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.
Our Privacy Commitment
The protection of the privacy of your health information is important to us. In addition, we are required by law to maintain the confidentiality of your health information and provide you with this Notice of our privacy practices.
How We Use & Disclose Your Health Information
Treatment: Your health information may be used to evaluate your health, diagnose medical conditions, and provide and coordinate quality care. Your health information may be used to remind you of an appointment and obtain information via pre-operative telephone calls. The information in our medical record, such as laboratory tests, X-rays, or prescriptions will be available to other health professionals who may provide treatment or may be consulted by our staff members.
Payment: Your health information may be used by us and other health care professionals involved in your treatment to obtain payment from you, your insurance company, and other sources of coverage or payment. For example, we may contact your insurance company to verify benefit eligibility or to notify them of services to be provided that may require preauthorization.
Health Care Operations: We use health information to evaluate and promote the quality of care and service provided to you and to support regular business activities. For example, we may use health information for evaluating the performance of staff, business planning, and financial management of our company.
In other circumstances we may use or disclose your health information without your authorization are as follows:
Patient Directory: While you are a patient, we will release limited information about you (name, location, room number, general condition, and for clergy only, your religious affiliation) from our patient directory for callers, visitors, and clergy who ask for you by name, unless you opt out or notify us of any restrictions or limitations.
Friends/Family: We may also disclose information to family or other representatives involved in your care or payment for your care, provided you do not object.
Educational: We may send you newsletters or announcements containing information you may find interesting about us or our services.
Public Health: We may use your health information for public health reporting purposes such as reporting communicable and other diseases and injuries permitted by law, reporting child or elder abuse or neglect, reporting work-related illnesses,
Serious Threat to Health or Safety: We may use your health information in order to prevent a serious threat to the health or safety of either the patient themselves or the public.
Governmental & Legal: We may provide your health information to law enforcement agencies to support government audits and inspections to facilitate investigations, health oversight activities, or to comply with government-mandated reporting, court orders, and subpoenas. We may also disclose to authorized federal officials for protection of the U.S. President, foreign heads of state, or other authorized persons, and to conduct special authorized investigations.
Military: We may use or disclose your health information if you are a current or former member of the Armed Forces for activities of military authorities.
National Security: We may provide your health information to the military for specialized government functions such as national security and intelligence activities.
Medical Examiners, Coroners, Funeral Directors: We may provide your health information to medical examiners, coroners, funeral directors, for the purpose of identification, cause of death, and end of life planning.
Organ Donation: We may disclose your health information for the purpose of organ and tissue donations.
Decedent: We are permitted to communicate with friends and family members involved in your care, or payment for care prior to death, unless you’ve previously expressed an objection.
Research: During your stay with us, you may be asked to participate in a research study. Your involvement in the study is completely voluntary. Before you are part of a research study, we will inform you about the study and seek your consent to participate in the study. If the research study involves your treatment, we will ask for your written permission to allow us and the researchers to use and disclose your medical information for the research study. In rare cases, we are allowed by law to use your medical information without your consent as long as a special review board authorizes the research study and ensures your privacy will be protected.
Workers Compensation: We may release your healthcare information that is applicable for workers’ compensation or other similar programs for work-related injuries or illness.
Most uses and disclosures of psychotherapy notes, uses and disclosures of protected health information for marketing purposes, and disclosures that constitute a sale of health information require patient authorization. Use or disclosure of your health information for purposes other than as described in our notice will require your written authorization. You may revoke your authorization at any time, provided it is in writing. However, your decision to revoke the authorization will not affect any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.
Your Individual Rights
Right of Access: You have the right to inspect and receive a paper or electronic copy of your health information that we maintain. For limited reasons as allowed by law, we may deny your access to specific health information, and you may request a review of our denial. As permitted by federal regulation, we require the requests be submitted in writing, addressed to our Health Information Management Department at 1868 Lombardy Drive, Rapid City, South Dakota 57703. You may contact us to obtain a form to request this access. Reasonable cost based fees for reproduction and mailing expenses may apply.
Right to Receive Confidential Communication: You have the right to receive confidential communications concerning your medical condition and treatment. For example, you may request we contact you only at a specific phone number or address. We will consider all reasonable requests.
Right to Request Restrictions: You have the right to request restrictions in writing on the use and disclosure of your protected health information to specific family/friends, and restrict visitors and/or telephone calls. We will consider all reasonable requests.
Right to Restrict Health Plan Disclosures: You have the right to restrict certain disclosures of your health information to health plans/insurance companies if you have paid out of pocket in full for the health care services provided by our facilities.
Right to Receive Accounting of Disclosures: You have the right to receive accounting of certain disclosures of your health information during a specified period of up to six years. The accounting does not include disclosures made for treatment, payment, health care operations, disclosures required by law and other disclosures as referenced in this Notice. The first request in a 12-month period is free, but we may charge you for our reasonable costs for additional requests in the same 12-month period.
Right to Request to Amend: You have the right to request to amend or submit corrections to your health information provided the request is in writing and you give us the reason for the request. We may deny your request in certain circumstances, such as when we believe the information is already accurate and complete. An amendment cannot change what is already part of the record, but instead will be an addition to the existing record.
Right to Receive a Copy of this Notice: You have the right to receive a paper copy of this Notice of Privacy Practice upon request, even if you previously agreed to receive it electronically.
Our Privacy Duties
Federal regulations require that we protect the privacy of protected health information, that we provide our patients with notice of our legal duties and privacy practices with respect to PHI, and to notify affected individuals following a breach of unsecured protected health information. We also are required to abide by the terms of our Notice of Privacy Practices that is currently in effect.
As permitted by law, we reserve the right to amend or modify our privacy practices. These changes may be a result of changes in federal or state laws and regulations. Current Notices will be posted in our facilities and on our website, www.bhsh.com. Upon request, we will provide you with a copy of the Notice.
Questions and Complaints
If you would like further information concerning our privacy practices or believe your privacy rights have been violated, you should contact us using the following address or telephone number:
Black Hills Surgical Hospital, LLP
1868 Lombardy Drive
Rapid City, SD 57703
Telephone: (605) 721-4700
Toll Free: (800) 818-1890
You will not be penalized or otherwise retaliated against for filing a complaint. You may also file a complaint with the Secretary of the Department of Health and Human Services.
Call or Walk-in 7-days a week.
Mon-Fri: 7AM to 7PM, Sat-Sun: 8AM-6PM
741 Mountain View Rd #1 Rapid City - 605-791-7777
120 E. Michigan St. Spearfish - 605-722-7777
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