Residential and Outpatient Handbook - Plymouth - 50

Ensuring Your Rights
services are most appropriate for you and will make it
difficult for us to carry out an effective treatment plan
for you and/or your family members.
How can I verify and contest the
accuracy of written information
about myself?
Submit a written request to us describing the nature of
your disagreement to the following address:
Hazelden Betty Ford
Attn: Medical Records
15251 Pleasant Valley Rd, P.O. Box 11
Center City, MN 55012-0011
DAANES Notification of Data
Collection (for Substance Use
Disorder Treatment Services)
This program will be collecting and disclosing the
statistical information specified below to the Minnesota
Department of Human Services (DHS) as required by
Minnesota Statute § 254A.03, sudb. 1(d) and Title 42
Parts 2.52 and 2.53 of the Code of Federal Regulations.
The information includes age, race, sex, living
arrangement, education, occupation, previous
treatment, substance use, legal status, and referral
information and for publicly funded patients,
and Minnesota health care programs placement
information. None of the forms will have your name
on them; a confidential code will be used.
This information will be used by DHS for internal
research, program evaluation, and auditing purposes
only. Federal confidentiality regulations (42 C.F.R. Part
2) prohibit the disclosure of patient data obtained in
the course of these data collection efforts for purposes
other than the original purposes for which it was
intended. Unless otherwise allowed or required by law,
no identifying information about you will be released
without your express written authorization.
If you have any questions about this notice you may
contact DHS at (651) 431-2470. This document is a copy
of this notice for you to keep.
Minnesota Government Data
Practices Act (Minnesota Outpatient
Mental Health Services Only)
Minnesota Government Data Practices Act (MGDPA),
Minn. Stat. § 13, is a state law that controls how
government data are collected, created, stored
(maintained), used and released (disseminated). The
MGDPA sets out certain requirements relating to the
right of the public to access government data and the
rights of individuals who are the subjects of government
data. It is a requirement that any patient participating
in licensed Outpatient Mental Health Services (e.g. 245I
Mental Health Clinic) ) receives information related to
the Minnesota Data Practices Act. This document is
your copy to keep.
Briefly, the MGDPA regulates:
* What information can be collected
* Who may see or have the information
* Classification of specific types of government data
* Duties of government personnel in administering the
provisions of the MGDPA
* Procedures for access to the information
* Procedures for classifying information
* Civil penalties for violation of the MGDPA
* Charging fees for copies of government data
The full text of Minn. Stat. § 13, and Minn. R. 1205, the
Rules Governing Data Practices as promulgated by the
Minnesota Department of Administration, can be found
online.
Patient Health Information/Records
In the course of providing service to you, Hazelden
Betty Ford collects and uses pertinent health
information and stores it in a secure medical record,
which is the property of Hazelden Betty Ford. Hazelden
Betty Ford complies with applicable state and federal
laws that govern medical record practices. Significant
laws are: 42 CFR Part 2, a federal regulation protecting
the confidentiality of alcohol and drug treatment
records; and HIPAA, a federal standard on privacy
of protected health information called the Health
Insurance Portability and Accountability Act.
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Residential and Outpatient Handbook - Plymouth

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