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Notice of Privacy Practices

We make every effort to maintain the privacy of your health information.  We are required by law to describe to you how health information that identifies you may be used and disclosed and how you can get access to this information. More detailed information is available upon request.

How we may disclose your health information:

Health Care Operations: We may disclose information about you for the operation of our health care practice.  For example our practice may share information with other health care providers that have a relationship with us (for example your health plan) for their health care operation activities.

Treatment: We may disclose information to doctors, nurses, technicians, or other personnel who are involved in taking care of you.  For example, we may ask you to have laboratory test) such as blood or urine test) and we may use the results to help us reach a diagnosis.  We may use your protected Health Information to write a prescription for you.  People who work in our practice may use or disclose your Health Information in order to treat you or to assist others in your treatment.

Payment: We will disclose information to an insurance company or a third party to coordinate payment for the services you receive.  We may contact your health insurance provider to certify that you are eligible for benefits (and for what range of benefits)  We may provide your insurance carrier with details regarding your treatment to determine if your insurance will cover, or pay for your treatment.  We may also talk with the policy holder or responsible parties such as family members of your insurance coverage.

Appointment Reminders: We may use and disclose information to contact you as a reminder that you have an appointment with us.

Special Situations

As Required By Law: We will disclose information about you when required by federal, state, or local law.

To Avert a Serious Threat: We may use and disclose information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public.

Workers Compensation: We may release information about you for workers compensation or similar programs.  These programs provide benefits for work related injuries or illness.

Public Health Risks: We may disclose information about you for public health activities such as to report births, deaths, child abuse or neglect, medication problems, product recalls, disease exposures, and adult abuse or neglect.  We will only make this disclosure if you agree or when required by law.

Military and Veterans: If you are a member of the armed forces or separated/discharged from military services, we may release health information about you as required by military command authorities or the Department of Veterans Affairs, as may be applicable.

Health Oversight Activities: We may disclose information to a health oversight agency for activities authorized by law. For example audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose information about you in response to a court or administrative order.  We may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone involved in the dispute, but only if efforts have been made to tell you about the request.

Law Enforcement: We may release information if asked to do so by a law enforcement official in reporting certain injuries or in response to a court order, subpoena, warrant, or similar process.

National Security and Protective Services: We may release information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.  We may disclosure your Health Information in order to protect the president, other officials or foreign heads of state or to conduct special investigations.

Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release information about you to the correctional institution or law enforcement official.  This release would be made if necessary for the institution to provide you with health care, to protect your health and safety or the health and safety of others and or for the safety and security of the correctional institution.

Your Rights Regarding Protected Health Information

Right to Inspect and Copy: You have the right to inspect and copy patient medical records and billing records with limited exceptions. You must submit your request in writing in order to inspect and obtain a copy of your Health Information.  To request a copy of your records, complete a release form.  We will charge you a cost-based fee for retrieval, reviewing fee, and copy charge if you request copies.

Right to Amend: If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information.  Your request must be made in writing and provide us with a reason that support your request for amendment.  We may deny your request in certain circumstances.

Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment payment or health care operations. You have the right to limit the health information we disclose to someone involved in your care.  For example, you could ask that we do not share information about a particular diagnosis or treatment with your spouse.  You must make your request in writing.  We are not required to agree.  If we agree, we will comply unless the information is needed to provide you with emergency treatment.

Communications: You have the right to request that we communicate with you about health matters in a certain way or at a certain location.  For example, you might request that we contact you at home rather than work.  To request, you must make your request in writing.  We will accommodate reasonable request.

Right to File a Complaint:  Individuals may complain to Southdale Ob/Gyn and to the Secretary of the Department of Health and Human Service, without fear of retaliation by the organization, if they believe their privacy rights have been violated.  To file a complaint with our office, contact:

Privacy Officer
Southdale Ob/Gyn Consultants
3625 W. 65th Street Suite 100
Edina, MN 55435

All complaints must be submitted in writing.  You will not be penalized for filing a complaint.

Southdale Ob/Gyn Consultants is required to abide by the terms of the Notice currently in effect.  We reserve the right to revise or amend this Notice of Privacy Practices.  Any revision or amendment to this notice will be effective for all or your records that our practice has created and maintained in the past, and for any of your records that we may create or maintain in the future.  Our practice will post a copy of our current Notice in our offices in a visible location at all times.  You may request a copy of our most current Notice at any time.

Southdale Ob/Gyn Consultants

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Edina Location

Southdale ObGyn Consultants

3625 West 65th, Suite 100
Edina, MN 55435
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Phone: 952-920-7001
Fax: 952-920-2245

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Burnsville Location

Southdale ObGyn Consultants

305 East Nicollet Blvd. Suite 393
Burnsville, MN 55337
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Phone: 952-435-9505
Fax: 952-435-6205

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