Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice describes how we will use and disclose your health information. The terms of this Notice apply to all health information generated or received by Stellher Human Services, Inc., whether recorded in your medical record, billing invoices, paper forms, video, or in other ways.

Get a copy of your medical record

You can ask to see or get a paper or electronic copy of your medical record and other health information we have about you. We will provide a copy or summary to you usually within 30 days of your request. We may charge a reasonable, cost-based fee. Access may be denied in some circumstances, such as to psychotherapy notes or when a certain law prohibits your access. In some circumstance you may have this decision reviewed.

Ask us to correct your medical records

Request confidential communications

Ask us to limit what we use or share

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior, who we’ve shared it with, and why. We will include all disclosures except for those about your treatment, payment, and our health care operations, and certain other disclosures (such as those you asked us to make). We will provide one accounting a year for free, but we will charge a reasonable cost-based fee if you ask for another within 12 months.

Get a copy of this privacy notice

Choose someone to act for you

File a complaint if you feel your rights are violated

Privacy Official
Stellher Human Services
P.O. Box 430
Bemidji, MN 56619
Phone: 218-444-2845
Office of Civil Rights
U.S. Department of Health and Human Services
200 Independence Ave, S.W.
Washington, D.C. 20201
Toll Free: 1-877-696-6775
www.hhs.gov/ocr/privacy/hipaa/complaints/

Your Choice

For certain health information, you can tell us your choices about what we share. If you have a clear preference of how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, you have both the right and choice to tell us to:

Share information with your family, close friends, or other involved in your care
Share information in a disaster relief situation

In these cases, we never share your information unless you give us written permission:

Marketing purposes
Sales of your information
Most sharing of psychotherapy notes

Our Uses and Disclosures

We typically use or share your health information in the following ways.

Treat You: We can use your health information and share it with other professionals who are treating you.
- Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization: We can use and share your health information to run our practice, improve your care, and contact you when necessary.
- Example: We use health information about you to manage your treatment and services.
Bill for your services: We can use and share your health information to bill and get payment from health plans or other entities.
- Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information? We are allowed or required to share your information in other ways-usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumer/index.html.

Help with public health and safety issues

Do Research

Comply with the law

Respond to organ and tissue donation requests

Work with a medical examiner

Address workers’ compensation, and other government requests

Respond to lawsuits and legal actions

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Visit HHS.gov for more information

Changes to the Terms of This Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

Stellher Human Services, Inc. works in partnership with school districts, counties and collaboratives to provide an array of services to children, families and adults. Some of the services include:

Children’s Therapeutic Services and Supports
Outpatient mental health services
Home-based mental health services
Truancy prevention and intervention
School-based intervention services

This notice is effective 12/20/03
Revised 9/20/18