Notice of Privacy Practices

Notice of Privacy Practices 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. This notice applies to the following Mayo entities and health care practices sites (collectively referred to as “Mayo Clinic”): Minnesota: Mayo Clinic Rochester, Saint Marys Hospital, Rochester Methodist Hospital, Mayo Psychiatry and Psychology Treatment Center (Generose), Mayo Foundation for Medical Education and Research, Mayo Clinic Hospice, Charter House, Mayo Clinic Pharmacy, Mayo Clinic Store, the Mayo Family Practice Clinic Kasson, the Mayo Family Practice Clinic Kenyon, and the Mayo Family Clinic Northwest and Northeast (collectively referred to as “Mayo Minnesota Entities”). Florida: Mayo Clinic Jacksonville and its health care practice sites including, but not limited to, its affiliated hospital and the primary care practices in Jacksonville Beach and St. Augustine, and Physician and Hospital Practices, Inc. (collectively referred to as “Mayo Florida Entities”) Arizona: Mayo Clinic Arizona and its health care practice sites including, but not limited to, Mayo Clinic Building (Scottsdale Campus), Mayo Clinic Specialty Building (Phoenix Campus), Mayo Clinic Hospital (Phoenix Campus), Mayo Clinic Family Medicine – Arrowhead, Mayo Clinic Family Medicine – Thunderbird, Mayo Clinic Family Medicine – Fountain Hills, and Mayo Clinic Women’s Health Internal Medicine (collectively referred to as “Mayo Arizona Entities”) Mayo Clinic’s Duties health care operations. This arrangement is only for sharing By law, Mayo Clinic must keep protected health information information and not for any other purpose. private. The federal government defines protected health information as any information, whether oral, electronic or A Word about Federal and State Law paper, which is created or received by Mayo Clinic and relates Federal and state laws require Mayo Clinic to protect your to a patient’s health care or payment for the provision of medical information and federal law requires Mayo Clinic to medical services. This includes not only the results of tests describe to you how we handle that information. When and notes written by doctors, nurses and other clinical federal and state privacy laws differ, and the state law is personnel, but also certain demographic information (such more protective of your information or provides you with as your name, address and telephone number) that is related greater access to your information, then state law will to your health records. override federal law. For example, where we have specifically identified additional applicable state law requirements in this Mayo Clinic is required by law to give you this notice and to notice, the referenced Mayo entities will follow the more follow the terms and conditions of the notice that is currently stringent state law requirements. in effect. Part I - Most Common Uses and Disclosures How Mayo Clinic Fulfills These Duties • Mayo Clinic considers patient privacy as part of its This section describes the most common circumstances in mission to serve the needs of the patient first. which Mayo Clinic may use or disclose protected health • Mayo Clinic takes necessary precautions against information. inappropriate use or disclosure of medical information. • Mayo Clinic employees are expected to access medical Treatment information only as necessary to perform their jobs. Mayo Clinic will use and disclose protected health • Mayo Clinic employees who violate these rules and information to provide, coordinate or manage your care. This policies are subject to sanctions, including discipline and includes communication and consultation between health termination. care providers - doctors, nurses, technicians and other The Health Care Providers Covered By This Notice members of your medical team. This applies to disclosures This notice covers Mayo Clinic and Mayo Clinic personnel, for treatment purposes to health care providers both within volunteers, students, and trainees. The notice also covers and outside of Mayo Clinic. For example, following other health care providers that come to Mayo Clinic’s orthopedic surgery, your doctor may refer you for facilities to care for patients (such as physicians, physician rehabilitation. Information will be shared between caregivers assistants, therapists, and other health care providers not to ensure continuity of care. employed by Mayo Clinic), unless these other health care providers give you their own notice of privacy practices that describes how they will protect your medical information. Mayo Clinic may share your medical information with these other health care providers for their treatment, payment and Page 1 of 6 MCS7662Rev0208 Additional Applicable State Law Requirements Mayo Clinic also may disclose protected health information to another health care provider who has treated you, or to your Minnesota law generally requires patient consent for insurance company, if such information is needed for certain disclosures of protected health information by Mayo health care operations of the health care provider or Minnesota Entities for treatment purposes, unless the insurance company, such as quality improvement activities, disclosure is to a Mayo-related entity or consent is not evaluations of health care professionals, and state and possible due to a medical emergency. federal regulatory reviews. Payment Additional Applicable State Law Requirements Mayo Clinic will use and disclose protected health information to create bills and collect payment from Minnesota law generally requires patient consent for insurance companies, Medicare and other payers. This may disclosures of protected health information by Mayo include providing information such as dates of service, Minnesota Entities for health care operations purposes, symptoms and diagnosis to your insurance company to show unless the disclosure is to a Mayo-related entity. that Mayo Clinic provided medical services to you. Mayo Clinic also may disclose protected health information to Florida law generally requires patient consent for disclosures another health care provider if such information is needed by of protected health information by Mayo Florida Entities for the other health care provider to obtain payment for medical health care operations purposes. services provided to you. Patient Contacts Additional Applicable State Law Requirements At times, Mayo Clinic may access information, such as your name, address and general medical condition to contact you Minnesota law generally requires patient consent for to: disclosures of protected health information by Mayo • set up or remind you about future appointments; Minnesota Entities for payment purposes, unless the disclosure is to a Mayo-related entity. • provide information about treatment alternatives or other information that may be of interest to you; or Florida law generally requires patient consent for disclosures • disclose health-related benefits or services that may be of of protected health information by Mayo Florida Entities for interest to you. payment purposes. Additional Applicable State Law Requirements Health Care Operations Mayo Clinic will use and disclose protected health Florida law generally requires patient consent for Mayo information if it is necessary to improve the quality of care we Florida Entities to contact their patients for purposes of provide to patients or to run our health care facilities. These providing information regarding treatment alternatives, include activities to monitor and improve patient care, services or goods. license staff to care for patients, prepare for state and federal regulatory reviews, train health care and non-health Philanthropy care professionals, manage health care operations and Mayo Clinic may contact you to raise funds to sustain the improve health care services. Here are some examples: Mayo mission. For example, you may receive letters or other publications asking you to consider making a tax-deductible • To reduce the infection rate after a surgery, it would be contribution to Mayo. When conducting fundraising necessary to look at medical records to determine the activities, Mayo Clinic may access only your basic rate of infections that occurred. demographic information (such as name and contact • To be licensed to do a certain procedure, a doctor may information) and the dates that you were treated at Mayo be required to show that he or she has successfully Clinic. Mayo Clinic does not sell or rent patients’ names or completed a number of procedures under the addresses to any organization outside of Mayo. supervision of another physician. • A Federal Drug Administration inspector may review Facility Directory/Patient Census patient records in a laboratory to ensure that accurate Mayo Clinic may include your name, location in a facility, and complete records are maintained for patient safety. health condition (in general terms, such as “good,” “fair”) and religious affiliation (should you choose to provide one) in Mayo facilities across the country, including but not limited to current patient lists for our facilities. This information is Mayo Clinic Rochester, Mayo Clinic Jacksonville and Mayo maintained for Mayo Clinic personnel to assist family Clinic Arizona, and the Mayo Health System clinics and members and other visitors or persons in locating you while hospitals in Iowa, Minnesota and Wisconsin, also work you are in Mayo Clinic’s facilities. For example,

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