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Notice of Privacy Practices

As we care about your health and wellness, we also protect your medical information. Notice of Privacy Practice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Tranquil Living by Acute Home Health Care of MN is committed to maintain your privacy right as a consumer. This Notice of Privacy Practice will tell you what information we collect, how we protect Private health Information, and what your rights are.

Tranquil Living by Acute Home Health Care of MN pledges to protect your medical information in accordance with the Health Insurance Portability and Accountability Act of 1996. Under Minnesota Statue §144.335 (access of health records law), subd. 3(a) established that :

"a provider or person who receives health records from a provider, may not release a patient's health record to a person without signed and dated consent from the patient or the patient's legally authorized representative authorizing the release, unless the release is specifically authorized by law."

What is Private Health Information?

Means information about your past or your present health status, condition, diagnosis, treatment, prognosis, personal information such as your name, date of birth, address, health insurance information such as ID number. This information is protected by policies and procedures that restrict the access and use of any identifiable data.

How do we use and disclose your Health Information?

Means information about your past or your present health status, condition, diagnosis, treatment, prognosis, personal information such as your name, date of birth, address, health insurance information such as ID number. This information is protected by policies and procedures that restrict the access and use of any identifiable data.

Acknowledgement of Receipt of Notice of Privacy Practices

I certify that I have received a Notice of Privacy Practices. The Notice of Privacy Practices describes the types of uses and disclosures of my protected health information that might occur in my treatment, payment or in the performance of Tranquil Living by Acute Home Health Care of MN's health care operations. The Notice of Privacy Practices also described my rights and Tranquil Living by Acute Home Health Care of MN's duties with respect to protect my health information. The Notice of Privacy Practices is placed in my file and also posted at my place. Tranquil Living by Acute Home Health Care of MN reserves the right to change the privacy practices that are described in the Notice of Privacy Practices. I may obtain a revised Notice of Privacy Practices by calling the office and requesting a revised copy be sent in the mail or asking for one at the time of my next appointment.

Patient or Representative's Name
Patient/Representative's Signature
date:
Agency Representative's Name
Agency Representative's Signature
date: