PRIVACY POLICY

Crystal Women’s Clinic protects health records and personal information in our possession. If you receive services through Crystal Women’s Clinic, your information will not be shared with any other party except what is mandatory by law and or through your consent given through a signed Release of Information.

HEALTH INFORMATION THAT WE MAINTAIN ABOUT YOU

We maintain records of:

• Your name and (if different) the name and relationship of the person receiving services
• Your address
• Your telephone number
• Your (or the patient’s, if different) condition that brings you here to Crystal Women’s Clinic.
• The date the doctor, nurse or medical professional reviewed your chart with you.
• Clinical findings related to the condition such as results of Pregnancy Tests and any other diagnostic or monitoring test to ensure your safety.

HOW WE USE AND DISCLOSE YOUR INFORMATION

We only use or disclose your health information as state and federal laws require or permit. In some cases, the law requires that you authorize the disclosure. In other cases, the law allows us to disclose your health information without your authorization.

Use and Disclosure Not Requiring Your Authorization

Treatment:  We may use your health information for treatment activities, such as disclosing it to other healthcare providers as helpful to treat you.

Payment:  Crystal Women’s Clinic  does not receive payment for any services we provide.

Healthcare Operations:  We may use and disclose your health information to manage our program operations, such as reviewing the quality of services you receive.

Business Associates:  We may disclose your health information to organizations that help us with our work. We have a written agreement that requires these organizations to use your health information for only the reasons necessary to do the work, and protect it from other uses or disclosures, just like we do.

To Contact You: We may use the information in your health records to contact you if we have information about treatment or other services that may be of interest to .

Legal Proceedings: We may disclose your health information in response to a court or administrative order, subpoena, discovery request, or other lawful process as required by law.

Law Enforcement: We may disclose your health information, within limitations, to law enforcement officials for several different purposes:

• To comply with a court order, warrant, subpoena, summons, or other similar process;
• To identify or locate a missing person;
• About criminal conduct we believe in good faith to have occurred on our premises; and
• To report a crime not occurring on our premises, the nature of a crime, the location of a crime, and the identity, description and location of the individual who committed the crime, in an emergency situation.

Serious Threat to Health or Safety: We may share health information about you for certain situations such as preventing disease, reporting suspected abuse, neglect, or domestic violence, preventing or reducing a serious threat to anyone’s health or safety, or to lessen a serious and imminent threat to health or safety in general.

Coroners, Medical Examiners, and Funeral Directors: We may use and disclose health information to a coroner or medical examiner. This disclosure may be necessary to identify a deceased person or determine the cause of death. We

may also disclose health information, as necessary, to funeral directors to assist them in performing their duties.

As Required by Law: We may also use and disclose your health information when required to do so by federal, state, or local law.

Uses and Disclosures with Your Authorization – Other uses and disclosures of your personal information require your written authorization. Unless we have already acted on your permission, you may take back or revoke your permission at any time by writing to us using the contact information below.

YOU HAVE THE FOLLOWING RIGHTS REGARDING THE HEALTH INFORMATION WE MAINTAIN ABOUT YOU:

Right to Request Restrictions: You have the right to request restrictions on how we use and disclose your health information for treatment or health care operations. In most circumstances, we are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing and submit it using the contact information below.

Right to Request Confidential Communications: You have the right to request that we communicate with you in a certain manner or at a certain location regarding the services you receive from us. We will not ask you the reason for your request. We will attempt to accommodate all reasonable requests.

Right to Inspect and Copy: You have the right to see or get a copy of your health information we have about you in paper or electronic format. In very limited cases, we may deny your request. To see or get a copy, you must make your request in writing and submit it using the contact information below.

Right to Amend: If you feel that your health information is incorrect or incomplete, you may request that we amend your information. To request an amendment, you must make your request in writing by filling out the appropriate form provided by us. We may deny your request for an amendment. If this occurs, you will be notified of the reason for the denial and given the opportunity to file a written statement of disagreement with us that will become part of your medical record.

Right to an Accounting of Disclosures: You have the right to request an accounting of disclosures we make of your health information. Please note that certain disclosures need not be included in the accounting we provide to you. You may ask for a list of the times we’ve shared your health information, with whom we shared it, and why. You may ask for a specific time period to be covered by the list, but we will not provide any information that goes back more than 6 years before your request. The list will not include any sharing done at your request or for care, operations or certain other cases.

Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice at any time, even if you previously agreed to receive this Notice electronically.

CHANGES TO THIS POLICY

We reserve the right to change the terms of this Privacy Policy at any time.

HOW YOU CAN REACH US

If you want additional information about our privacy practices or if you believe Crystal Women’s Clinic has violated this Privacy Policy, you may file a complaint in writing by contacting Crystal Women’s Clinic  Attn: Nurse Manager at: 5640 West Broadway Ave, Suite D, Crystal, MN 55428

Crystal Women’s Clinic does not retaliate against people who file a complaint.

There are no references to complying with a legal proceeding or law enforcement request.

We are allowed, and sometimes required, to share your information in other ways, such as public health and research, but we must meet many conditions in the law before we can share your information for these purposes including the following:

Legal Proceedings: We may disclose your health information in response to a court or administrative order, subpoena, discovery request, or other lawful process as required by law.

Law Enforcement: We may disclose your health information, within limitations, to law enforcement officials for several different purposes:

• To comply with a court order, warrant, subpoena, summons, or other similar process;
• To identify or locate a missing person;
• About criminal conduct we believe in good faith to have occurred on our premises; and
• To report a crime not occurring on our premises, the nature of a crime, the location of a crime, and the identity, description and location of the individual who committed the crime, in an emergency situation.

Serious Threat to Health or Safety: We may share health information about you for certain situations such as preventing disease, reporting suspected abuse, neglect, or domestic violence, preventing or reducing a serious threat to anyone’s health or safety, or to lessen a serious and imminent threat to health or safety in general. 

Coroners, Medical Examiners, and Funeral Directors: We may use and disclose health information to a coroner or medical examiner. This disclosure may be necessary to identify a deceased person or determine the cause of death. We may also disclose health information, as necessary, to funeral directors to assist them in performing their duties.

As Required by Law: We may use and disclose your health information when required to do so by federal, state, or local law.