ÁÔÆæÖØ¿Ú

Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities. 

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.  

Your Rights 

You have the right to: 

• Get a copy of your paper or electronic medical record 
• Correct your paper or electronic medical record 
• Request confidential communication 
• Ask us to limit the information we share 
• Get a list of those with whom we’ve shared your information 
• Get a copy of this privacy notice 
• Choose someone to act for you 
• File a complaint if you believe your privacy rights have been violated 

Our Uses and Disclosures 

We may use and share your information as we: 

• Treat you 
• Run our organization 
• Bill for your services 
• Help with public health and safety issues 
• Do research 
• Comply with the law 
• Address workers’ compensation, law enforcement, and other government requests 
• Respond to lawsuits and legal actions 

Your Rights 

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. 

Get an electronic or paper copy of your medical record 

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. 
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. 

Ask us to correct your medical record 

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. 
• We may say “no” to your request, but we’ll tell you why in writing within 60 days. 

Request confidential communication 

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. 
• We will say “yes” to all reasonable requests. 

Ask us to limit what we use or share 

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it affects your care. 
• If you pay for a service or health care item out of pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information. 

Get a list of those with whom we’ve shared information 

• You can ask for a list of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. 
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. 

Get a copy of this privacy notice 

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. 

Choose someone to act for you 

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. 
• We will make sure the person has this authority and can act for you before we take any action. 

File a complaint if you feel your rights are violated 

• You can complain if you feel we have violated your rights by contacting us using the information on the bottom of the page. 
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting . 
• We will not retaliate against you for filing a complaint. 
• Compliance officer: Brian Chaszar. 406-243-6076. brian.chaszar@mso.umt.edu. 

Your Choices 

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. 

If you cannot tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety. 

In these cases, we never share your information unless you give us written permission: 

• Marketing purposes 
• Sale of your information 
• Most sharing of psychotherapy notes 

Our Uses and Disclosures 

How do we typically use or share your health information? We typically use or share your health information in the following ways. 

Treat you. We can use your health information and share it with other professionals who are treating you. (Example: A doctor treating you for an injury asks another doctor about your overall health condition.) 

Run our organization. We can use and share your health information to run our practice, improve your care, and contact you when necessary. (Example: We use health information about you to manage your treatment and services.) 

Bill for your services. We can use and share your health information to bill and get payment from health plans or other entities. (Example: We give information about you to your health insurance plan so it will pay for your services.) 

How else can we use or share your health information? 

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before we can share your information for these purposes. For more information see: . 

Help with public health and safety issues. We can share health information about you for certain situations such as: 

• Preventing disease 
• Helping with product recalls 
• Reporting adverse reactions to medications 
• Reporting suspected abuse, neglect, or domestic violence 
• Preventing or reducing a serious threat to anyone’s health or safety 

Do research. We can use or share your information for health research. 

Comply with the law. We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law. 

Respond to organ and tissue donation requests. We can share health information about you with organ procurement organizations. 

Work with a medical examiner or funeral director. We can share health information with a coroner, medical examiner, or funeral director when an individual dies. 

Address workers’ compensation, law enforcement, and other government requests 

• We can use or share health information about you: 
• For workers’ compensation claims 
• For law enforcement purposes or with a law enforcement official 
• With health oversight agencies for activities authorized by law 
• For special government functions such as military, national security, and presidential protective services 

Respond to lawsuits and legal actions. We can share health information about you in response to a court or administrative order, or in response to a subpoena. 

Our Responsibilities 

• We are required by law to maintain the privacy and security of your protected health information. 
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. 
• We must follow the duties and privacy practices described in this notice and give you a copy of it. 
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see: . 
• We can change the terms of this notice, and the changes will apply to all the information we have about you. The new notice will be available upon request, in our office. 

Additional HIPPA and Uses and Disclosures Information

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.

Certain covered entities within The ÁÔÆæÖØ¿Ú must maintain the privacy of your personal health information. These covered entities include the ÁÔÆæÖØ¿Ú Adaptive Equipment Program (MAEP), MonTECH, The Hearing Conservation Project, the New Directions program, Curry Health Center and the Health Service Pharmacy in the Curry Health Center. This notice describes how your protected health information about treatment, payment, health care operations, or for other purposes that are permitted or required may be used or disclosed. It also describes your rights to access and control your protected health information.  Please note that all your personal health information will be available for release to you, to a provider regarding your treatment, or to certain other entities as required by law.

