1-800-206-6991
Nurse Line

218-278-2000
Littlefork

218-283-5503
Rainy Lake Clinic

218-283-4481
Hospital

1400 Highway 71
International Falls, MN 56649

Community Care

Rainy Lake Medical Center’s Community Care program (Financial assistance) provides free or reduced cost healthcare to patients who are unable to pay fully for services received at our facility.

Coverage

Community Care covers inpatient, outpatient, and clinic services. However, the program may not cover services that are provided by medical personnel not considered part of the facility’s medical staff, such as radiologists or specialists not employed by Rainy Lake Medical Center.

Community Care covers those services that are deemed “medically necessary” and does not cover elective or cosmetic services.

Financial Assistance Policy

Eligibility

Eligibility is based on three criteria: your income, your resources, and your application for, and use of, any private or government healthcare coverage available to you.

Once these three criteria are met, Community Care may assist you with unpaid bills, including those resulting from insurance deductibles and co-pays.

Community Care is divided into three categories based on income and resources:

  • If your income is at or below 100 percent of the Federal Poverty Level based on family size (see attached chart), you are entitled to free care. There are no resource limits.
  • If your income is between 100 and 200 percent of the Federal Poverty Level based on family size (see attached chart), you are entitled to reduced-cost care based on the sliding scale established by the Medical Center, which is available upon request. There are resource limits on this level of eligibility.
  • If your income exceeds 200 percent of the Federal Poverty Level based on family size, you may be eligible for reduced cost care if your income and resources are not sufficient enough to enable you to pay fully for Medical Center services. Rainy Lake Medical Center determines whether to reduce charges if your income is at this level.

Determining Eligibility

When reviewing applications for Community Care, Rainy Lake Medical Center makes an initial determination and a final determination of eligibility.

The initial determination is made when you request an application for Community Care and meet with a Rainy Lake Medical Center financial representative to provide the required information. During this time, you will be asked to sign a statement confirming the accuracy of the information. The Medical Center will not take collection actions or request a deposit from you when you participate in this initial determination. If you are determined eligible for Community Care, collection actions are delayed pending final determination.

Once you are initially determined eligible for Community Care, you have 14 calendar days to supply documentation supporting the information you provided to the Medical Center’s financial representative. Based on this documentation, the Medical Center will make a final determination on your eligibility for the program. In addition, the hospital will make every reasonable effort to determine whether a government agency or private insurance company will cover some or all of your Medical Center’s charges. Based on your application, you may be required to submit documentation as evidence of your eligibility for Community Care. If you are covered under the Minnesota Senior Federation, the income verification requirement may be waived.

Application process

When the Medical Center requests your insurance information during registration, we can provide information on Community Care in writing. If you are unable to read, or do not understand the policy, a Rainy Lake Medical Center financial representative can explain the program. Additionally, Medical Center’s staff will give you a Community Care application and brochure at any time. Don’t hesitate to ask for this information; we are happy to provide it to you.

If you are denied coverage through Community Care, you will receive a notice stating the reason why. If you would like your application reconsidered, the hospital offers an appeal process. If your appeal is denied, you will be notified in writing of the reason and collection actions will resume.

If you have any questions about Community Care or your ability to pay for Medical Center’s services, please contact our Financial Counselor at (218) 283-5300.

Medical Records And Info

How secure are my medical records?

Security of your medical records is top priority at Rainy Lake Medical Center. Every effort is made to protect the contents. Information is released after verifying proper authorization. State and Federal laws are very strict regarding inappropriate release of information from your medical record.

Do I need to come to the hospital to request records?

No, you may send a written or a faxed request to the medical records department. The request must identify who you are, where you would like them sent, what records you are asking for and why you need them. Your signature will be authenticated with signatures we have in your medical record to ensure someone other than yourself does not authorize the release.

 

Can my spouse or another family member sign for release of my records?

No, only you can authorize release of your medical records. State, Federal and Rainy Lake Medical Center guidelines prohibit anyone else from authorizing release of your medical records.

Can I look at my medical records?

Yes, you may call medical records at 283-5463 to set up an appointment to view your records. Personnel will be available to assist you.

What do I need to do to get copies of my medical records?

Your medical records are confidential and cannot be released without your authorization. If you would like copies, the release of information clerk will ask you to complete a “Release of Information” form. This form will identify who you are, your date of birth, to whom the records are going, why you need your records, and which records you are asking for. The form must be dated and signed by you. You may be asked to provide identification to ensure we are not releasing records to an imposter.

Will there be a charge?

Depending on your need for information from your record, there may be a charge. Please call the release of information clerk at 283-5463.

For more information, click here to read the full text of our Notice of Privacy Practices.

Rainy Lake Medical Center
Hospital Campus
1400 Highway 11
International Falls, MN 56649


Clinic Campus
2501 Keenan Drive
International Falls, MN 56649

Original Effective Date: April 14, 2003
Effective Date of Last Revision: April 2013

_________________________________

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.

INTRODUCTION:

At Rainy Lake Medical Center, we are committed to the handling of protected health information about you in a responsible manner. This Notice of Health Information Practices describes the personal information we collect, and how we use or disclose that information. It also describes your rights as they relate to your protected health information. This notice is effective April 14, 2003 and applies to all protected health information. A federal regulation, known as the Health Insurance Portability and

Accountability Act “HIPAA” Privacy Rule requires that we provide detailed notice in writing of our privacy practices. We know that this Notice is long. The HIPAA Privacy Rule requires us to address many specific things in this Notice. If you have questions and would like additional information, you may contact the Rainy Lake Medical Center Privacy Officer at 218-283-5412. Rainy Lake Medical Center reserves the right to make changes to this Notice and to make changes effective for all protected health information we may already have about you. If and when this Notice is changed, we will post copies in prominent locations throughout the facility and at our website www.RainyLakeMedical.com. We will also provide you with a copy of the revised Notice upon a request to our Privacy Officer.

UNDERSTANDING YOUR HEALTH RECORD INFORMATION:

Each time you visit Rainy Lake Medical Center, after signing consent to receive treatment or services, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

Basis for planning your care and treatment

Means of communication among the many health professionals who contribute to your care

Legal document describing the care you received

Means by which you or a third-party payer can verify that services billed were actually provided

Tool in educating health professionals

Source of data for medical research

Source of information for public health officials charged with improving the health of this state or nation

Source of data for our planning and marketing

Tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what is in your record and how your health information is used helps you to: ensure its accuracy; better understand who, what, when, where, and why others may access your health information; and for you to make more informed decisions when authorizing disclosure to others.

YOUR HEALTH INFORMATION RIGHTS:

Although your health record is the physical property of Rainy Lake Medical Center, the information belongs to you. You have the right to request in writing:

The opportunity to inspect and obtain a copy your protected health information with the following exceptions: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, a criminal, or an administrative proceeding; and protected health information that is subject to law that prohibits access to review. You may have a right to have the decision reviewed. Please contact the Privacy Officer if you have questions.

To amend your health care information if you disagree with its content. Any discussion for amendment must be addressed to the Privacy Officer or designee.

To request communications of your health information by alternative means or at alternative locations upon written request to the Privacy Officer.

To obtain an accounting of disclosures of your paper or electronic health information.

To request a restriction on certain uses and disclosures of your information.

To restrict disclosures of PHI to a health plan or a RLMC business associate for payment purposes or to carry out health care operations and when it is not required by law when you pay in full for the item or service provided.

To revoke your authorization to use or disclose health information except to the extent that action has already been taken.

OUR RESPONSIBILITIES:

Rainy Lake Medical Center is required to:

Maintain the privacy of your health information;

Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you;

Notify you if there is a breach of your unsecured protected information that compromises the security or privacy of your unsecured protected information;

Abide by the terms of this notice;

Notify you if we are unable to agree to a requested restriction

Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue using or disclosing your health information after the date on the authorization or after we have received a written revocation of the authorization according to the procedures included in the authorization.

FOR MORE INFORMATION OR TO REPORT A PROBLEM OR COMPLAINT:

If you believe your privacy rights have been violated, you can file a complaint with Rainy Lake Medical Center’s Privacy Officer or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with the Privacy Officer or the Office for Civil Rights.

Contacts:

Rainy Lake Medical Center Privacy Officer, 218-283-5412; or

The Office for Civil Rights address listed below:

Office for Civil Rights

U.S. Department of Health and Human Services

200 Independence Avenue S.W.

Room 509F HHH Building

Washington, D.C. 20201

OUR COMMITMENT TO PROTECTING HEALTH INFORMATION ABOUT YOU:

In this Notice, we describe the ways that we may use or disclose health information about our patients. The HIPAA Privacy Rule requires that we protect the privacy of health information that identifies a patient, or where there is a reasonable basis to believe the information can be used to identify a patient. This information is called “protected health information” or “PHI.” This notice describes your rights as our patient and our obligations regarding the use and disclosure of PHI. We are required by law to:

Maintain the privacy of PHI about you;

Give you this Notice of our legal duties and privacy practices with respect to PHI;

Notify you if there is a breach of your unsecured protected information that compromises the security or privacy of your unsecured protected information

Comply with the terms of our Notice of Privacy Practices that is currently in effect.

HOW WE MAY USE AND DISCLOSURE PROTECTED HEALTH INFORMATION ABOUT YOU:

The following categories describe the different ways we may use and disclose PHI for treatment, payment, or health care operations. The examples included with each category do not list every type of use disclosure that may fall within that category.

Treatment: We are permitted to use and disclose your PHI to doctors, nurses, technicians, medical students or other personnel who are involved in your care or provide you with medical treatment or services at Rainy Lake Medical Center. For example, a doctor treating you in the hospital may need to know if you have diabetes, because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so he or she can arrange for appropriate meals. Different departments of RLMC may also share your PHI in order to coordinate the services such as laboratory tests, x-rays and medications. We also may disclose your PHI to healthcare providers outside RLMC involved in your medical care, such as physicians who provide follow-up care, physical therapy providers, medical equipment suppliers, and skilled nursing facilities.

