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Tsab Ntawv Qhia Txog Kev<br />
Siv Cov Ntaub Ntawv Vas<br />
Tsis Pub Lwm Tus Paub Txog<br />
(Joint Notice of Privacy Practices)<br />
Tsab cai uas hu ua (<strong>Health</strong> Insurance Portability and<br />
Accountability Act (HIPAA) no nws muaj ntau txoj cai uas<br />
cov chaw kho mob (health care providers) yuav tsum tau<br />
ua raws. Cov cai tshiab no yog tsim los ntawm tseem<br />
fwv Asmesliskas kom koj to taub txog seb kev siv koj<br />
cov ntaub ntawv (medical information) ntawd siv li cas<br />
tiag. Raws li txoj cai, peb yuav tsum tau muab cov ntsiab<br />
lus uas nyob rau hauv phau ntawv nov, uas qhia txog<br />
seb <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> siv thiab qhia tawm koj<br />
cov ntaub ntawv kho mob li cas, tawm rau sawv daws.<br />
Cov ntsiab lus hauv nov yog qhia seb lub <strong>Mayo</strong> <strong>Clinic</strong><br />
<strong>Health</strong> <strong>System</strong> siv thiab muab nej cov (medical record)<br />
qhia tawm sab nraud li cas. Cov cai nov yog ua rau txhua<br />
txhua lub chaw kho mob uas nyob rau hauv teb chaws<br />
Asmesliskas nov uas siv computer sib xa cov lus.
Hom phiaj<br />
Hom phiaj ntawm phau ntawv nov yog:<br />
• Qhia rau koj paub txog seb peb siv los yog peb muab koj cov (protected health<br />
information) tawm sab nraud li cas. Protected <strong>Health</strong> Information (PHI) yog txhua<br />
txhua yam txog ntawm koj tus kheej (demographic) tsis hais yog tej lus hais, tej<br />
ntaub ntawv uas tsim tawm los yog tau txais los ntawm tej chaw kho mob uas<br />
piav txog kev kho koj tus mob, los yog kev them tej nuj nqi txog ntawm kev kho<br />
koj tus mob. Cov nov yog tag nrho koj lub npe, chaw nyob, xov tooj los mus rau tej<br />
ntaub ntawv (result) uas lawv kuaj koj thiab tej nyuag ntaub natwv uas cov kws<br />
kho mob los yog chaw kho mob sau tej ntawd tib si.<br />
• Qhia txog koj cov cai nyob rau hauv cov ntaub ntawv no thiab qhia txog tias <strong>Mayo</strong><br />
<strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav teb nej cov lus li cas thaum nej muaj lus nug.<br />
TSAB NTAWV NO QHIA TXOG PEB KEV SIV THIAB KEV MUAB KOJ COV<br />
NTAUB NTAWV TAWM SAB NRAUD, THIAB KOJ TXOJ KEV UAS YUAV<br />
MUAB TAU COV NTAUB NTAWV NO. KOJ YUAV TSUM TAU SAIB TSAB<br />
NTAWV NO KOM ZOO ZOO.<br />
2<br />
Daim Ntawv No Yog Rau Tag Nrho Cov Chaw Nram Qab No:<br />
n <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> hauv Eau Claire<br />
• <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> cov neeg ua hauj lwm, nrog rau cov uas raug xaiv tsa<br />
thiab kev koom tes los ntawm lwm tus kws kho mob<br />
• <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> hauv Eau Claire – Luther campus<br />
• <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> hauv Eau Claire – Clairemont campus<br />
• <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> Express Care hauv Eau Claire<br />
n <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> - Northland<br />
• Tsev kho mob<br />
• Cov neeg ua haujlwm nyob rau hauv tsev kho mob, nrog rau cov uas raug xaiv tsa<br />
thiab kev koom tes los ntawm lwm tus kws kho mob<br />
• Barron<br />
• Cameron<br />
• Chetek<br />
• Prairie Farm<br />
• Rice Lake<br />
• Barron Nursing Home<br />