The covered entities within The ÁÔÆæÖØ¿Ú are required to abide by the terms of this Notice of Privacy Practices. However, the University reserves the right to change the privacy practices described in this notice, in accordance with the law. Changes to the privacy practices would apply to all health information maintained in the covered entities. If the privacy practices are changed, you may receive a revised copy of the privacy notice by contacting The ÁÔÆæÖØ¿Ú Chief Privacy Officer in the Office of Research (116 UH; 406-243-6670).

Uses and Disclosures of Protected Health Information

Uses and Disclosures of Protected Health Information Based Upon Your Consent of Written Privacy Notice

Before you are provided with health care by a covered entity, you will be asked to sign a form acknowledging your receipt of this Privacy Notice. Once you have signed the acknowledgement form, you consent to the provisions of this Privacy Notice and your health information may be used and disclosed for the following purposes:

1. Treatment. Health care providers may use the information in your medical record to determine which treatment options best address your health needs. For example, your protected health information may be used to provide, coordinate, or manage your health care. This may include disclosure of your protected health information to a home health agency or to a pharmacy or medical equipment provider. In addition, your protected health information may be disclosed to a specialist or a laboratory which becomes involved with your health care diagnosis or treatment.
2. Payment. In order for an insurance company to pay for your treatment, a bill that identifies you, your diagnosis, and the treatment provided to you must be submitted. Such health information will be passed to an insurer in order to help receive payment for your medical bills.
3. Health Care Operations. Your diagnosis, treatment, and outcome information may be needed in order to improve the quality or cost of health care delivered. These quality and cost improvement activities may include evaluating the performance of your health care providers or examining the effectiveness of treatment provided to you.

In addition, your health information may be used for appointment reminders. For example, your medical record may be used to determine the date and time of your next appointment so a reminder can be sent or a telephone call made to remind you of the appointment. Also, your medical information may be examined to decide if another treatment or a new service may help you.

NOTE: If you refuse to provide your consent, treatment may be refused.

Uses and Disclosures of Protected Health Information That Can Be Made Without Your Written Consent

1. As required or permitted by law. Some types of health information must be reported to legal authorities, such as law enforcement officials, court officials, or government agencies. For example, abuse, neglect, domestic violence or certain physical injuries may have to be reported. Also, responses to court orders are mandated by law.
2. For public health activities. Certain health authorities may require reporting of your health information to prevent or control disease, injury, or disability. This may include using your medical record to report certain diseases, injuries, birth or death information, information of concern to the Food and Drug Administration, or information related to child abuse or neglect. Also, certain work-related injuries may need to be reported to your employer so that your workplace can be monitored for safety.
3. For health oversight activities. Your health information may be disclosed to authorities so they can monitor, investigate, inspect, discipline or license those who work in the health care system or for government benefit programs.
4. For activities related to death. Your health information may be disclosed to coroners, medical examiners and funeral directors so they can carry out their duties related to your death, such as identifying the body, determining the cause of death or, in the case of funeral directors, to carry out funeral preparation activities. 1 45 CFR ' 164.506(b) (2001).
5. For organ, eye or tissue donation. Your health information may be disclosed to people involved with obtaining, storing or transplanting organs, eyes or tissue of cadavers for donation purposes.
6. For research.  Under certain circumstances, and only after a special approval process that usually involves removal of identifiers from disclosed information, your health information may be disclosed to help conduct research.
7. To avoid a serious threat to health or safety. As required by law and standards of ethical conduct, your health information may be disclosed to the proper authorities if, in good faith, it is believed that such release is necessary to prevent or minimize a serious and approaching threat to you or the public safety.
8. For military, national security, or incarceration/law enforcement custody. If you are involved with the military, national security or intelligence agencies, or you are in the custody of law enforcement officials or an inmate in a correctional institution, your health information may be released to the proper authorities so that they may carry out their duties under the law.
9. For worker's compensation. Your health information may be disclosed to the appropriate persons to comply with laws related to worker's compensation or other similar programs. These programs may provide benefits for work-related injuries or illness.
10. To those involved with your care or payment of care. If people such as family members, relatives, or close personal friends are helping care for you or helping you pay your medical bills, important health information about you may be released to those people. You have the right to object to such disclosure, unless you are unable to function or there is an emergency.  