Payment: We may use and disclose medical information about you so that the treatment and services you receive may be billed to, and payment may be collected from, you, an insurance company, or another third party. For example, we may need to give your health plan information about treatment you received while under our care so your plan will pay us or reimburse you for the treatment. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. We will get your written consent upon admission for treatment which permits us to make such disclosures for payment purposes. Health Care Operations: We may use and disclose medical information about you for Rainy Lake Medical Center health care operations. For example, members of our internal staff such as the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health care record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care services we provide. Written consent is obtained prior to disclosing such information to outside facilities.

Appointment Reminders and Other Health Information: We may use your protected health information to send you reminders or call to remind you about scheduled appointments. We may also call you and leave health related information on your voice mail. If you do not wish to have a voice mail message left for you, you have the right to request in writing how we may communicate with you. Examples of alternatives would be by mail, at work or at home.

Business Associates: There are some services provided in our organization through contracts with business associates. Examples include Rainy Lake Medical Center’s reviewing agencies such as Joint Commission on the Accreditation of Healthcare Services, clearing houses associated with collections of accounts, and consultants. We may disclose your health information to our business associate(s) so that they can perform the job we have contracted them to do. To protect your health information that is disclosed, each business associate is required to sign an agreement to appropriately safeguard the information and to not re-disclose the information unless specifically permitted by law.

Directory: We may include certain limited information about you in our directory while you are a patient. This information may include your name, location in the facility, and your religious affiliation if you provide this information to us. The directory information, except for your religious affiliation and condition, may be released to people who ask for you by name. This is so your family, friends, and clergy can know your location. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don’t ask for you by name. If you prefer that Rainy Lake Medical Center not make these disclosures, please notify the registration clerk at the time of admission for services, or the Privacy Officer.

Notification to People Assisting in Your Care: Rainy Lake Medical Center will only disclose medical information to those taking care of you, helping you pay your bills, or other close family members or friends if these people need to know the information to help you, and then only to the extent permitted by law. We may, for example, provide limited medical information to allow a family member to pick up a prescription for you. Generally, we will get your consent prior to making disclosures about you to family or friends. If you are able to make your own health care decisions, Rainy Lake Medical Center will ask your permission before using your medical information for these purposes. If you are unable to make health care decisions, Rainy Lake Medical Center will disclose relevant medical information to family members or other responsible people if we feel it is in your best interests to do so, including an emergency situation.

Research: Rainy Lake Medical Center does not do research. However, Federal law permits Rainy Lake Medical Center to use and disclose medical information about you for research purposes, either with your specific written authorization or when the study has been reviewed for privacy protection by an Institutional Review Board or Privacy Board before research begins. In some cases, researchers may be permitted to use information in a limited way to determine whether the study or the potential participants are appropriate. Minnesota law requires that we get your general consent before we disclose your health information to an outside researcher. We will make a good faith effort to obtain your consent or refusal to participate in any research study, as required by law, prior to releasing any identifiable information about you to outside researchers.

As Required by Law: We will disclose medical information about you when we are required to do so by federal, state, or local laws.

To Avert a Serious Threat or Health Safety: We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure must be only to someone able to prevent that threat. In addition, Minnesota law generally does not permit these disclosures unless we have your written consent to do so or when the disclosure is specifically required by law, including the limited circumstances in which Rainy Lake Medical Center care professionals have a “duty to warn.”

YOUR MEDICAL INFORMATION MAY BE RELEASED IN THE FOLLOWING SPECIAL SITUATIONS:

Coroners, Medical Examiners and Funeral Directors: We will release medical information to a coroner or medical examiner in the case of certain types of death, and we must disclose health records upon request of the coroner or medical examiner. This may be necessary, for example, to identify you or to determine the cause of death. We may also release the fact of death and certain demographic information about you to funeral directors as necessary to carry out their duties. Other disclosures from your health record will require the consent of the surviving spouse, parent, or a person appointed by you in writing, or your legally authorized representative.

Military and Veterans: If you are a member of the armed forces, we will release medical information about you as requested by military command authorities if we are required to do so by law, or when we have your written consent. We may also release medical information about foreign military personnel to the appropriate foreign military authority as required by law or written consent.

National Security and Intelligence Activities: We will release medical information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities only as required by law or with your written consent.

Protective Services for the President and Others: We will disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state, or conduct special investigations only as required by law or with your written consent.

Organ Procurement Organizations: We may release your medical information to organizations that handle organ procurement or organ, eye or tissue transplantation, or to an organ donation bank, as necessary to facilitate organ or a tissue donation and transplantation. The information that Rainy Lake Medical Center may disclose is limited to the information necessary to make a transplant possible.

Fundraising: Occasionally, Rainy Lake Medical Center may use limited information (your name address, and the dates you were seen for medical services) to let you know about fundraising or other charitable events. You have a right to opt-out of fundraising communications. If you would like to do so, please contact the Rainy Lake Medical Center Privacy Officer.

Marketing: Rainy Lake Medical Center will not participate in marketing efforts in any way without first consulting with you or obtaining your written consent unless the marketing is conducted through a face-to-face communication or involves a gift of nominal value.

