If you want to file a concern or complaint about Immanuel St. Joseph's �

Mayo Health System�s use or disclosure of protected health information,

you can provide the written complaint or concern to the:

Immanuel St. Joseph's � Mayo Health System

1025 Marsh St

P O Box 8673

Mankato, MN 56002-8673

Springfield Medical Center�MHS

625 North Jackson Avenue

Springfield, MN 56087

Waseca Medical Center-Mayo Health System

501 North State St

Waseca, MN 56093

or the Department of Health and Human Services � Office for Civil

Rights.

Immanuel St. Joseph's � Mayo Health System honors your right to file a

concern or complaint. Immanuel St. Joseph's � Mayo Health System

would not � nor could it legally or ethically - take action against you for

filing a concern or complaint. Immanuel St. Joseph's � Mayo Health

System reserves the right, however, to take necessary and appropriate

action to maintain an environment that serves the best interests of its

patients and providers.

� The effective date of this notice is April 14, 2003.

� Additional paper copies of this notice will be provided upon request.

� Immanuel St. Joseph's � Mayo Health System reserves the right to

change the terms of this notice in accordance with the HIPAA rules or

other laws or Immanuel St. Joseph's � Mayo Health System�s policies

and make the new notice provisions effective for all protected health

information maintained by Immanuel St. Joseph's � Mayo Health

System. Immanuel St. Joseph's � Mayo Health System will follow the

terms and conditions of the Notice that is currently in effect.

� When the notice is revised, it will be available upon request at

Immanuel St. Joseph's � Mayo Health System facilities, at

www.isj-mhs.org, or by mail. It will also be posted at Immanuel St.

Joseph's � Mayo Health System�s locations.

Authorization is your signed, written permission, specific to a narrow,

defined purpose � such as for a medical research authorization.You may

be asked to sign the same authorization form each year, if required by

state law.You may revoke your authorization in writing at any time.

Health Insurance Portability and Accountability Act (HIPAA) is federal law

designed to protect patient�s medical information. Health�care organizations

in the United States need to fully comply with HIPAA regulations

by April 14, 2003.

Protected health information means any information whether oral, electronic,

or paper, which is created or received by Immanuel St. Joseph's �

Mayo Health System and relates to a patient�s health care or payment for

provision of heath care.

MC5256-xx

This notice applies to the following entities which are collectively referenced

as Immanuel St. Joseph's � Mayo Health System:

Immanuel St. Joseph�s Hospital, ISJ Clinic, NorthRidge Clinic, Madelia

Clinic, Parkview Medical Clinic, St. Peter Clinic, LeSueur Clinic, ISJ Home

Care & Hospice, ISJ Home Medical Equipment Services;

Waseca Medical Center � Mayo Health System:

Waseca Hospital,Waseca Clinic, Janesville Clinic,Waterville Clinic;

Springfield Medical Center � Mayo Health System:

Springfield Hospital, Springfield Clinic, Lamberton Clinic.

To provide appropriate and consistent care, it is often necessary to share

your information within related organizations. These include: Mayo Clinic

Rochester, Saint Mary�s Hospital, Rochester Methodist Hospital, and

other Mayo Health System Facilities.

By law, Immanuel St. Joseph's � Mayo Health System must keep protected

health information private. The federal government defines protected

health information as any information, whether oral, electronic or

paper, which is created or received by Immanuel St. Joseph's � Mayo

Health System and relates to a patient�s health care or payment for the

provision of health care. This includes the results of tests and notes written

by doctor and nurses, as well as your name, address and telephone

number.

Immanuel St. Joseph's � Mayo Health System will follow the rules of its

privacy notice currently in effect.

� Immanuel St. Joseph's � Mayo Health System makes every effort to

maintain the confidentiality of medical information.

� Immanuel St. Joseph's � Mayo Health System takes necessary precautions

against inappropriate use or disclosure of medical information.

Federal and state law require Immanuel St. Joseph's � Mayo Health

System to protect your medical information, and federal law requires

Immanuel St. Joseph's � Mayo Health System to describe to you how

we handle that information. When state and federal privacy laws differ,

and Minnesota law is more protective of your information or provides

you with greater access to your information, then state law will override

federal law.

