Minnesota Valley Health Center
621 South Fourth Street
Le Sueur MN 56058

Notice of Privacy Practices

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

1. Minnesota Valley Health Center is permitted to make uses and disclosures of protected health information for treatment, payment and health care operations, as described in the following examples:
   1. For treatment - i.e. medical emergency, health care facilities assuming patient's care and means of communication among physicians, nurses and professionals contributing to patient's care.
   2. For payment - i.e. to facilitate payment by third party payer and workers compensation.
   3. For health care operations - i.e. Department of Health, Workers Compensation cases, Quality Assurance, Accreditation Bodies and as required by law.
2. Minnesota Valley Health Center is permitted or required, under specific circumstances, to use or disclose protected health information without the individual's written authorization.
3. Other uses and disclosures will be made only with the Individual's written authorization, and the individual may revoke such authorization.
4. Minnesota Valley Health Center intends to engage in the following activity:
   1. Minnesota Valley Health Center may contact the individual to provide appointment reminders or information about treatment alternatives or other heath-related benefits and services that may be of interest to the individual or patient.
5. The Individual has the following rights regarding protected health information:
   1. The right to request restrictions on certain uses and disclosures of protected health information. Minnesota Valley Health Center is not required to agree to a requested restriction, however.
   2. The right to receive confidential communications of protected health information, as applicable.
   3. The right to inspect and copy protected health information, as provided in the Privacy Regulation.
   4. The right to amend protected health information, as provided in the Privacy Regulation.
   5. The right to receive an accounting of disclosures of protected health information.
   6. The right to obtain a paper copy of the Notice from the covered entity upon request.
6. Minnesota Valley Health Center is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and Privacy practices with respect to protected health information.
7. Minnesota Valley Health Center is required to abide by the terms of the Notice currently in effect.
8. Minnesota Valley Health Center reserves the right to change the terms of this Notice. The new Notice provisions will be effective for all protected health information that it maintains.
9. Minnesota Valley Health Center will provide individuals or patients with a revised Notice by printed format when registering.
10. Minnesota Valley Health Center's contact person for matters relating to complaints is:
    1. Jerry Boerboom, CEO
       507-665-3375 or 507-665-8661
       621 South Fourth Street, Le Sueur MN 56058
11. Individuals may complain to Minnesota Valley Health Center and to the Secretary of the Department of Health and Human Services, without fear of retaliation by the organization, if they believe their privacy rights have been violated. A brief description of how the individual may file a complaint follows: Complaints must be written format and can be submitted to: Patient Relations Committee of the Board of Directors of Minnesota Valley Health Center, 621 South Fourth Street, Le Sueur MN 56058; Minnesota Department of Health and Human Services, 444 Lafayette Road North, St. Paul MN 55155 or Commissioner of Commerce, Minnesota Department of Commerce, 85 - 7th Place East, Suite 500, St. Paul MN 55101.
12. This Notice is first in effect on April 14, 2003.

Notice Version 1, 4/14/2003