Psychotherapy Notes: We will not use or disclose any notes from a mental health professional without your authorization except to carry out certain treatment, payment, or health care operations including allowing the note taker to use them for treatment, using the notes for our training programs, or using the notes in defense of a legal proceeding.

Sale of Protected Information: We will not accept payment of any kind for protected information without your prior authorization. Sale of protected information is prohibited only as it is defined by law and does not include Rainy Lake Medical Center accepting payment for your treatment.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement.

Workers Compensation: We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses. We are permitted to disclose this information to the parties involved in the claim without any specific consent, so long as the information is related to a workers’ compensation claim.

Public Health: We may disclose medical information to public health authorities about you for public health activities. These disclosures generally include the following:

  • Preventing or controlling disease, injury, or disability;
  • Reporting births or deaths;
  • Reporting child abuse or neglect or abuse of a vulnerable adult;
  • Reporting reactions to medications or problems with products;
  • Notifying people of recalls of products that we may be using;
  • Notifying a person who may have been exposed to a disease or may be at the risk for contracting or spreading a disease or condition;
  • Reporting to the Federal Food and Drug Administration as permitted or required by law.

Correctional Institution/Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we will release medical information about you to the correctional institution or law enforcement official only as required by law or with your written consent.

Law Enforcement: We may release medical information if asked to do so by a law enforcement official in response to a valid court order, grand jury subpoena, or warrant, or with your written consent. In addition, we are required to report certain types of wounds, such as gunshot wounds and some burns. In most cases, reports will only include the fact of injury, and any disclosures would require your consent or a court order. We may also release information to law enforcement that is not part of your health record (in other words, non-medical information) for the following reasons:

  • To identify or locate a suspect, fugitive, material witness, or missing person.
  • If you are the victim of a crime and if, under certain limited circumstances, we are unable to obtain your agreement.
  • The information relates to a death we believe may be the result of a criminal conduct.
  • The information relates to criminal conduct at our facility.
  • In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime.

Lawsuits and Disputes: If you are involved in a lawsuit, dispute, or other judicial proceedings, we will disclose medical information about you only in response to a valid court order, administrative order, or a grand jury subpoena, or with your written consent.

Thank you for choosing Rainy Lake Medical Center for your health care services.

REFERENCES:

Federal Register, 45 CFR Parts 160 and 164 – Standards for

Privacy and Individually Identifiable Health Information;

Original and Final Rule

MN Statute 144.335

Field Guide to HIPAA Implementation

American Medical Association – 2002

Dorsey and Whitney, LLPHIPPA Forms and Explanation

In association with SMDC Health System

www.RainyLakeMedical.com

MN SURE Marketplace

The MNsure Marketplace is your one stop shop to apply and qualify for Advance Premium Tax Credits and a low cost or a free plan. MNsure is all about choice, clear information, streamlined application, no pre-existing exclusions, no denial of coverage, and no annual or lifetime benefit limits.

Appointments

Rainy Lake Medical Center has 2 MNsure Navigators to assist you through the process. For appointments, please call:

– Rebecca Bliss (218) 283-5300
– Sarah Christianson (218) 283-5438

For more information about MNsure, visit their website:
https://www.mnsure.org/

Documents

2013 Community Health Needs Assessment (CHNA)

2016 Community Health Needs Assessment (CHNA)

CHNA Implementation Strategy

Financial Assistance Policy

Quality Measures

Payment Options

At Rainy Lake Medical Center, we’re sensitive to the high cost of healthcare. That’s why we provide a Financial Counselor dedicated to helping you understand your bill and finding the best way for you to pay for services.

We’ve created five convenient options to help you meet the cost of your healthcare:

  • Cash
  • Check
  • Credit card (Visa, Mastercard, Discover, and American Express)
  • Extended payment plan, which was designed to help those who are unable to pay in full. If approved for this plan, you can make monthly payments on your bill.
  • Community Care program (see “Financial Assistance Information” link)

Insurance
Rainy Lake Medical Center bills patients’ insurance plans as a courtesy, however, patients and their legal guardians are ultimately responsible for medical costs. Insurance companies require the hospital to review your insurance card upon each visit. Expenses not covered by insurance providers may include:

  • Elective procedures
  • Exclusions from your regularly insured treatment
  • Deductibles and co-payments

Delinquency policy
Accounts are considered late if no payments are received within 120 days of billing.

Price Estimates

To determine the estimated price for a procedure, you can call our price estimate team at (218) 283-5300.

Legal Info

Non-Discrimination Policy

As a recipient of Federal financial assistance Rainy Lake Medical Center does not exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, disability, or age in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, whether carried out by RLMC directly or through a contractor or any other entity with which RLMC arranges to carry out its programs and activities.

This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Regulations of the U.S. Department of Health and Human Services issued pursuant to these statues at Title 45 Code of Federal Regulations Parts 80, 84, and 91.

Patients’ Bill of Rights

Minnesota Outpatient Surgical Center Patients’ Bill of Rights Minnesota Legislature 2004 Patients and residents of health care facilities; bill of rights.