NOTE: Except for the situations listed above, your specific, written authorization must be obtained for any other release of your health information. An authorization is different than consent. One primary difference is that, unlike cases with consents, a provider must treat you even if you do not wish to sign an authorization form.

If you sign an authorization form, you may withdraw your authorization at any time, as long as your withdrawal is in writing. If you wish to withdraw your authorization, please submit your written withdrawal to the covered entity to which you submitted the authorization (the ÁÔÆæÖØ¿Ú Adaptive Equipment Program (MAEP), MonTECH, The Hearing Conservation Project, the New Directions program, Curry Health Center and the Health Service Pharmacy in the Curry Health Center).   

2 45 CFR ' 164.508(e)(ii) (2001).

Your Health Information Rights

You have several rights with regard to your health information. If you wish to exercise any of the following rights, please contact The ÁÔÆæÖØ¿Ú Chief Privacy Officer in the Office of Research  (116 UH, 406-243-6670). Specifically, you have the right to:

1. Inspect and obtain a copy your health information. With a few exceptions, you have the right to inspect and obtain a copy of your health information. However, this right does not apply to psychotherapy notes or information gathered for judicial proceedings, for example. In addition, a reasonable fee may be charged if you request a copy of your health information.
2. Request to correct your health information. If you believe your health information is incorrect, you may ask that the information be corrected. You should make such requests in writing and give a reason why your health information should be changed. However, your request may be denied if covered entities at The ÁÔÆæÖØ¿Ú did not create the health information you believe is incorrect or if these entities believe your information is correct.
3. Request restrictions on certain uses and disclosures. You have the right to ask for restrictions on how your health information is used or to whom your information is disclosed, even if the restriction affects your treatment, payment, or health care operation activities. Or, you may want to limit the health information provided to family or friends involved in your care or payment of medical bills.  You may also want to limit the health information provided to authorities involved in disaster relief efforts. However, The ÁÔÆæÖØ¿Ú is not required to agree to your requested restrictions in all circumstances.
   If you receive certain medical devices (for example, life-supportive devices used outside a covered entity’s facility), you may refuse to release or may restrict the release of your name, telephone number, social security number or other identifying information for purpose of tracking the medical device.
4. As applicable, receive confidential communication of health information. You have the right to ask that your health information is communicated to you in different ways or places. For example, you may wish to receive information about your health status in a special, private room or through a written letter to a private address. Reasonable requests for confidentiality made by you must be accommodated by the health care provider.
5. Receive a record of disclosures of your health information. In some limited instances, you have the right to ask for a list of the disclosures of your health information made from covered entities in The ÁÔÆæÖØ¿Ú during the previous six years, but the request cannot include dates before April 14, 2003. This list must include the date of each disclosure, who received the disclosed health information, a brief description of the health information disclosed, and why the disclosure was made. The covered entities must comply with your request for a list within 60 days, unless you agree to a 30-day extension, and there will be no charge for the list, unless you request such a list more than once per year.  In addition, the list of disclosures will not include disclosures made to you, or for purposes of treatment, payment, health care operations, inclusion in the entity’s directory, or for  national security, law enforcement/corrections, and certain health oversight activities.
6. Obtain a paper copy of this notice. Upon request, you may at any time receive a paper copy of this notice, even if you earlier agreed to receive this notice electronically.
7. Complaints. If you believe that your privacy rights have been violated, you may file a complaint with The ÁÔÆæÖØ¿Ú and with the federal Department of Health and Human Services.  The ÁÔÆæÖØ¿Ú will not retaliate against you for filing such a complaint. To file a complaint, please contact the Chief Privacy Officer at The ÁÔÆæÖØ¿Ú in the Office of Research (116 UH; 406-243-6670). This individual will provide you with the necessary assistance and paperwork.

Again, if you have any questions or concerns regarding your privacy rights or the information in this notice, please contact the Chief Privacy Officer in the Office of Research at The ÁÔÆæÖØ¿Ú (116 UH; 406-243-6670).