• Maplecroft Retirement Community<br />
n <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> - Chippewa Valley<br />
• Tsev kho mob<br />
• Cov neeg ua haujlwm nyob rau hauv tsev kho mob, nrog rau cov uas raug xaiv tsa<br />
thiab kev koom tes los ntawm lwm tus kws kho mob<br />
• Bloomer<br />
• Chippewa Falls<br />
• Colfax<br />
• Maplewood Nursing Home<br />
n <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> - Oakridge<br />
• Tsev kho mob<br />
• Cov neeg ua haujlwm nyob rau hauv tsev kho mob, nrog rau cov uas raug xaiv tsa<br />
thiab kev koom tes los ntawm lwm tus kws kho mob<br />
• Osseo<br />
• Mondovi<br />
• Osseo Nursing Home
n <strong>Mayo</strong> <strong>Clinic</strong> hauv Jacksonville, Rochester thiab Scottsdale<br />
n <strong>Mayo</strong> <strong>Health</strong> <strong>Clinic</strong> <strong>System</strong> cov chaw hauv Wisconsin, Minnesota,<br />
Iowa thiab Georgia<br />
n <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> – Home <strong>Health</strong> & Hospice<br />
n <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> – Supportive Home Care<br />
n <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> – Pharmacy & Home Medical<br />
n <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> – Medical Store<br />
n Pain <strong>Clinic</strong> of Northwestern Wisconsin, S.C.<br />
Tej thaum cov chaw saum no kuj ua hauj lwm ua ke pab kho cov neeg mob. Yuav kom<br />
ua tau hauj lwm zoo, cov chaw saum no yuav tsum tau sib qhia txog koj cov (PHI)<br />
thaum lub caij hais txog kev kho koj, tej nuj nqi kho koj, thiab kev khiav dej num hauv<br />
chaw kho mob xws li hais tias koj tuaj phais nyob rau ntawm tsev kho mob <strong>Mayo</strong><br />
<strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> tab sis mas ho siv kev pab los ntawm Eau Claire Cov Neeg Tso<br />
Tshuaj Tsaug Zog/Tshuaj Loog uas yog ib ceg ntawm cov neeg ua hauj lwm rau <strong>Mayo</strong><br />
<strong>Clinic</strong> <strong>Health</strong> <strong>System</strong>. Tus neeg uas yuav phais koj ntawd yuav tsum tau nrog tus neeg<br />
tso tshuaj tsaug zog/tshuaj loog sib tham thiaj li yuav tsis muaj kev cov nyom rau<br />
qhov yuav phais koj. Ib qho piv txwv ntxiv, tej zaum lub chaw kho mob uas koj niaj<br />
zaus mus kuaj mob kuj xa koj mus rau lub chaw kho mob (Pain <strong>Clinic</strong>) nyob rau qaum<br />
teb (Wisconsin) kom lawv pab ntsuam xyuas koj tus mob. Yog li ntawd, koj lub chaw<br />
kho mob yuav tsum tau nrog lawv cov neeg ua hauj lwm tom lub (Pain <strong>Clinic</strong>) tham<br />
txog koj tus mob. Hauv daim ntawv no thoob plaws, yuav kom tsis txhob txhaum txoj<br />
cai nyob rau hauv HIPAA mas txhua zaus uas siv lo lus “<strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong>”<br />
no ces yog hais kav hlo cov chaw uas muaj npe nyob rau saum no. Siv lub npe li nov,<br />
tab sis yeej tsis pub kom puas cov.<br />
<strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> saib xyuas<br />
koj cov ntaub ntawv kho mob li cas<br />
“Use” yog kev siv koj cov PHI nyob rau hauv <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong>. Nyob rau<br />
hauv <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> cov chaw kho mob, chaw kuaj mob, cov kws kho<br />
mob sawv daws tag nrho ua hauj lwm ua ke kho koj tus mob. Txhua txhua leej uas tu<br />