Legislative intent.

It is the intent of the legislature and the purpose of this section to promote the interests and well being of the patients and residents of health care facilities. No health care facility may require a patient or resident to waive these rights as a condition of admission to the facility. Any guardian or conservator of a patient or resident or, in the absence of a guardian or conservator, an interested person, may seek enforcement of these rights on behalf of a patient or resident. An interested person may also seek enforcement of these rights on behalf of a patient or resident who has a guardian or conservator through administrative agencies or in district court having jurisdiction over guardianships and conservatorships. Pending the outcome of an enforcement proceeding the health care facility may, in good faith, comply with the instructions of a guardian or conservator. It is the intent of this section that every patient’s civil and religious liberties, including the right to independent personal decisions and knowledge of available choices, shall not be infringed and that the facility shall encourage and assist in the fullest possible exercise of these rights.

Definitions

For purposes of subdivisions 4 to 9, 12, 13, 15, 16, and 18 to 20, “patient” also means a person who receives health care services at an outpatient surgical center. Information about rights. Patients shall, at admission, be told that there are legal rights for their protection during their stay at the facility or throughout their course of treatment and maintenance in the community and that these are described in an accompanying written statement of the applicable rights and responsibilities set forth in this section. Reasonable accommodations shall be made for those with communication Impairments and those who speak a language other than English.

Current facility policies, inspection findings of state and local health authorities, and further explanation of the written statement of rights shall be available to patients, their guardians or their chosen representatives upon reasonable request to the administrator or other designated staff person, consistent with chapter 13, the Data Practices Act, and section 626.557, relating to vulnerable adults.

Courteous treatment

Patients have the right to be treated with courtesy and respect for their individuality by employees of or persons providing service in a health care facility.

Appropriate health care

Patients shall have the right to appropriate medical and personal care based on individual needs.

Physician’s identity.

Patients shall have or be given, in writing, the name, business address, telephone number, and specialty, if any, of the physician responsible for coordination of their care. In cases where it is medically inadvisable, as documented by the attending physician in a patient’s care record, the information shall be given to the patient’s guardian or other person designated by the patient as a representative.

Relationship with other health services.

Patients who receive services from an outside provider are entitled, upon request, to be told the identity of the provider. Information shall include the name of the outside provider, the address, and a description of the service which may be rendered. In cases where it is medically inadvisable, as documented by the attending physician in a patient’s care record, the information shall be given to the patient’s guardian or other person designated by the patient as a representative.

Information about treatment.

Patients shall be given by their physicians’ complete and current information concerning their diagnosis, treatment, alternatives, risks, and prognosis as required by the physician’s legal duty to disclose. This information shall be in terms and language the patients can reasonably be expected to understand. Patients may be accompanied by a family member or other chosen representative. This information shall include the likely medical or major psychological results of the treatment and its alternatives. In cases where it is medically inadvisable, as documented by the attending physician in a patient’s medical record, the information shall be given to the patient’s guardian or other person designated by the patient or resident as a representative. Individuals have the right to refuse this information.

Every patient suffering from any form of breast cancer shall be fully informed, prior to or at the time of admission and during her stay, of all alternative effective methods of treatment of which the treating physician is knowledgeable, including surgical, radiological, or chemotherapeutic treatments or combinations of treatments and the risks associated with each of those methods.

Right to refuse care.

Competent patients shall have the right to refuse treatment based on the information required in subdivision 9. In cases where a patient is incapable of understanding the circumstances but has not been adjudicated incompetent, or when legal requirements limit the right to refuse treatment, the conditions and circumstances shall be fully documented by the attending physician in the patient’s medical record.

Experimental research.

Written, informed consent must be obtained prior to a patient’s participation in experimental research. Patients have the right to refuse participation. Both consent and refusal shall be documented in the individual care record.

Treatment privacy.

Patients shall have the right to respectfulness and privacy as it relates to their medical and personal care program. Case discussion, consultation, examination, and treatment are confidential and shall be conducted
discreetly. Privacy shall be respected during toileting, bathing, and other activities of personal hygiene, except as needed for patient safety or assistance.

Confidentiality of records.

Patients shall be assured confidential treatment of their personal and medical records, and may approve or refuse their release to any individual outside the facility. Copies of records and written information from the records shall be made available in accordance with this subdivision and section 144.335. This right does not apply to complaint investigations and inspections by the Department of Health, where required by third party payment contracts, or where otherwise provided by law Responsive service. Patients shall have the right to a prompt and reasonable response to their questions and requests.

Personal privacy.

Patients shall have the right to every consideration of their privacy, individuality, and cultural identity as related to their social, religious, and psychological well-being. Facility staff shall respect the privacy of a resident’s room by knocking on the door and seeking consent before entering, except in an emergency or where clearly inadvisable.

Grievances.

Patients shall be encouraged and assisted, throughout their stay in a facility or their course of treatment, to understand and exercise their rights as patients and citizens. Patients may voice grievances and recommend changes in policies and services to facility staff and others of their choice, free from restraint, interference, coercion, discrimination, or reprisal, including threat of discharge.