This section describes the most common uses of protected health information.

These apply to virtually all Immanuel St. Joseph's � Mayo

Health System patients.

There are common ways Immanuel St. Joseph's � Mayo Health System

will use medical information: They include treatment, billing and healthcare

operations. Immanuel St. Joseph's � Mayo Health System may also

release information, where appropriate, to other related Mayo Foundation

entities.

"Protected health information"means any information, whether oral,

electronic or paper, which is created or received by Immanuel St. Joseph's

� Mayo Health System and relates to a patient�s health care or payment

for the provision of health care. This includes not only the results of tests

and notes written by doctors and nurses, but also certain demographic

information (such as your name, address and telephone number) that is

related to your health records.

Immanuel St. Joseph's � Mayo Health System will use and disclose protected

health information to provide, coordinate or manage your care.

This includes communication and consultation between health-care

providers � doctors, nurses, technicians and other members of your medical

team. For example, following orthopedic surgery, your doctor may

refer you for rehabilitation. Information will be shared to ensure continuity

of care.

Minnesota law requires Immanuel St. Joseph's � Mayo Health System to

obtain your written consent to disclose your medical information outside

of Immanuel St. Joseph's � Mayo Health System or related entities for

treatment.You would not need to provide consent in cases of medical

emergency, within related health care entities when necessary for current

treatment, or to third parties who requested or paid for independent

medical exams.

Immanuel St. Joseph's � Mayo Health System uses protected health

information to create bills and collect from insurance companies,

Medicare and other payers. This includes providing information such as

dates of service, symptoms and diagnosis to your insurance company to

show that Immanuel St. Joseph's � Mayo Health System provided medical

services to you.

Minnesota law requires your written consent to disclose information outside

of Immanuel St. Joseph's � Mayo Health System for payment. This

consent will continue to be collected at registration.

Immanuel St. Joseph's � Mayo Health System uses protected health

information for internal activities to monitor and improve patient care,

license staff to care for patients, prepare for state and federal regulatory

reviews, manage health-care operations and improve health-care services.

Here are some examples:

� To reduce the infection rate after a surgery, it would be necessary to

look at medical records to determine the rate of infections that occurred.

� To be licensed to do a certain procedure, a doctor may be required to

show that he or she has successfully completed a number of procedures

under the supervision of another physician.

� A federal Drug Administration inspector may review patient records in

a laboratory to ensure that accurate and complete records are maintained

for patient safety.

Minnesota law requires specific written consent to disclose information

for health-care operations to others outside Immanuel St. Joseph's �

Mayo Health System. This includes things like sharing information with

your insurance company for billing.

At times, Immanuel St. Joseph's � Mayo Health System accesses information,

such as name, address and general medical condition, to contact

you to:

� Provide appointment reminders

� Provide information about treatment alternatives or other information

that may be of interest to you

� Disclose health-related benefits or services that may be of interest to

you

Immanuel St. Joseph's � Mayo Health System may contact you to raise

funds to sustain the Immanuel St. Joseph's � Mayo Health System mission.

When conducting fundraising activities, Immanuel St. Joseph's �

Mayo Health System may access only your basic demographic information

(such as name and address) and the dates you were treated at

Immanuel St. Joseph's � Mayo Health System.You may receive letters or

other publications asking you to consider making a tax-deductible contribution

to Immanuel St. Joseph's � Mayo Health System.

Immanuel St. Joseph's � Mayo Health System does not engage in telephone

solicitations, nor does Immanuel St. Joseph's � Mayo Health

System sell or rent patient�s names or address to any organization outside

Immanuel St. Joseph's � Mayo Health System.

Immanuel St. Joseph's � Mayo Health System will use your name, location

in the facility, condition (in general terms, such as "good","fair") and

religion affiliation (should you choose to provide one) in current patient

lists. For example, a relative may wish to visit you in the hospital and

would need to know your hospital room number. A family member

meeting you for an appointment may have forgotten which floor your

appointment is on.You can choose to be excluded from these lists.

This information is only shared with those asking about you by name or

with members of the clergy. Clergy members will also receive information

about your religious affiliation if it is known.