koj, sawv daws sau txog sawv daws kev kho koj rau hauv <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong><br />
cov ntaub ntawv kho mobno. (Qhov no yog ib qho tseem ceeb rau <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong><br />
<strong>System</strong> kev kho koj, thiab nws yog ib txoj kev zoo rau cov neeg ua hauj lwm rau hauv<br />
<strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> sib tham tau zoo txog ntawm koj tus mob.)<br />
Cov neeg kho mob ntawm txhua txhia fab nyias muaj nyias feem xyuam txog rau<br />
ntawm kev kho koj, thiab cov ntaub ntawv sau txog ntawm kev kho koj no yuav yog<br />
los ntawm, xws li:<br />
• Cov tsev kho mob uas kho koj<br />
• Cov nas maum, cov zuaj ib ce (therapists) thiab lwm yam kws kho mob<br />
• Cov (lab test results)<br />
• Cov xoos fais fab (radiology reports)<br />
• Koj cov kev mob yav dhau los<br />
• Lwm yam ntaub ntawv yav tag los hais txog ntawm koj kev mob nkeeg<br />
Sau hlo cov ntaub ntawv nov los ua ke yuav ua tau rau <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong><br />
kho tau koj zoo tshaj. Txhua txhua tus tib neeg uas ua hauj lwm nyob rau hauv <strong>Mayo</strong><br />
<strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yeej yuav tsum tiv thaiv tsis pub cov ntaub ntawv hais txog koj<br />
3
tshwm mus sab nraud li. Peb cov tib neeg ua hauj lwm tsuas saib koj tej ntaub ntawv<br />
thaum lub sij hawm uas lawv yuav tsum tau saib xwb, xws li sijhawm lawv yuav kho<br />
koj, nuj nqis thiab kev khiav dej num hauv chaw kho mob. “Disclosure” yog hais txog<br />
kev muab koj cov ntaub ntawv tawm hauv <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> mus rau sab<br />
nraud. Kev <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav muab cov ntaub ntawv no tawm yog<br />
muab raws li uas tau sau cia rau ntawm 2 nqe lus “Use” thiab “Disclosure” uas nyob<br />
rau hauv tsab ntawv no.<br />
<strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> Txoj Hauj Lwm<br />
Nyob rau hauv tsab ntawv no thoob plaws, thaum hais txog ntawm kev “Siv” thiab<br />
kev tso koj cov ntaub ntawv tawm sab nraud ces yog hais txog ntawm cov ntsiab lus<br />
uas peb muab tau los ntawm koj cov (general medical record) nkaus xwb, tib qho<br />
txawv ces tsuas yog ntawm qhov hais tias lub xeev Wisconsin muaj ib tsab cai tiv thaiv<br />
ntxiv rau cov ntaub ntawv kho mob ntawm kev coj xeeb ceem (behavioral health<br />
treatment records). Nej yuav pom cov lus hais txog cov ntaub ntawv kho mob ntawm<br />
kev coj xeeb ceem uas hais txog cov kev tiv thaiv ntxiv no.<br />
• <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav khaws koj cov PHI raws li txoj cai tsis pub lwm<br />
tus sab nraud paub.<br />
• <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav tsum tau qhia rau koj raws txoj cai txog qhov<br />
(Notice of Privacy Practice) uas qhia txog peb txoj cai uas peb muaj thiab yam uas<br />
peb yuav tsum tau ua hais txog ntawm koj cov PHI.<br />
• Raws txoj cai, <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav tsum tau caum cov cai uas muaj<br />
nyob rau hauv tsab (Notice of Private Practices) uas tam sim nov siv.<br />
• <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav tsum tau muab ib daim Notice of Privacy<br />
Practices rau koj thawj thawj zaug uas koj tuaj ntsib peb. Tom qab uas koj tuaj ntsib<br />