Notice of the grievance procedure of the facility or program, as well as addresses and telephone numbers for the Office of Health Facility Complaints and the area nursing home ombudsman pursuant to the Older Americans Act, section 307(a)(12) shall be posted in a conspicuous place.

Compliance by outpatient surgery centers with section 144.691 and compliance by health maintenance organizations with section 62D.11 is deemed to be compliance with the requirement for a written internal grievance procedure.

IF YOU HAVE A COMPLAINT ABOUT THE AGENCY OR PERSON PROVIDING YOU OUTPATIENT SURGICAL SERVICES, YOU MAY CALL, WRITE, OR VISIT THE OFFICE OF HEALTH FACILITY COMPLAINTS, MINNESOTA DEPARTMENT OF HEALTH. YOU MAY ALSO CONTACT THE OMBUDSMAN FOR OLDER MINNESOTANS.

Office of Health Facility Complaints
(651) 215-8713
1-800- 369-7994
Fax: (651) 215-8712

Mailing Address:
Minnesota Department of Health
Office of Health Facility Complaints
85 East Seventh Place, Suite 300
P.O. Box 64970
St. Paul, Minnesota 55164-0970

Office of Ombudsman for Older Minnesotans
(651) 431-2555
1-800-657-3591
Fax: (651) 431-7452

Mailing Address:
Ombudsman for Older Minnesotans
PO Box 64971
St. Paul, MN 55164-0971

Notice of Privacy Practices

Rainy Lake Medical Center

Hospital Campus
1400 Highway 11
International Falls, MN 56649

Clinic Campus
2501 Keenan Drive
International Falls, MN 56649

Original Effective Date: April 14, 2003

Effective Date of Last Revision: April 2013
_________________________________

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.

INTRODUCTION:

At Rainy Lake Medical Center, we are committed to the handling of protected health information about you in a responsible manner. This Notice of Health Information Practices describes the personal information we collect, and how we use or disclose that information. It also describes your rights as they relate to your protected health information. This notice is effective April 14, 2003 and applies to all protected health information. A federal regulation, known as the Health Insurance Portability and
Accountability Act “HIPAA” Privacy Rule requires that we provide detailed notice in writing of our privacy practices. We know that this Notice is long. The HIPAA Privacy Rule requires us to address many specific things in this Notice. If you have questions and would like additional information, you may contact the Rainy Lake Medical Center Privacy Officer at 218-283-5412. Rainy Lake Medical Center reserves the right to make changes to this Notice and to make changes effective for all protected health information we may already have about you. If and when this Notice is changed, we will post copies in prominent locations throughout the facility and at our website www.RainyLakeMedical.com. We will also provide you with a copy of the revised Notice upon a request to our Privacy Officer.

UNDERSTANDING YOUR HEALTH RECORD INFORMATION:

Each time you visit Rainy Lake Medical Center, after signing consent to receive treatment or services, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

Basis for planning your care and treatment
Means of communication among the many health professionals who contribute to your care
Legal document describing the care you received
Means by which you or a third-party payer can verify that services billed were actually provided
Tool in educating health professionals
Source of data for medical research
Source of information for public health officials charged with improving the health of this state or nation
Source of data for our planning and marketing

Tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what is in your record and how your health information is used helps you to: ensure its accuracy; better understand who, what, when, where, and why others may access your health information; and for you to make more informed decisions when authorizing disclosure to others.

YOUR HEALTH INFORMATION RIGHTS:

Although your health record is the physical property of Rainy Lake Medical Center, the information belongs to you. You have the right to request in writing:

The opportunity to inspect and obtain a copy your protected health information with the following exceptions: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, a criminal, or an administrative proceeding; and protected health information that is subject to law that prohibits access to review. You may have a right to have the decision reviewed. Please contact the Privacy Officer if you have questions.
To amend your health care information if you disagree with its content. Any discussion for amendment must be addressed to the Privacy Officer or designee.
To request communications of your health information by alternative means or at alternative locations upon written request to the Privacy Officer.
To obtain an accounting of disclosures of your paper or electronic health information.
To request a restriction on certain uses and disclosures of your information.
To restrict disclosures of PHI to a health plan or a RLMC business associate for payment purposes or to carry out health care operations and when it is not required by law when you pay in full for the item or service provided.
To revoke your authorization to use or disclose healthinformation except to the extent that action has already been taken.

OUR RESPONSIBILITIES:

Rainy Lake Medical Center is required to:

Maintain the privacy of your health information;
Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you;
Notify you if there is a breach of your unsecured protected information that compromises the security or privacy of your unsecured protected information;
Abide by the terms of this notice;
Notify you if we are unable to agree to a requested restriction
Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue using or disclosing your health information after the date on the authorization or after we have received a written revocation of the authorization according to the procedures included in the authorization.

FOR MORE INFORMATION OR TO REPORT A PROBLEM OR COMPLAINT:

If you believe your privacy rights have been violated, you can file a complaint with Rainy Lake Medical Center’s Privacy Officer or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with the Privacy Officer or the Office for Civil Rights.

