About Careers Patient Login Pay Online On-Demand Appointment Home For Patients Medical Services Clinic Locations Physician Directory Contact Notice of Privacy Practices: How Your Medical Information is used. 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. Understanding Your Health Information Each time you visit Family Health Care of Siouxland, a record of your visit is made. Typically, this health record contains your medical history, symptoms, examination and test results, diagnosis, treatment, care plan, insurance, billing, and employment information. This health information, often referred to as your health record, serves as a basis for planning your care and treatment and is a vital means of communication among the many health professionals who contribute to your health care. Your health information is also used by insurance companies and other third-party payers to verify the appropriateness of billed services. Our Responsibilities We are required by law to: Maintain the privacy of your health information. Provide you with an additional current copy of our Notice upon request. Abide by the terms of our current Notice. We will not use or disclose your health information without your written authorization, except as described in this Notice. Such authorization may be revoked in writing at any time except with respect to any actions we have taken in reliance on it. Examples of Using Health Information for Treatment, Payment and Health Care Operations We will use and disclose your health information for treatment purposes For example: Information obtained by a nurse, physician or other member of your health care team will be recorded in your record and used to determine the course of treatment. Health care team members will communicate with one another personally and through the health record to coordinate care provided. We will also provide your physician or subsequent health care provider with copies of various reports that should assist him or her in treating you in the future. We will use and disclose your health information for payment purposes For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. We may disclose health information about you to other qualified parties for their payment purposes. For example, if you are brought in by ambulance, we may disclose your health information to the ambulance provider for its billing purposes. We will use and disclose your health information for health care operations For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of health care we provide. In some cases, we will furnish your health information to other qualified parties for their health care operations. The ambulance company, for example, may want information regarding your condition to help them know whether they have done an effective job of stabilizing your condition. Health Information Exchange We may make your protected health information available electronically through an information exchange service to other health care providers, health plans and health care clearinghouses that request your information. Participation in information exchange services also lets us see their information about you. Other Uses and Disclosures of Your Health Information Notification We may use or disclose health information to notify or assist in notifying a family member, personal representative, or another person responsible for your care of your location and general condition. Communication with Family and Others We may disclose relevant health information to a family member, friend, or other person involved in your care. We will only disclose this information if you agree, are given the opportunity to object and do not, or if in our professional judgment, it would be in your best interest to allow the person to receive the information or act on your behalf. Decedents We may make relevant disclosures to the deceased’s family and friends under essentially the same circumstances such disclosures are permitted when the patient was alive. That is when these individuals were involved in providing care or payment for care and we are aware of any expressed preference to the contrary. The privacy rule eliminates the protection of protected health information 50 years after a patient’s death. Business Associates There are some services provided in our organization through contracts with business associates. When these services are contracted, we may disclose your health information to our business associates so that they can perform such services. However, we require the covered entity to appropriately safeguard your information. Public Health We may disclose health information about you for public health activities. These activities may include disclosures: To a public health authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability; To appropriate authorities authorized to receive reports of abuse and neglect; To FDA-regulated entities for purposes of monitoring or reporting the quality, safety or effectiveness of FDA-regulated products; or to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition. Workers’ Compensation We may disclose health information to the extent authorized and necessary to comply with laws relating to workers’ compensation or other similar programs established by law. Childhood Immunizations We may disclose immunizations to schools required to obtain proof of immunization prior to admitting your student so long as we have and document the student(s) legal representative’s “informal agreement” to the disclosure. Correctional Institutions If you are an inmate of a correctional institution or under custody of a law enforcement official, we may disclose to the correctional institution, its agents or the law enforcement official your health information necessary for your health or the health and safety of other individuals. Law Enforcement We may disclose health information if asked to do so by a law enforcement official as required or permitted by law or in response to a subpoena. Health Oversight Activities We may disclose health information for health oversight activities authorized by law. For example, oversight activities include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws. Threats to Health or Safety Under certain circumstances, we may use or disclose your health information if we believe it is necessary to avert or lessen a serious threat to health and safety and is to a person reasonably able to prevent or lessen the threat or is necessary for law enforcement authorities to identify or apprehend an individual involved in a crime. Specialized Government Functions We may disclose your information for national security and intelligence activities authorized by law, for protective services of the president; or if you are a military member, to the military under limited circumstances. As Required by Law We will use or disclose your health information as required by federal, state or local law. Lawsuits and Administrative Proceedings We may release your health information in response to a court or administrative order. We may also provide your information in response to a subpoena or other discovery request, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. Funeral Directors, Medical Examiners, and Coroners We may disclose your health information to funeral directors, medical examiners, and coroners consistent with applicable law to carry out their duties. Organ Procurement Organizations Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant. Incidental Uses and Disclosures There are certain incidental uses or disclosures of your health information that occur while we are