peb thawj zaug los ntawm <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> ib qhov chaw kho mob<br />
lawm, yog koj mus ntsib peb cov chaw ua hauj lwm rau lwm qhov, tej zaum lawv<br />
yuav tsis muab los yog tsis qhia rau koj ntxiv lawm los muaj. Piv txwv hais tias,<br />
thawj zaug yog koj tuaj rau ntawm <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> lub tsev kho mob<br />
hauv Eau Claire lawm, tom qab koj ho mus rau lub chaw kuaj mob <strong>Mayo</strong> <strong>Clinic</strong><br />
<strong>Health</strong> <strong>System</strong> Northland no ces tej zaum koj yuav tsis tais txais ib daim Notice of<br />
Privacy Practices ntxiv lawm. <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> txaus siab yuav muab<br />
dua ib daim Notice of Privacy Practices rau koj yog koj hais kom muab.<br />
Kev Ua Kom Tau Raws Li Lub Luag Hauj Lwm<br />
(Fufillment of These Duties)<br />
• <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav ua tiag saib kom zoo tsis pub lam tau lam siv<br />
thiab lam tau lam tso koj cov ntaub ntawv tawm.<br />
• Cov neeg ua hauj lwm yuav tsum rho koj cov ntaub ntawv uas lawv toob kas los<br />
ua lawv cov hauj lwm XWB.<br />
• Cov neeg ua hauj lwm leej twg tsis caum cov cai nov yuav raug teeb meem thiab<br />
raug tawm hauj lwm.<br />
Ntsiab Lus Hais Txog Tsab Ntawv No<br />
(Information About This Notice)<br />
• Tsab ntawv no yuav siv txij li lub 7 hli tim 1, 2007<br />
4
• <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> tseg txoj cai rau nws hais txog kev yuav hloov cov<br />
ntsiab lus hauv no raws li cov cai hauv HIPAA thiab lwm yam cai, thiab muaj cai<br />
ua dua lwm daim (Notice provision) rau txhua txhua qhov PHI.<br />
• Thaum daim ntawv no raug kho lawd, yog nej leej twg xav tau no, peb yuav muaj<br />
daim tshiab nyob rau <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> cov chaw kho mob txhua qhov<br />
chaw, nyob rau hauv Web site uas yog mayoclinichealthsystem.org, los yog peb xa<br />
tuaj rau nej los tau.<br />
Kev Siv Thiab Kev Muab PHI Tawm Sab Nraud<br />
Txhua txhua qhov kev siv thiab kev muab tawm, yog hais tias txawv cov uas tau<br />
hais los saum no, peb yuav tsum tau kev sau ntawv tso cai los ntawm koj tso, thiab<br />
koj muaj cai uas muab koj daim ntawv tso cai ntawd rho tawm, tib qho uas koj rho<br />
tsis tau koj daim ntawv tso cai ntawd tawm ces tsuas yog thaum uas twb siv thaum<br />
lub sij hawm koj tau tso cai lawm.<br />
Kev Kho (Treatment)<br />
<strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav siv thiab muab tawm sab nraud, tsis hais koj cov<br />
PHI xws li koj cov (behavioral health treatment records) tib si kom thiaj li pab tau kev<br />
yuav kho koj nyob tawm sab nraud lub tsev kho mob <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> no.<br />
Kev kho muaj xws li cov kws kho mob thiab cov neeg ua haujlwm nrog kws kho mob<br />
lawv kev sib tham thiab tawm tswv yim. Xws li tom qab koj raug phais tag es koj tus<br />
kws kho mob xa koj mus kho ntxiv kom zoo tu qab. Ib qho piv txwv ntxiv, yog kev siv<br />
koj cov PHI rau koj kev kho mob nyob rau <strong>Mayo</strong> <strong>Clinic</strong> hauv Jacksonville, Rochester,<br />
Scottsdale lossis <strong>Mayo</strong> cov tsev kho mob nyob hauv Wisconsin, Iowa, Minnesota, thiab<br />