Contacts:

Rainy Lake Medical Center Privacy Officer, 218-283-5412; or
The Office for Civil Rights address listed below:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue S.W.
Room 509F HHH Building
Washington, D.C. 20201

OUR COMMITMENT TO PROTECTING HEALTH INFORMATION ABOUT YOU:

In this Notice, we describe the ways that we may use or disclose health information about our patients. The HIPAA Privacy Rule requires that we protect the privacy of health information that identifies a patient, or where there is a reasonable basis to believe the information can be used to identify a patient. This information is called “protected health information” or “PHI.” This notice describes your rights as our patient and our obligations regarding the use and disclosure of PHI. We are required by law to:

Maintain the privacy of PHI about you;
Give you this Notice of our legal duties and privacy practices with respect to PHI;
Notify you if there is a breach of your unsecured protected information that compromises the security or privacy of your unsecured protected information
Comply with the terms of our Notice of Privacy Practices that is currently in effect.

HOW WE MAY USE AND DISCLOSURE PROTECTED HEALTH INFORMATION ABOUT YOU:

The following categories describe the different ways we may use and disclose PHI for treatment, payment, or health care operations. The examples included with each category do not list every type of use disclosure that may fall within that category.

Treatment: We are permitted to use and disclose your PHI to doctors, nurses, technicians, medical students or other personnel who are involved in your care or provide you with medical treatment or services at Rainy Lake Medical Center. For example, a doctor treating you in the hospital may need to know if you have diabetes, because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so he or she can arrange for appropriate meals. Different departments of RLMC may also share your PHI in order to coordinate the services such as laboratory tests, x-rays and medications. We also may disclose your PHI to healthcare providers outside RLMC involved in your medical care, such as physicians who provide follow-up care, physical therapy providers, medical equipment suppliers, and skilled nursing facilities.

Payment: We may use and disclose medical information about you so that the treatment and services you receive may be billed to, and payment may be collected from, you, an insurance company, or another third party. For example, we may need to give your health plan information about treatment you received while under our care so your plan will pay us or reimburse you for the treatment. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. We will get your written consent upon admission for treatment which permits us to make such disclosures for payment purposes. Health Care Operations: We may use and disclose medical information about you for Rainy Lake Medical Center health care operations. For example, members of our internal staff such as the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health care record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care services we provide. Written consent is obtained prior to disclosing such information to outside facilities.

Appointment Reminders and Other Health Information: We may use your protected health information to send you reminders or call to remind you about scheduled appointments. We may also call you and leave health related information on your voice mail. If you do not wish to have a voice mail message left for you, you have the right to request in writing how we may communicate with you. Examples of alternatives would be by mail, at work or at home.

Business Associates: There are some services provided in our organization through contracts with business associates. Examples include Rainy Lake Medical Center’s reviewing agencies such as Joint Commission on the Accreditation of Healthcare Services, clearing houses associated with collections of accounts, and consultants. We may disclose your health information to our business associate(s) so that they can perform the job we have contracted them to do. To protect your health information that is disclosed, each business associate is required to sign an agreement to appropriately safeguard the information and to not re-disclose the information unless specifically permitted by law.

Directory: We may include certain limited information about you in our directory while you are a patient. This information may include your name, location in the facility, and your religious affiliation if you provide this information to us. The directory information, except for your religious affiliation and condition, may be released to people who ask for you by name. This is so your family, friends, and clergy can know your location. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don’t ask for you by name. If you prefer that Rainy Lake Medical Center not make these disclosures, please notify the registration clerk at the time of admission for services, or the Privacy Officer.

Notification to People Assisting in Your Care: Rainy Lake Medical Center will only disclose medical information to those taking care of you, helping you pay your bills, or other close family members or friends if these people need to know the information to help you, and then only to the extent permitted by law. We may, for example, provide limited medical information to allow a family member to pick up a prescription for you. Generally, we will get your consent prior to making disclosures about you to family or friends. If you are able to make your own health care decisions, Rainy Lake Medical Center will ask your permission before using your medical information for these purposes. If you are unable to make health care decisions, Rainy Lake Medical Center will disclose relevant medical information to family members or other responsible people if we feel it is in your best interests to do so, including an emergency situation.

Research: Rainy Lake Medical Center does not do research. However, Federal law permits Rainy Lake Medical Center to use and disclose medical information about you for research purposes, either with your specific written authorization or when the study has been reviewed for privacy protection by an Institutional Review Board or Privacy Board before research begins. In some cases, researchers may be permitted to use information in a limited way to determine whether the study or the potential participants are appropriate. Minnesota law requires that we get your general consent before we disclose your health information to an outside researcher. We will make a good faith effort to obtain your consent or refusal to participate in any research study, as required by law, prior to releasing any identifiable information about you to outside researchers.

As Required by Law: We will disclose medical information about you when we are required to do so by federal, state, or local laws.

To Avert a Serious Threat or Health Safety: We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure must be only to someone able to prevent that threat. In addition, Minnesota law generally does not permit these disclosures unless we have your written consent to do so or when the disclosure is specifically required by law, including the limited circumstances in which Rainy Lake Medical Center care professionals have a “duty to warn.”