providing services to you or conducting our business. For example, after a procedure the nurse or doctor may need to use your name to identify family members that may be waiting for you in a waiting area. Other individuals waiting in the same area may hear your name called. We will make reasonable efforts to limit these incidental uses and disclosures. Patient Surveys You may be asked to complete a survey. We use information from surveys to better understand the needs of our patients and to gather information about health care trends and issues. We generally do not ask for information in surveys that would personally identify you. If we do request contact information for follow-up, you may decline to provide it. If survey respondents provide personal information (such as an email address) in a survey, it is shared only with those people who need to see it to respond to the question or request, or with third parties who perform data management services for our site. Those third parties have agreed to keep all data from surveys confidential. Also, we may share information from surveys in an aggregated, de-identified form with third parties with whom we have a business relationship. Patient On-Line Services, E-mail Communications, Newsletter and related services Family Health Care provides you with the opportunity to receive communications from us or third parties. You can sign up for our free Patient On-Line Services via submitting your email address at any clinic or through our website www.fhcsl.com. You can unsubscribe from this at anytime. Email communication that you send to us via the Patient On-Line Services links on our site may be shared with our staff that are most able to address your inquiry. We make every effort to respond in a timely fashion once communications are received. Once we have responded to your communication, it is saved to your electronic chart. How we and our affiliates collect and use personal information Family Health Care’s website may contain links to websites operated by third parties. Our website, www.fhcsl.com, has no control over the privacy policies and practices of such third party sites, and if you have any concerns, you are urged to review the terms of those sites for more information about the policies applicable to those sites. Marketing Communication We have the right to notify you of third-party products or services without written authorization when: The physician/provider receives no compensation for the communication The communication is face-to-face The communication involves a drug or biologic the patient is currently being prescribed and the payment is limited to reasonable reimbursement of the costs of the communication (no profit) The communication involves general health promotion, rather than the promotion of specific products or services The communication involves government or government-sponsored programs We are permitted to give patients promotional gifts of nominal value (e.g. pamphlets) Sale of Protected Health Information We are prohibited from selling your protected health information in the absence of a written authorization. This also extends to licenses and lease agreements, and to the receipt of financial or in-kind benefits. This also includes disclosures in conjunction with research if the remuneration received includes any profit margin. On the other hand, the prohibited sale does not extend to permit disclosures for payment or treatment nor to permit disclosures to patients or their designees in exchange for a reasonable costbased fee. Your Health Information Rights You have the following rights regarding your health information: Right to Inspect and Copy You may request a copy of your medical records. We have 30 days to respond to a written request for your PHI with one 30 day-extension. Our records are in an electronic format. Therefore, we will provide a copy of your medical record electronically via one of the following methods: Secure Patient Online Service Family Health Care provided new USB/Memory Stick Hard copies are permitted only when you, as the patient, reject all readily reproducible e-formats. If you request a copy of your records in any format, we may charge you a fee. Right to Request Amendment You may request that your health information be amended if you feel that the information is not correct. Your request must be in writing and provide rationale for the amendment. Please send your request to the Medical Records Department. We may deny your request, and will notify you of our decision in writing. Right to an Accounting of Disclosures You may request an accounting of certain disclosures of your health information showing with whom your health information has been shared (does not apply to disclosures to you, with your authorization, for treatment, payment or health care operations, and in certain other cases). To request an accounting of disclosures, you must send a written request to the Medical Records Department. Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003. Right to Request Restrictions You may request restrictions on how your health information is used for treatment, payment or health care operations, or to certain family members or others who are involved in your care. At the patient’s request we may not disclose information about your care that you have paid out-of-pocket to health plans, unless for treatment purposes or in the rare event the disclosure is required by law. To request a restriction, you must send a written request to the Medical Records Department, specifying what information you wish to restrict and to whom the restriction applies. You will receive a written response to your request. Right to Request Private Communications You may request that we communicate with you in a certain way in a certain location. You must make your request in writing to the patient registration area and explain how or where you wish to be contacted. Right to a Paper Copy of this Notice You may request an additional copy of this Notice at any time from any Family Health Care facility listed on the front of this booklet. Policy updated 03/2013 This Notice applies to the following Family Health Care locations: CLINIC LOCATIONS Indian Hills Morningside Northside Dakota Dunes South Sioux City BECOME A PATIENT SUBSCRIBE TO OUR NEWSLETTER * indicates required Email Address * First Name Last Name RECENT POSTS Season’s Eatings: 5 Holiday Tips for People with Diabetes Healthy Hacks for Halloween Candy Healthy & Happy: 5 Fun Activities for Kids this Fall! 10 Important Things You Can Do for Your Health 5 Tips for a Healthy, Active Summer Sleep Center 345 West Steamboat Drive, Suite 404 Dakota Dunes, SD 57049 Dakota Dunes Clinic 345 West Steamboat Drive, Suite 300 Dakota Dunes, SD 57049 Indian Hills Clinic 2600 Outer Drive N Sioux City, IA 51104 Morningside Clinic Morningside Urgent Care 4545 Sergeant Road Sioux City, IA 51106 South Sioux City Clinic 3250 Plaza Drive South Sioux City, NE 68776 Corporate Offices 814 Pierce Street, Suite 300 Sioux City, IA 51101 Imaging Center 345 West Steamboat Drive, Suite 401 Dakota Dunes, SD 57049 Northside Clinic Northside Urgent Care 4230 Hamilton Boulevard Sioux City, IA 51104 The organizations listed will use and distribute this Notice as their Joint Notice of Privacy Practices and follow the information practices described in this Notice when using or disclosing records and information. They will share your health information with each other, as necessary, to carry out treatment, payment, or health care operations as described in this Notice. 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