Georgia. Koj tej ntaub ntawv kho mob yuav raug muab rau lwm qhov chaw siv raws li<br />
qhov yuav tsum tau siv kom kho tau koj zoo.<br />
Nqi Yuav Them (Payment)<br />
<strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> siv koj cov ntaub ntawv PHI los mus ua nqi thiab sau nyiaj<br />
los ntawm cov es saws las (insurance companies), Medicare thiab lwm qhov. Qhov no<br />
yuav tsum tau muab tej ntaub ntawv hais txog koj kev kho mob xa rau koj lub es saws<br />
las paub tias <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yeej kho mob rau koj lawm tiag. Yog hais tias<br />
peb muaj kev cog lus ua hauj lwm nrog rau xeev (state) los yog (county) no, peb yuav<br />
tsum qhia txog cov ntaub ntawv kho tus neeg mob ntawd rau lawv thaum peb kom<br />
lawv them nyiaj rau cov neeg mob uas peb kho ntawd rau peb. <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong><br />
<strong>System</strong> tsis tas yuav tau kev tso cai hauv ntaub ntawv los ntawm koj mas thiaj li muaj<br />
cai muab koj cov ntaub ntawv PHI tso tawm, yog hais tias qhov uas kho koj ntawd<br />
nws ntsig txog cov nyiaj raug mob tom hauj lwm (workers’ compensation claim).<br />
Cov Kev Ua Hauj Lwm Hauv Kev Kho Mob<br />
(<strong>Health</strong> Care Operations)<br />
<strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> siv PHI rau ntau ntau yam uas nyob rau sab hauv thiab<br />
sab nraud, xws li siv coj los ntsuas thiab kho kom txoj kev kho cov neeg mob kom zoo<br />
ntxiv, ua kev kawm thiab kev qhia, coj los npaj rau tseem fwv thaum lawv tuaj kuaj<br />
peb cov hauj lwm, ntsuam xyuas txog kev dhia hauj lwm, thiab pab kom kev ua hauj<br />
lwm zoo tshaj qub. Hauv qab no yog tej yam uas peb ua:<br />
5
• Nyob rau hauv <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> no, peb siv PHI coj los ntsuam xyuas<br />
peb cov hauj lwm thiab tiv thaiv kom cov neeg mob tsis txhob raug mob ntxiv<br />
(safety).<br />
• Nyob rau hauv <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong>, peb siv PHI coj los teb cov tib neeg<br />
mob tej lus tsis haum siab thiab lus tsis txaus siab hais txog peb kev tu cov neeg<br />
mob.<br />
• <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav tso cai rau tseem fwv uas tuaj hauv lub xeev<br />
(state) tuaj ntawd tuaj kuaj cov neeg mob cov ntaub ntawv kom lawv pom thiab<br />
paub hais tias peb yeej ua raws nraim li tseem fwv (state) thiab (federal) cov cai,<br />
xws li (Medicare) cov cai.<br />
• <strong>Mayo</strong> cov chaw ua haujlwm nyob rau hauv tebchaws no, nrog rau <strong>Mayo</strong> <strong>Clinic</strong><br />
nyob rau Jacksonville, Rochester, Scottsdale thiab <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong><br />
tej tsev kho mob nyob hauv Wisconsin, Iowa, Minnesota thiab Georgia, kuj ua<br />
haujlwm uake los mus txhim kho peb txoj kev kho mob nkeeg kom zoo ntxiv, yog<br />
li ntawd tej zaum peb kuj yuav siv koj cov ntaub ntawv PHI rau tej yam li no.<br />
• Tej zaum <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> kuj yuav muab koj cov PHI qhia rau lwm<br />
qhov chaw uas koj tau mus siv lawm, rau lawv kev ua dejnum. Nws kuj muaj qee<br />
yam kev txwv.<br />
Kev Tiv Tauj Koj (Patient Contacts)<br />
Muaj tej lub caij, <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav siv PHI xws li koj lub npe, chaw<br />
