Seminary Plaza
Fairview Regional Community Services
Fairview Clinics
Fairview Home Care and Hospice
Fairview Oxboro Clinics
Behavioral HealthCare Providers
Fairview Foundation
Fairview Pharmacy Services LLC
Fairview Partners

CHANGES TO THIS NOTICE
We must follow the terms of this Notice of Privacy Practices. We can change this Notice of Privacy Practices, however, and reserve the right to make the new notice effective for health 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 in this facility and on our website at www.Fairview.org. The effective date of this notice is listed on the first page.

If you have any questions about this notice, please call the Fairview privacy office at 612-672-5647.