Under federal regulations, Immanuel St. Joseph's � Mayo Health System

may disclose relevant protected health information to a family member or

friend involved with your care, or handling your bills. If family or friends

are present while care is being provided, Immanuel St. Joseph's � Mayo

Health System will assume your companions may hear the discussion,

unless you state otherwise. Federal regulations allow Immanuel St.

Joseph's � Mayo Health System to share limited protected health information

to notify a family member or legal representative of your location,

condition or death.

Minnesota law requires your written consent to share health information

in most situations to family members or friends except in the case of

emergency.

Medical research is vital to the advancement of medical science. Federal

regulations permit use of protected health information in medical

research, with either your authorization or when the research study at

Immanuel St. Joseph's � Mayo Health System is reviewed and approved

by an Institutional Review Board before any medical research study

begins. In some situations, limited information may be used before

approval of the research study to allow a researcher to determine whether

enough patients exist to make a study scientifically valid.

Minnesota law generally requires a written consent before Immanuel St.

Joseph's � Mayo Health System can disclose any medical information

about you for medical research to an outside researcher. Immanuel St.

Joseph's � Mayo Health System will obtain your consent or refusal to

participate in any research study, or will make a good faith effort to

obtain your consent or refusal, before releasing any identifiable information

about you for research purposes.

This section outlines less common circumstances that apply to some

patients. Federal and/or state law requires or permits Immanuel St.

Joseph's � Mayo Health System to provide protected health information

outside the organization in the following situations:

Immanuel St. Joseph's � Mayo Health System uses and discloses protected

health information to alert those able to lessen or prevent the

threat of a serious threat to the health or safety of a patient, another person

or the public.

Minnesota law allows disclosures under limited circumstances in which

Immanuel St. Joseph's � Mayo Health System professionals have a

"duty to warn".

If Immanuel St. Joseph's � Mayo Health System professionals determine

that a patient might be a candidate for organ or tissue donation,

Immanuel St. Joseph's � Mayo Health System may release protected

health information to organizations that handle organ procurement, or

organ, eye, tissue donation banks, or other healthcare organizations as

needed to make organ or tissue donation and transplantation possible.

Under federal regulations, if a patient is a member of the United States

Armed Forces, Immanuel St. Joseph's � Mayo Health System is permitted

to release protected health information as required by military

authorities. Immanuel St. Joseph's � Mayo Health System also may

release protected health information about foreign military personnel to

the appropriate foreign military authority. When the military organization

is sponsoring the medical evaluation, the patient�s medical information is

shared with both the patient and the sponsoring organization. Patients

being evaluated on behalf of the military are aware of these arrangements.

Minnesota law generally requires your consent in order to make such disclosures

unless another federal law requires the disclosure.

If you are seen for a worker�s compensation claim, federal rules permit

the release of information related to your claim, as permitted or required

by state law.

Minnesota law permits disclosure of information related to a worker�s

compensation claim without consent to those parties that are involved in

the claim.

Immanuel St. Joseph's � Mayo Health System may disclose protected

health information for public health purposes. The following are some

examples of releases that are allowed for public health purposes:

� To prevent or control disease or injury

� To report births and deaths

� To report maltreatment of a child or vulnerable adult

� To report to the federal government adverse reactions to medication or

safety problems with FDA-regulated products

� To notify people of product recalls

� To notify a person exposed to certain types of disease of those at risk

for contracting or spreading a disease

� To report vital statistics

Minnesota law requires reporting suspected cases of, carriers of or deaths

from specific diseases to appropriate government agencies. This includes

reporting unusual or unexpected cases caused by infectious agents; diseases

acquired outside of the United States and considered rare; noncompliance

with treatment for tuberculosis or other infectious diseases;

sexually transmitted diseases; and certain newborn metabolic diseases.

Immanuel St. Joseph's � Mayo Health System must disclose protected

health information to health-care oversight agencies, where required by

law. Oversight activities can include licensure, accreditation, audits and

investigations. It is standard practice for regulatory agencies such as the

Joint Commission on Accreditation of Healthcare Organizations to review

a sample of medical records to assure the quality of care provided.

