Ridgeview Home Medical Equipment Privacy Rights

Right to Request Restrictions: You have the right to ask that we limit the information we use or disclose about you for treatment, payment or health care operations. You also have the right to ask for a limit on the medical information we provide about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request. If we do agree, we will complete your request unless the information is needed to provide emergency treatment. To request restrictions, you must submit your request in writing to Ridgeview’s Privacy Officer. In your request, you must tell us:

What information you want to limit
Whether you want to limit our use, disclosure, or both
To whom you want the limits to apply, for example, disclosures to your spouse.

Right to Ask for Private Communications: You have the right to ask that we communicate with you about medical 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 submit your request in writing to Ridgeview’s Privacy Officer. We will not ask you the reason for your request, and we will agree with all reasonable requests. Your request must say how or where your wish to be contacted.
Right to a Paper Copy of the Complete Notice: You have the right to a paper copy of Ridgeview’s complete privacy notice. You may ask us to give you a copy of the privacy notice at any time by requesting a copy from any member of our hospital staff. What You Should Do if You Believe Your Privacy Rights Have Been Violated If you feel your privacy rights have been violated, you may file a complaint with Ridgeview Medical Center and/or the Secretary of the U.S. Department of Health & Human Services. You will not be retaliated against for filing a complaint. To file a complaint with Ridgeview, please contact the Ridgeview Medical Center Privacy Officer at (952) 442-2191, ext. 36370. To file a complaint with the Secretary, write to the U.S. Department of Health & Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201.
Changes to This Notice: We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical 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 our facilities and on our Web site. The notice will contain the effective date. Copies of the notice will be available at our service locations.
This Notice Will Be Updated: This notice is in effect April 14, 2003, and Ridgeview Medical Center will abide by the terms of the privacy notice currently in effect. We may periodically modify our privacy practices and will post a revised notice in writing, electronically or by other legally acceptable means.

Other Uses of Medical Information Other uses and disclosures of medical 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 the right to use medical information about you, you may revoke that permission, in writing, at any time. You understand that we cannot take back any information that we have already released with your permission, and that we are required to retain our records of care that we provided to you.

The health and billing records we maintain are the physical property of Ridgeview Medical Center. You have the following rights regarding your medical information:

Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. (Usually, this includes medical and billing records but does not include psychotherapy notes.) To inspect and/or copy medical information about you, contact Ridgeview’s Privacy Officer at (952) 442-2191, ext. 36370. If you request a copy of the information, we will charge a fee for the costs of copying, mailing or other expenses associated with your request.
Right to Amend: If you feel that medical information Ridgeview Medical Center has 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 Ridgeview Medical Center. To request a change, you must submit it in writing to Ridgeview’s Privacy Officer. You must also provide a reason that supports your request. We may deny your request for a change if it is not in writing or does not include a reason to support the request. In addition, we may deny your request to change information, if the information: - was not created by us, unless the person or company that created the information is no longer available to make the amendment. - is not part of the medical information kept by or for us - is not part of the information which you would be permitted to inspect and copy under the law - is accurate and complete.
Right to an Accounting of Disclosures: You have the right to ask for an accounting of disclosures. This is a list of the disclosures we made of medical information about you to others, except for the purposes of treatment, payment and operations identified earlier. To request an accounting of disclosures list, you must submit your request in writing to Ridgeview’s Privacy Officer. The first list of disclosures you ask for within a 12-month period will be free. We may charge for the costs of providing additional lists. We will notify you of the cost and you may choose to remove or change your request before any costs are incurred.