nyob thiab tej yam hais txog koj tus mob coj los txuas lus nrog koj hais txog:<br />
• Kev rov qab qhia rau koj hais txog koj lub caij koj tau teem nrog peb lawd<br />
• Qhia rau koj txog lwm txoj kev uas yuav kho koj<br />
• Qhia rau koj txog lwm txoj kev los yog kev pab koj uas yuav zoo rau koj tus kheej<br />
• Muab <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> daim ntawv sojntsuam txog kev txaus siab<br />
rau koj<br />
Kev Pub Nyiaj Rau Lwm Tus/Lwm Pab Pawg (Philanthropy)<br />
Tej zaum lub tsev kho mob <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> kuj yuav hu rau koj txog kev<br />
nrhiav nyiaj txiag los mus pab rau lub tsev kho mob <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> lub<br />
hom phiaj. Sijhawm nrhiav nyiaj, <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav muab koj tej ntaub<br />
ntawv hais txog koj (xws li npe thiab chaw nyob) thiab cov sijhawm uas koj mus kho<br />
mob rau ntawm <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong>. Tej zaum lawv kuj yuav sau ntawv lossis<br />
luam ntawv tawm tuaj thov koj pab nyiaj (tax-deductible contribution) rau lub tsev<br />
kho mob <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong>. <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yeej tsis lam tau lam<br />
hu xov tooj mus rau tib neeg es muab lawv tej npe siv, thiab peb yeej tsis lam tau lam<br />
muab neeg tej npe thiab chaw nyob muag rau lwm lub koom haum.<br />
6<br />
Phau Ntawv Teev Npe thiab Chav Pw (Directory)<br />
Nyob rau hauv peb lub tsev kho mob <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> no, peb yuav siv koj<br />
lub npe, hoob pw nyob rau hauv no thiab seb koj ntseeg kev cai dab tsi (yog hais tias<br />
koj kam qhia rau peb) coj los tso rau hauv phau ntawv uas muaj cov neeg mob cov<br />
npe. Qhov nov yuav pab tau koj tsev neeg nrhiav tau koj thaum koj tuaj pw rau hauv<br />
tsev kho mob nov. Piv txwv hais tias koj muaj ib tug txheeb ze uas xav tuaj saib koj<br />
nyob rau hauv tsev kho mob es xav paub koj lub hoob pw. Koj tsev neeg ib tug muaj<br />
kev yuav tuaj ntsib koj es nws tuaj txog tom peb lub (<strong>Clinic</strong>) no, tab sis nws tsis nco
qab xyov yog yuav ntsib koj rau xab twg lawm. Thaum zoo li ntawd lawm peb thiaj li<br />
muab tau cov chaw li nov rau lawv yog lawv nug peb.<br />
• Cov neeg uas peb yuav qhia tej yam li nov rau tsuas yog cov uas nug peb es yeej<br />
paub nej npe meej meej.<br />
• Koj muaj cai xaiv kom peb tsi txhob muab koj tso rau hauv phau ntawv uas muaj<br />
cov neeg mob cov npe (Patient Directory).<br />
• <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav tsis qhia rau hauv phau ntawv no hais tias seb<br />
koj yog ib tug neeg uas tau muaj (behavioral health treatment) los tsis tau muaj<br />
thiab yuav tsis qhia tej no rau leej twg yog tsis tau kev tso cai hauv ntaub ntawv<br />
los ntawm koj.<br />
Cov Neeg Uas Muaj Feem Xyuam Txog Kev Kho Koj Thiab Kev<br />
Qhia Rau (Individuals Involved in Care and Notification)<br />
Tej zaum <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav tsis kam muab koj cov PHI rau koj tsev<br />
neeg los yog koj cov txheeb ze uas lawv yog cov kho/tu koj, them koj cov nuj nqi yog<br />
hais tias koj tsis sau ntawv tso cai rau lawv. Yog hais tias lub caij uas peb tab tom kho<br />