Minnesota law requires that patient�identifying information be removed

from most disclosures for health oversight activities, unless you have provided

written consent for access to your protected health information.

Immanuel St. Joseph's � Mayo Health System must disclose protected

health information in response to a valid court or administrative order.

Minnesota law permits disclosures in response to a valid Minnesota court

order, but requires written consent from the patient to release information

in response to court orders from other states, subpoenas (except

grand jury subpoenas) and discovery requests. In these cases, if the

patient does not consent to the release, Immanuel St. Joseph's � Mayo

Health System will not release the information unless the person

requesting the information provides a court order that is valid in

Minnesota.

Immanuel St. Joseph's � Mayo Health System may disclose protected

health information to law enforcement officials:

� In response to a court order or valid warrant

� To identify a suspect, fugitive or missing person

� About the victim of a crime under certain limited circumstances

� About a death believed to be a result of criminal circumstances

� About a crime committed on Immanuel St. Joseph's � Mayo Health

System premises

� In emergency circumstances when necessary to maintain safety and

security of Immanuel St. Joseph's � Mayo Health System personnel and

patients

Minnesota law generally does not allow the release of information from

the health record without a valid court order or warrant. Minnesota

allows the release of information to law enforcement in limited situations

when a serious, specific threat of harm has been communicated to certain

types of health care professions. Immanuel St. Joseph's � Mayo Health

System may disclose information that is not in the health record when a

crime has occurred on Immanuel St. Joseph's � Mayo Health System

property or in certain types of emergencies. In addition, health professionals

must report certain types of wounds, such as gunshots and burns.

In most cases, reports will include only the fact of injury, but additional

disclosures would require patient consent or a court order.

Immanuel St. Joseph's � Mayo Health System may release protected

health information to a coroner or medical examiner when necessary to

identify the deceased or determine the cause of death, or as otherwise

authorized by law. Release of information to a funeral director may occur

when necessary to handle arrangements after death.

Minnesota law requires written authorization signed by a family or legal

representative to release medical information to funeral directors.

Minnesota law requires reports of certain types of deaths to a coroner or

medial examiner and in those cases must disclose health records upon

the request of the coroner or medical examiner. Funeral directors are

required to collect fact of death and certain demographic information.

Immanuel St. Joseph's � Mayo Health System will disclose this information

to those in charge or the disposition of a body. Any additional disclosures

from the health record will require consent from a surviving spouse,

parent, person appointed by the patient in writing, or the patient�s legally

authorized representative.

Immanuel St. Joseph's � Mayo Health System may release protected

health information to authorized federal officials for intelligence, counterintelligence

or other national security activities authorized by law.

Immanuel St. Joseph's � Mayo Health System may disclose protected

health information to authorized federal officials so they may provide

protection to the President or other authorized individuals.

Minnesota law generally does not permit this type of disclosure without

written consent, or unless otherwise required by federal law.

You have a right to inspect and to request a copy of information maintained

in Immanuel St. Joseph's � Mayo Health System�s record about

you. This includes medical and billing records maintained and used by

Immanuel St. Joseph's � Mayo Health System to make decisions about

your care. In certain situations, where providing access may be detrimental

to your health, Immanuel St. Joseph's � Mayo Health System is permitted

by state and federal law to withhold access.

To obtain or inspect a copy of your medical information, submit a written

authorization to the Designated Privacy Officer at the appropriate site of

Immanuel St. Joseph's � Mayo Health System. Immanuel St. Joseph's �

Mayo Health System may charge reasonable, cost-based fees to cover the

expense of providing the copies.

Most patients have full access to inspect and receive a copy of the full

medical record. On rare occasions, Immanuel St. Joseph's � Mayo

Health System may deny a request to inspect and receive a copy of some

information in the medical record. This may occur if in the professional

judgment of your physician, the information could cause a threat to you

or others. In these cases, Immanuel St. Joseph's � Mayo Health System

may supply the information to an appropriate third party who may then

release the information to the patient.

If you are denied access to information, you may request a review of the

denial. Another licensed health-care professional who was not involved

in the original decision within Immanuel St. Joseph's � Mayo Health

System will independently review both the original request and denial.

