Privacy Practices Disclosure
THIS DISCLOSURE DESCRIBES YOUR RIGHTS REGARDING YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION AND EXPLAINS WHEN YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION
MAY BE USED OR DISCLOSED
In this Disclosure, “we,” “us,” “our,” or “the Center” refers to Hope Pregnancy Center, a Minnesota nonprofit, and its workforce (including physicians, nurses, employees, staff and volunteers).
Purpose of this Disclosure
Minnesota law gives you important rights regarding your individually identifiable health information. This Disclosure explains:
1. When your individually identifiable health information may be released without your written consent, and
2. Your right to access and obtain copies of your individually identifiable health information.
We create and maintain records about the care we provide. We are committed to protecting your privacy and using or disclosing your individually identifiable health information only as permitted by Minnesota law.
Our Responsibilities
We will not release your individually identifiable health information to others without your written, signed, and dated consent, except in specific situations permitted or required by Minnesota law.
We will follow the practices described in this Disclosure and provide you a copy upon request.
How We Use Your Individually Identifiable Health Information Within the Center
We may use your individually identifiable health information internally (within the Center) as needed to provide care to you and to operate the Center (for example, care coordination within the Center, quality improvement, and training). Internal use for these purposes is not a “release” under Minnesota law.
When Individually Identifiable Health Information May be Released Without Written Consent
Minnesota law allows or requires release of individually identifiable health information without consent only in limited circumstances, including the following:
• Medical Emergencies: If you have a medical emergency and cannot give consent, we may release relevant records to other health care providers to ensure you receive appropriate care.
• As Required by Law: We may release records when a specific federal, state, or local law requires or authorizes the release (for example, certain public health reporting obligations).
• Court Orders: We may release records in response to a valid court or administrative order.
• Public Health Activities: We may release records to public health authorities when required or authorized by law (for example, to report certain communicable diseases).
• Threats to Health or Safety: We may release records when necessary to prevent or lessen a serious and imminent threat to your health or safety or the health or safety of others, as permitted by law.
• Coroners and Medical Examiners: We may release records to a coroner or medical examiner to identify a deceased person or determine a cause of death in response to a valid subpoena.
• External Research (Limited): We may release records for medical or scientific research only as permitted by Minnesota law, which generally requires advance notice and an opportunity for you to object, or your written authorization.
• Important: Outside of these limited situations, your written consent is required before we release your individually identifiable health information to anyone outside of the Center, including other health care providers.
Releases That Require Your Written Consent
Unless the law clearly allows or requires us to share your individually identifiable health information as written above, we will share your individually identifiable health information only if you give us your written permission. This includes sharing your records:
• With health care providers outside of the Center,
• With outside service providers or vendors, and
• For any other reason not listed above.
You may revoke (cancel) your consent in writing at any time. Revocation will apply to future releases only. Under Minnesota law, consent is generally valid for one year unless a shorter period is stated in the consent or a different period is provided by law.
Fundraising Communications
As a charitable organization, we may use limited contact information (such as your name and mailing address) to contact you about supporting our mission. We will not release your individually identifiable health information to outside organizations for fundraising without your consent. You may opt out of fundraising communications at any time by contacting us at the Center. (320)235-7619 or PO Box 334, Willmar MN 56201
Your Rights Regarding Your Individually Identifiable Health Information
Right to Access and Obtain Copies
• You have the right to see and obtain copies of your Individually Identifiable Health Information.
• Upon written request, we will provide access or copies within 30 days.
• If your request is to review information about your current care, no fee will be charged.
• For other copy requests, any fees will not exceed the maximum amounts allowed by Minnesota law.
Limited Withholding
In some cases, if we reasonably determine that providing certain information would be detrimental to your physical or mental health or likely to cause you to harm yourself or others, we may withhold that information as permitted by law.
Acknowledge of Receipt of this Disclosure:
The first time you request services from HPC and then annually, or as appropriate, we will request that you sign a Privacy Practices Disclosure Acknowledgment, acknowledging you have read and been offered a copy of this disclosure. If you choose, or are not able to sign, a member of HPC Staff will sign their name and date. This acknowledgement will be filled with your records.
The Privacy Practices Disclosure will be posted in the Center and additional copies will be available to Clients upon request. If the Privacy Practices Disclosure is revised, the previous posted version will be updated as well.
Questions or Complaints
If you have questions about this disclosure or concerns about our Individually Identifiable Health Information practices, please contact the Center’s Nurse Manager at (320)235-7619 or 1520 Mavis Lane SE, PO Box 334, Willmar MN 56201
Privacy Practices Disclosure Acknowledgement:
The Privacy Practices Disclosure is provided to all Clients. This Privacy Practices Disclosure identifies:
1) how individually identifiable health information may be used or disclosed;
2) your rights to access individually identifiable health information, amend individually identifiable health information, request and accounting of disclosures of individually identifiable health information, and request additional restrictions on our uses and disclosures of individually identifiable health information;
3) your rights to complain if you believe your privacy rights have been violated; and
4) our responsibilities for maintaining individually identifiable health information.
The undersigned certifies that he/she has read the Privacy Practices Disclosure, was offered a physical copy and is the Client.
If the Client is unable to sign this acknowledgement or it is to be signed by the Client’s personal representative, the physical copy of the Privacy Practices Disclosure Acknowledgement must be completed and uploaded to the Client’s HPC file.