koj ntawd, yog koj tsev neeg los yog koj cov phooj ywg ho nyob ntawd thiab no, <strong>Mayo</strong><br />
<strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yeej to taub hais tias cov neeg ntawd yeej yuav tsum hnov tej lus<br />
uas peb sib tham xwb yog hais tias koj tsis kom lawv txav ntawm qhov chaw ntawd<br />
mus rau lwm qhov. <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav qhia tsawg li tsawg tau txog koj<br />
qhov PHI rau tus neeg uas koj tau tso cai rau nws kom paub txog ntawm koj lub chav<br />
pw, ntawm koj tus mob lossis txog ntawm koj kev tuag.<br />
Ib “tug neeg uas koj tso cai rau” yog:<br />
• Niam txiv, tus neeg uas saib xyuas los yog ib tus neeg uas tau txoj cai saib xyuas ib<br />
tug me nyuam uas tsis tau muaj 18 xyoo<br />
• Ib tus neeg uas saib xyuas ib tus tib neeg laus uas nws saib xyuas tsis tau nws<br />
tus kheej<br />
• Ib tug neeg sawv cev hauv kev kho mob (health care agent) uas tau kev tso cai los<br />
saib xyuas tus neeg mob ntawd<br />
• Ib tug sawv cev los yog tus poj niam los yog tus txiv ntawm ib tug neeg tuag<br />
• Yog hais tias koj tus poj niam los yog koj tus txiv ho tuag ua ntej koj lawm no ces<br />
“ib tus neeg uas koj tso cai rau” kuj yog ib tug neeg laus hauv koj tsev neeg kiag.<br />
Yog hais txog cov (behavioral health treatment) lawm no ces tej zaum, (tshwj cov chaw<br />
pab kho txog yeeb tshuaj thiab dej caw), <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav kam muab<br />
cov PHI rau nws tus poj niam los yog tus txiv, rau cov niam txiv, cov kwv los yog cov<br />
tij uas muaj tshaj 18 xyoo lawd. Qhov no mas ua ntej yuav muab los yuav tsum yog<br />
cov neeg uas hais los nov yeej yog cov uas tau koom, thiab saib xyuas tus neeg mob no<br />
los mus lawm. Tsis tas li ntawd xwb yuav tsum yog lub tsev kho mob twb yeej tso cai<br />
ua ntej lawm:<br />
• Cov ntaub ntawv uas muaj txog koj cov kev kuaj koj<br />
• Ib daim ntawv sau tas nrho koj cov tshuaj<br />
• Txoj kev seb yuav kho koj li cas lawm tom ntej<br />
Yog hais tias tus tib neeg mob ntawd hais tsis taus lawm, cov neeg ntawm lub chaw<br />
kho mob ntawd mam li qhia rau tus neeg mob ntawd txog qhov uas yuav muab nws<br />
cov PHI ntawd tawm.<br />
7
Yog hais txog cov (behavioral health treatment) no, (tshwj cov chaw pab kho txog yeeb<br />
tshuaj thiab dej caw), tej zaum <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav:<br />
• Qhia rau tus txij nkawm, cov niam txiv los yog tus me nyuam tias tus tib neeg<br />
ntawd og ib tug neeg mob pw tim tsev kho mob<br />
• Muab (ad litem) rau tus neeg mob ntawd tus kws hais plaub thiab (County<br />
Corporation Counsel), muab tus neeg mob ntawd cov PHI coj mus npaj tej yam<br />
xws li (detention, admission) los yog (commitment).<br />
• Muab cov PHI uas yuav pab kom to taub tus neeg mob uas tawm hauv lub tsev<br />
kho mob (behavioral) ntawd mus yam tsis tau kev tso cai (tej yam uas yuav tsum<br />
tau kev tso cai).<br />
Koj muaj cai txiav txim seb koj xav kom lawv ua yam twg, tsis xav kom lawv ua<br />
yam twg hais txog cov nqe saum no. Koj mus saib rau nqe lus (Right to Request<br />
Restrictions).<br />
Yog Thaum Muaj Xwm Ceev Tuaj Lawm<br />
(Emergency Circumstances)<br />
Tej zaum <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav tau muab koj cov PHI qhia rau ib tug kws<br />