YOUR MEDICAL INFORMATION MAY BE RELEASED IN THE FOLLOWING SPECIAL SITUATIONS:

Coroners, Medical Examiners and Funeral Directors: We will release medical information to a coroner or medical examiner in the case of certain types of death, and we must disclose health records upon request of the coroner or medical examiner. This may be necessary, for example, to identify you or to determine the cause of death. We may also release the fact of death and certain demographic information about you to funeral directors as necessary to carry out their duties. Other disclosures from your health record will require the consent of the surviving spouse, parent, or a person appointed by you in writing, or your legally authorized representative.

Military and Veterans: If you are a member of the armed forces, we will release medical information about you as requested by military command authorities if we are required to do so by law, or when we have your written consent. We may also release medical information about foreign military personnel to the appropriate foreign military authority as required by law or written consent.

National Security and Intelligence Activities: We will release medical information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities only as required by law or with your written consent.

Protective Services for the President and Others: We will disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state, or conduct special investigations only as required by law or with your written consent.

Organ Procurement Organizations: We may release your medical information to organizations that handle organ procurement or organ, eye or tissue transplantation, or to an organ donation bank, as necessary to facilitate organ or a tissue donation and transplantation. The information that Rainy Lake Medical Center may disclose is limited to the information necessary to make a transplant possible.

Fundraising: Occasionally, Rainy Lake Medical Center may use limited information (your name address, and the dates you were seen for medical services) to let you know about fundraising or other charitable events. You have a right to opt-out of fundraising communications. If you would like to do so, please contact the Rainy Lake Medical Center Privacy Officer.

Marketing: Rainy Lake Medical Center will not participate in marketing efforts in any way without first consulting with you or obtaining your written consent unless the marketing is conducted through a face-to-face communication or involves a gift of nominal value.

Psychotherapy Notes: We will not use or disclose any notes from a mental health professional without your authorization except to carry out certain treatment, payment, or health care operations including allowing the note taker to use them for treatment, using the notes for our training programs, or using the notes in defense of a legal proceeding.

Sale of Protected Information: We will not accept payment of any kind for protected information without your prior authorization. Sale of protected information is prohibited only as it is defined by law and does not include Rainy Lake Medical Center accepting payment for your treatment.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement.

Workers Compensation: We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses. We are permitted to disclose this information to the parties involved in the claim without any specific consent, so long as the information is related to a workers’ compensation claim.
Public Health: We may disclose medical information to public health authorities about you for public health activities. These disclosures generally include the following:

  • Preventing or controlling disease, injury, or disability;
  • Reporting births or deaths;
  • Reporting child abuse or neglect or abuse of a vulnerable adult;
  • Reporting reactions to medications or problems with products;
  • Notifying people of recalls of products that we may be using;
  • Notifying a person who may have been exposed to a disease or may be at the risk for contracting or spreading a disease or condition;
  • Reporting to the Federal Food and Drug Administration as permitted or required by law.

Correctional Institution/Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we will release medical information about you to the correctional institution or law enforcement official only as required by law or with your written consent.

Law Enforcement: We may release medical information if asked to do so by a law enforcement official in response to a valid court order, grand jury subpoena, or warrant, or with your written consent. In addition, we are required to report certain types of wounds, such as gunshot wounds and some burns. In most cases, reports will only include the fact of injury, and any disclosures would require your consent or a court order. We may also release information to law enforcement that is not part of your health record (in other words, non-medical information) for the following reasons:

  • To identify or locate a suspect, fugitive, material witness, or missing person.
  • If you are the victim of a crime and if, under certain limited circumstances, we are unable to obtain your agreement.
  • The information relates to a death we believe may be the result of a criminal conduct.
  • The information relates to criminal conduct at our facility.
  • In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime.

Lawsuits and Disputes: If you are involved in a lawsuit, dispute, or other judicial proceedings, we will disclose medical information about you only in response to a valid court order, administrative order, or a grand jury subpoena, or with your written consent.

Thank you for choosing Rainy Lake Medical Center for your health care services.

REFERENCES:

Federal Register, 45 CFR Parts 160 and 164 – Standards for
Privacy and Individually Identifiable Health Information;
Original and Final Rule
MN Statute 144.335
Field Guide to HIPAA Implementation
American Medical Association – 2002
Dorsey and Whitney, LLPHIPPA Forms and Explanation
In association with SMDC Health System
www.RainyLakeMedical.com

We want your healthcare experience at Rainy Lake Medical Center to be as pleasant as possible. The links on this page were created to provide helpful, easily-accessible information. If you don’t see a resource here, please call Rainy Lake Medical Center at the numbers listed below

Hospital Campus:
1400 Highway 71
International Falls, MN 56649
218-283-4481
24/7 Emergency and Staffed Patient Care

Hospital Urgent Care:

Weekends including Holidays: 10 a.m. – 6 p.m.

Emergency Department: 24/7

RLMC Nurse Line: 1-800-206-6991
Rainy Lake Clinic: (218) 283-5503