Cook Hospital and Care Center Notice of Health Information Practices

This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Health Information Rights

Although your health record is the physical property of the healthcare facility that compiled it, the information belongs to you. You have the right to:

  • request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522
  • obtain a paper copy of the notice of information practices upon request
  • inspect and copy your health record as provided for in 45 CFR 164.524
  • amend your health record as provided in 45CFR 164.528
  • obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528
  • request communications of your health information by alternative means or at alternative locations
  • revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Our Responsibilities

  • This organization is required to:
  • maintain the privacy of your health information
  • provide you with a notice describing our privacy practices and legal responsibilities with respect to information we collect and maintain about you
  • 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 of at alternative location.

We reserve the right to change our practices and to make new provisions effective for all protected health information we maintain. The most current copy of the Notice will be posted and made available for distribution.

We will not use or disclose your health information without your authorization, except as described in this notice.

For more information or to report a problem

If you have questions and would like additional information, you may contact the Director of Health Information at 218-666-6206.

If you believe your privacy rights have been violated, you can file a complaint with the Director of Health Information or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

Examples of Disclosures for Treatment, Payment and Healthcare Operations

We will use your health information for treatment. For example: All information obtained by a nurse, physician or other member of the healthcare team will be recorded in your record and used to communicate with other members of the healthcare team involved in your care.

We will use your health information for payment. For example: A bill may be sent to you or a third party payer. The information on the bill includes information that identifies you and diagnosis and procedure information.

We will use your health information for regular healthcare operations. Your health information will be reviewed by medical staff and other professionals in an effort to continually improve the quality and effectiveness of healthcare and service we provide. Storing the information involves entering some of the data into databases as well as filing and storing the paper documents in your chart. These functions may be handled by a number of different employees.

Business Associates: There are some services provided in our organization through agreements with business associates. Examples of some of our business associates are computer system vendors and collection agencies. In order for them to perform the work we have asked them to do, we may need to disclose some health information. We require business associates to safeguard information in the same manner we do.

Directory: Unless you notify us that you object, we will use your name, location in the facility, general condition, and religious affiliation for directory information. This information may be provided to clergy and, except for religious affiliation, to other people who ask for you by name.

Notification: We may use of disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.

Communication with family: Health Professionals, using their best judgement, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.

Funeral directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties. Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Appointment Reminders: We may contact you to remind you of an appointment.

Fundraising: We may contact you as a part of a fund raising effort.

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 disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.

Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.

Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a court order.

Federal Law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

Effective Date: 11/01/02
Revised: 1/29/03