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.

During your treatment at the Minneapolis Clinic of Neurology (MCN), doctors, nurses, and other caregivers may gather information about your medical history and your current health. This notice will explain how such information may be used and shared with others. It will also explain your privacy rights regarding this kind of information.

Your medical information will be used and disclosed for the following purposes

Treatment

We will use your information to provide, coordinate, and manage your care and treatment. For example, a neurologist may share your medical information with another physician for a consultation or a referral.

Payment

We will use your information to receive payment for the services we provide. For example, we will disclose information in order to submit bills or claims to insurance companies and/or Medicare or Medicaid.

Health Care Operations

We will use your information for certain activities related to the functioning of the Clinic. For example, we may use or disclose information for quality assurance activities, legal services, underwriting, and other business management and administrative activities.

Appointment Reminders and Other Health Information

We may use your medical information to send you reminders about future appointments. Your medical information may also be used to provide you with information about new or alternative treatments or other health care services.

Fundraising

We may use information to notify you about fund-raising campaigns or other charitable events.

Family Members

We may disclose information to people who will be taking care of you or helping to pay your medical bills, such as family members or close friends. We will only disclose medical information that these people need to know. We may also use your medical information to let family members or other designated caregivers know where you are and what your general medical condition is. If you are able to make your own health care decisions, we will ask your permission before using your medical information for these purposes. If you are not able to make health care decisions, we will disclose relevant medical information to family members or other designated caregivers if we feel it is in your best interest to do so. For example, we may provide limited medical information to allow a family member to pick up a prescription or x-ray for you.

Emergency Conditions

Under emergency conditions, we may disclose information about you to the government or other groups that assist in emergencies or disasters.

Research

Under certain circumstances, we may use and disclose medical information about you for research purposes. In some cases, we will only disclose information about you for research purposes with your authorization. In other cases, where there is only a minimal risk to your privacy, for example a research project comparing the health and recovery of all patients who received one medication to those who received another, for the same condition, we may disclose information about you without your authorization. All research projects are subject to a special approval process, which evaluates each proposed research project and its use of medical information. We will only disclose information about you for research without your authorization when the special approval process results in a determination that there is only a minimal risk to your privacy, and we have initiated processes to protect your privacy to the greatest extent possible.

Other Uses or Disclosures

We also may disclose or use your information without your consent in the following cases:

• when required by law;
• for public health activities;
• relating to victims of abuse, neglect, domestic violence, if required/authorized by law and/or if you agree;
• for health oversight activities;
• for judicial and administrative proceedings to the extent permitted by law;
• for law enforcement purposes, as permitted or required by law;
• to coroners/medical examiners/funeral directors, as permitted by law;
• for organ donation purposes;
• for research purposes under certain circumstances;
• to avert a serious threat to health or safety;
• certain specialized government functions, such as military discharge, and national security and intelligence
• for workers' compensation purposes.

MCN will not use or disclose your medical information in any other way unless you allow us to do so in writing. If you do give us permission to use or disclose your medical information for another purpose, you have the right to change your mind and revoke the permission at any time.

Your privacy rights

Restrict Use and Disclosure

You may request that MCN not use medical information in certain ways or for certain purposes. You may also request that MCN not provide medical information to certain people. However, MCN has the right to refuse your request. MCN may use or disclose the patient's medical information in situations requiring emergency treatment, in which case we will ask the entities that receive the information not to further use or disclose the information.

Provide Confidentiality

You may request that MCN provide you with your medical information in a confidential manner. For example, you can request that we send appointment reminders, bills and other mailings to a different address or that we notify you of this kind of information in another way, such as by telephone call. You must make this request in writing and specify another address or means of communication. We must agree to your written request. We may also ask you to give us information on how you will pay your bills.

Inspection and Copy

You may ask to see and copy your medical records, unless he information is protected by law. You must make these requests in writing. If your request to look at or copy your medical records is denied, you have the right to have the denial reviewed by a health care professional. We will act upon your request within 30 days and may charge you a legally acceptable amount for copying costs.

Change Information or Amend Medical Records

You may ask us to change information in your medical records. If your request is denied, you can write a statement of disagreement with the denial that we will keep with your medical information.

Accounting of Disclosures

You may ask us to provide you with information about certain disclosures of your medical information we made in the past. Requests for accountings will not be made prior to April 14, 2003. Your request can go back 6 years after April 14, 2009.

Paper Copy

If you have received this notice of the medical information privacy rights electronically, you may ask us to provide you with a paper copy.

Privacy Violations

If you feel your medical information privacy rights have been violated, you may file a complaint with the clinic contact person listed below. Filing a complaint will not affect the quality of the services you receive from MCN and you will not be retaliated against for filing a complaint.

You may contact the designated privacy official at MCN:

Jackie Rucke
Minneapolis Clinic of Neurology
4225 Golden Valley Road
Golden Valley, MN 55422
(763) 588-0661
This e-mail address is being protected from spambots. You need JavaScript enabled to view it

The effective date of this notice is April 14, 2003. MCN is required by law to maintain the privacy of protected health information and to provide individuals with this notice of its legal duties and privacy practices with respect to health information. MCN is required to abide by the terms of the notice currently in effect. MCN reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information maintained by MCN. If the terms of this notice are changed, MCN will provide individuals with a revised notice upon request and by posting the revised notice in designated locations at MCN offices and by electronically posting on MCN's web site.