THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.PLEASE REVIEW IT CAREFULLY.
“Protected Health Information” is information that identifies you and relates to your past, present or future physical or mental health or condition; the provision of health care to you; or the past, present, or future payment for health care furnished to you. In this notice, we call Protected Health Information "health information". If you have any questions about this notice, please contact the Fairview Privacy Office at 612-672-5647.
OUR PLEDGE REGARDING HEALTH INFORMATION:We understand that health information about you is personal. We are committed to protecting the privacy of your health information by complying with all applicable federal and state privacy and confidentiality requirements. Accordingly, we have developed policies, enhanced the controls over our computers and other systems, which access and store health data, and educated our employees about protecting your health information. We are required by law to maintain the privacy of health information and to provide you with this notice of our legal duties and privacy practices with respect to health information.
We create a record of the care and services you receive through Fairview’s Employee Assistance Program. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways in which we may use and disclose health information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of health information and how we will ensure that your information is kept private.Fairview’s Employee Assistance Program is part of Fairview Health Services. However, the Employee Assistance Program services and records are kept separate from the rest of the Fairview system. EAP does not share personal health information with any other part of Fairview unless authorized by you or required by law. This notice sets forth how we use and disclose that health information.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU.The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we explain what we mean and give an example. Not every use or disclosure in a category will be listed; however, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Payment. Fairview’s Employee Assistance Program contracts with other businesses to provide EAP services to their employees. In that capacity, the health information of clients of those businesses may be shared so that the services they receive may be billed to and payment may be collected. This information is limited to the date of the service(s) provided.
In addition, Fairview EAP staff in need of EAP services may receive those services from an external agency. That agency uses the client’s date of service for billing purposes.
For EAP clients who are Fairview employees and receive services from Fairview’s EAP, there is no billing for services that involves health information.
For Health Care Operations. We may use and disclose health information about you for health care operations. These uses and disclosures are necessary to operate our program and make sure that all of our clients receive quality care. For example, we may use health information to review our services and to evaluate the performance of our staff in caring for you. This information will only be shared within the EAP department. With your permission, we may use your address in order to send you a customer satisfaction survey. We may also combine health information about many clients to decide what additional services we should offer, what services are not needed, and how to improve our services.
Appointment Reminders. With your permission, we may use and disclose health information to contact you as a reminder that you have an appointment for services or as needed if there is a change in your appointment status. The health information is limited to your name, phone number, and date and time of service.-
Individuals Involved in Your Care or Payment for Your Care. With your authorization, we may release health information about you to a friend or family member who is involved in your health care. You may limit the health information we disclose about you to someone who is involved in your care. In the event you are incapacitated or in the event of an emergency, we will exercise our professional judgment to determine whether a disclosure of this type is in your best interest.-
AS REQUIRED BY LAW. We will disclose health information about you without your authorization when required to do so by federal, state or local law:
To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you 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 someone able to help prevent the threat.
To Report the Abuse or Neglect of a Vulnerable Adult or Child. We may need to use and disclose health information about you when necessary to report the abuse or neglect of a vulnerable adult or child. Any disclosure would be to an agency responsible for investigating the allegation.
To the Parent or Guardian of a Minor Except As Limited by Minnesota Statutes. We may disclose health information to parents or guardians when the parent or guardian has consented for the minor to receive health care services. Health information regarding minors who are able to consent for their own treatment (emancipated minors or minors consenting for services related to pregnancy, venereal disease, alcohol or other drug abuse) will only be released to the parent upon signed authorization by the minor.
Judicial or Administrative Proceedings. We will disclose health information in response to a court of administrative order and in response to subpoena, discovery request or other lawful process if certain conditions are met and we receive the required assurances.-
You have the following rights regarding health information we maintain about you:
Right to Inspect and Copy. You have the right to inspect and copy your health information. You must submit your request in writing to: Fairview’s Employee Assistance Program, Attn: EAP Manager, 2450 Riverside Avenue, F196, Minneapolis, MN 55454. If you request a copy of the information, 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 and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. Another licensed health care professional chosen by us 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 feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for us. To request an amendment, submit a written request to: Fairview’s Employee Assistance Program, Attn: EAP Manager, 2450 Riverside Avenue, F196, Minneapolis, MN 55454. You must provide 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:-
Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;Is not part of the health information kept by or for us;
Is not part of the information which you would be permitted to inspect and copy; or
Is accurate and complete.
We will notify you in writing if we deny your request. If the request is denied, you have the right to submit a written statement disagreeing with the denial, which will be appended or linked to the health information in question.
Right to an Accounting of Disclosures. You have the right to request a list of the disclosures of your health information, if any, we have made without your written authorization to third parties other than for treatment, payment, health care operations and certain other limited purposes. These disclosures are typically those required by law for purposes such as, protection of vulnerable adults and children. To request this list or accounting of disclosures, you must submit your request in writing to: Fairview’s Employee Assistance Program, Attn: EAP Manager, 2450 Riverside Avenue, F196, Minneapolis, MN 55454. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will 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 Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. Federal law states that we are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to: Fairview’s Employee Assistance Program, Attn: EAP Manager, 2450 Riverside Avenue, F196, Minneapolis, MN 55454. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to: Fairview’s Employee Assistance Program, Attn: EAP Manager, 2450 Riverside Avenue, F196, Minneapolis, MN 55454.We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.-
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. You may obtain a copy of this notice at our EAP intranet website To obtain a paper copy of this notice, you may request a copy via e-mail to email@example.com , or in writing to Fairview Privacy Office, 2450 Riverside Ave, Minneapolis, MN 55454.-
We are required to abide by the terms of our Notice of Privacy Practice currently in effect. We reserve the right to change this Notice of Privacy Practice. We reserve the right to make the revised or changed 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 EAP intranet website. The effective date of the notice will be listed on the first page.COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services or with Fairview directly. To file a complaint with us or to obtain the contact information for the Department of Health and Human Services, contact the Fairview Privacy Office, 2450 Riverside Ave, Minneapolis, MN 55454, or by phone at 612-672-5647. All formal complaints must be submitted in writing. You will not be penalized for filing a complaint.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 give us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.