Immanuel St. Joseph's � Mayo Health System will comply with the outcome

of the independent review. Contact the Privacy Officer at the

appropriate site of Immanuel St. Joseph's � Mayo Health System.

You have the right to request that protected health information in

Immanuel St. Joseph's � Mayo Health System record be amended. To

request an amendment, submit a written request to the Privacy Officer at

the appropriated site of Immanuel St. Joseph's � Mayo Health System.

The request must include a reason to support the amendment. Immanuel

St. Joseph's � Mayo Health System may deny a request for amendment

based upon any of the following circumstances:

� The request is not in writing or does not include a supporting reason

� The information you want to change was not created by Immanuel St.

Joseph's � Mayo Health System, and the originator of the information is

available to make the amendment

� The information is not part of the designated medical record

� The information in the record is accurate and complete

If Immanuel St. Joseph's � Mayo Health System denies your request for

an amendment, Immanuel St. Joseph's � Mayo Health System will give

you a written explanation of the denial. If you still disagree with the

explanation provided, you can submit your written disagreement to the

privacy officer at the appropriate site of Immanuel St. Joseph's � Mayo

Health System, or you can ask that your request for amendment and

explanation of denial be included in any future disclosure of the pertinent

protected health information. If you submit a statement of disagreement,

Immanuel St. Joseph's � Mayo Health System may write a rebuttal to

your statement of disagreement that will be included in your record.

You can ask Immanuel St. Joseph's � Mayo Health System for a list of

where Immanuel St. Joseph's � Mayo Health System has shared your

protected health information. This list would provide you with a summary

of all disclosures Immanuel St. Joseph's � Mayo Health System has

made that you would not otherwise expect or know about. The list would

not include any of the following disclosures:

� for treatment, payment, and health-care operations

� made directly to you (the patient)

� that you have specifically authorized

� provided from facility directories

� made for national security or intelligence purposes

� made to correctional institutions or law enforcement having custody of

the patient

� that took place before April 14, 2003

To get a copy of the list, submit a written request to the Privacy Officer at

the appropriate site of Immanuel St. Joseph's � Mayo Health System.

Your request must include a start date and an end date (beginning no

earlier than April 14, 2003 when the rules go into effect and cannot be

longer than six years). The first list within a 12-month period is free. For

more lists, Immanuel St. Joseph's � Mayo Health System may charge for

the cost of providing the list.

You can ask Immanuel St. Joseph's � Mayo Health System to restrict the

use or disclosure of protected health information about you.Your request

must be in writing and submitted to the Privacy Officer at the appropriate

site of Immanuel St. Joseph's � Mayo Health System.

Immanuel St. Joseph's � Mayo Health System will carefully consider all

requests. However, because of the integrated nature of Immanuel St.

Joseph's � Mayo Health System�s medical record, Immanuel St. Joseph's

� Mayo Health System is not generally able to honor most requests, nor

is Immanuel St. Joseph's � Mayo Health System legally required to do

so.

You have a right to request that Immanuel St. Joseph's � Mayo Health

System communicate with you in various ways (such as a letter or phone)

or at a certain location. For example, you may ask that contact occur only

at home or only at your place of business. In this situation, you may submit

a written request to the Privacy Officer at the appropriate site of

Immanuel St. Joseph's � Mayo Health System specifying the communication

method or alternate location being requested.

Immanuel St. Joseph's � Mayo Health System will accommodate reasonable

requests. However, if the request could result in Immanuel St.

Joseph's � Mayo Health System not being able to collect for services,

Immanuel St. Joseph's � Mayo Health System reserves the right to

require you to provide additional information about how payment for

services will be handled.

Except as described above or specifically required or permitted by law,

Immanuel St. Joseph's � Mayo Health System will not use or disclose

your protected information without a specific authorization from you. At

times, we may ask you to provide a specific written permission to allow

Immanuel St. Joseph's � Mayo Health System to use or disclose medical

information about you.

� An authorization is your signed, written permission to release medical

information.You may ask to sign the same authorization form periodically

as required by state or federal law.

� An authorization may be revoked in writing at any time. Written revocation

of authorization must be submitted to the Privacy Officer at the

appropriate site of Immanuel St. Joseph's � Mayo Health System.