Notice Effective May 12, 2005

This notice tells you how your medical and financial information can be used and shared, and how you can get access to this information. Please read it carefully. If you have any questions, please contact our Privacy Officer, Glenna Daniels, at the address or phone number listed below.

Who will follow this notice?

The Northeast Missouri Rural Health Network (NMRHN) provides services to consumers, and works with physicians, other medical professionals and organizations. The following list tells you who will follow the outlined practice for keeping your data private –

♦ NMRHN staff, representatives of our member agencies and contracted personnel; and

♦ any business associate or partner that we share health or financial information with.  

Our pledge to you.

We understand that health and financial data about you is private. We promise to protect this data. We will make a record of the service you receive so we can provide good care and to comply with legal rules. This notice applies to all of your records that we maintain, whether they were made by our staff or by your own doctor. Your doctor may have other rules or a notice about use and release of your health record kept in their office.

By law we must:

♦ keep your health and financial data private;

♦ give you this notice of our legal duties and our practice of keeping your health and financial data private; and

♦ follow terms of the notice in effect at the current time.

Changes to this Notice.

We may change our policies at any time. Changes will apply to health and financial data we have on file, as well as new data we record after the notice is changed.  Before we make a major change in our policies, we will change our notice and post the new notice in our office.  You can get a copy of the current notice at any time. The date it went into effect is listed just below the title. You will be mailed a copy of any changes made to the privacy practice notice.  You will also be asked to sign your name to show that you received this notice.

How we are allowed to use and share your health and financial data.

Subject to certain rules, we may use or share your health and financial data without your prior permission for the following reasons:

♦ to support health care efforts (processing applications for prescription drugs, or referrals to physicians or other health care facilities);

♦ for public health issues; and

♦ to report abuse or neglect.

When required to by law, we also may share health care data. In certain cases we must respond to requests from law enforcement officials or valid court orders.

We also may contact you to remind you about a scheduled appointment, to relay information on medications or suggest health-related services that may be of interest to you. 

This information may also be shared with disaster relief authorities so they can contact your family to tell them where you are and see how you are doing.

We may ask for your support in marketing efforts.

Other uses of health and financial data.

Upon written request we may share your health care and financial data with a friend or family member who is involved in your health care.

In any other situation not covered by this notice, we will ask for your written permission before we use or share your health or financial data. If you choose to permit us to use or share this data, you can later revoke that permission by telling us about your decision in writing.

Your rights about your health and financial data.

♦ In most cases, you may make a written request to look at, or get a copy of your data we use to make choices for your care. If you request copies, we may charge a fee for the cost of copying, mailing or other related supplies. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision.

♦ If you think that data in your record is wrong or if important items are missing, you have the right to request that we correct the records. You may submit a written request providing your reason for requesting the change. We could deny your request to amend a record if it was not created by us; if it is not part of the data maintained by us; or if we decide that the record is correct. You may submit a written appeal if we decide not to amend a record.

♦ You have the right to receive a list showing where we have shared data about you.  The request must state the time period you want us to include. It must begin after May 12, 2005. Within a 12-month period, the first list you request is free. If you make more requests, you will be charged our cost to produce the list. We will tell you about the cost before you are charged.

♦ You have the right to request that your health data be given to you in a private manner.  You may ask us to send mail to an address other than your home, or tell us in writing about a certain way or place we can use to inform you.

♦ You may request, in writing, that we not use or share your health or financial data to persons involved in your care except when specifically authorized by you; when required by law; or in an emergency.

We will review your request but we are not required by law to accept it. We will inform you of our decision on your request. All written requests or appeals should be submitted to our Privacy Officer at the address or phone number listed at the top of this notice.

Complaints.

♦ If you are concerned that your privacy rights may have been violated; or you disagree with a decision we made about access to your records; you may contact our Privacy Officer, Glenna Daniels, at the address or phone number listed at the top of this notice.

♦ You may also contact State Department of Health, Bureau of Health Facility Regulation: 1-573-751-6303 and/or the State Attorney General’s Office Consumer Hot Line: 1-800-392-8222 for more help.

♦ You may send a written complaint to the U.S.  Department of Health and Human Services Office of Civil Rights. Our Privacy Officer can give you the address.

♦ We will not punish you or take action against you if you file a complaint.

Northeast Missouri Rural Health Network 117 W. Potter Avenue, Kirksville, MO 63501 Phone 660-665-0330 Toll Free 877-539-2227 Fax 660-665-0030 nmrhn@sbcglobal.net