kho mob uas nws pom tau hais tias tus neeg mob ntawd tus mob loj heev lawm yog<br />
tsis tau tus neeg ntawd cov ntaub ntawv txog (behavioral health treatment record) ces<br />
yuav kho nyuaj. Qhov yuav muab cov ntaub ntawv nov rau tus neeg ntawd los tsuas<br />
yog muab tej yam uas coj mus kom pab tau rau lub caij ntawd xwb.<br />
Tshawb Nrhiav Txog Kev Kho Mob (Medical Research)<br />
Hais txog kev tshawb nrhiav txog kev kho mob (medical research) mas tseem fwv txoj<br />
cai thiab Wisconsin txoj cai tso cai siv thiab tso koj cov PHI tawm tau tsis tas yuav tau<br />
kev tso cai hauv ntawv los ntawm koj yog hais tias qhov ntawd yog tej yam uas tsim<br />
nyog lawm. Kev tshawb nrhiav txog kev kho mob nyob rau hauv <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong><br />
<strong>System</strong> no yog tau kev tso cai thiab pom zoo los ntawm lub (Institutional Review<br />
Board (IRB). Tam sim nov tseem fwv txoj cai yeej kom cov neeg tshawb txog kev kho<br />
mob no yuav tsum muaj qhov uas yuav tsum saib kom zoo tsis pub rau lwm leej lwm<br />
tus tib neeg paub txog koj PHI. Yog hais tias koj yog ib tug neeg mob uas koj them koj<br />
tus kheej no, koj muaj cai hais kom tsis txhob muab koj cov PHI los mus siv ua kev<br />
tshawb nrhiav.<br />
Yuav kom <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> siv tau koj cov PHI coj los ua kev tshawb nrhiav<br />
txog kev kho mob (medical reseach), feem ntau yuav tsum tau daim ntawv tso cai mas<br />
<strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> thiaj li kam muab koj cov PHI tawm tau rau lwm tus neeg<br />
los yog lwm lub chaw sab nraud.<br />
Kev Tso Cai Los Yog Qhov Uas Txoj Cai Kom Yus Ua<br />
(Authorized or Required by Law)<br />
<strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav siv thiab muab koj cov PHI tawm rau lwm tus paub<br />
raws li tseem fwv nyob rau hauv xeev (state) los yog teb chaws (federal) txoj cai los yog<br />
thaum uas chaw hais plaub (court) hais kom ua lossis pom tias yuav tau siv los yog<br />
muab tawm xwb.<br />
8
Los Tiv Thaiv Ib Qho Kev Hawv Txog Kev Ua Phem Mus<br />
Rau Lwm Qhov (To Avert a Serious Threat of Harm)<br />
Yog thaum twg <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> pom hais tias yog siv koj cov PHI yuav<br />
pab tau koj tus kheej los yog pab tau zej zos rau tej yam kev kub ntxhov mas <strong>Mayo</strong><br />
<strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> thiaj li siv los yog muab koj cov PHI tawm xwb. Piv txwv li tias,<br />
yog peb pom hais tias koj pom kev tsis zoo es qhov ntawd yuav ua rau koj tsav tsis tau<br />
tsheb no ces peb yuav tau qhia koj npe thiab tej yam tseem ceeb rau nram qhov chaw<br />
saib txog kev tsav tsheb (Department of Transportation).<br />
Kev Muab Ib Yam Khoom Ntawm Yus Lub Cev Rau<br />
Lwm Tus Tib Neeg (Organ and Tissue Donation)<br />
<strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav qhia txog koj cov PHI rau cov koom haum uas ua<br />
hauj lwm rau tej (organ), qhov muag los yog tej chaws uas khaws tej (tissue) los yog<br />
lwm lub koom haum kom lawv thiaj li tsim tau tej nqaij thiab coj mus pub tau rau lwm<br />
tus tib neeg.<br />
Tseem Fwv Hais Tuaj (Government Agency Requests)<br />
<strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav qhia koj cov PHI rau tseev fwv yog hais tias lawv sau<br />
ntawv tuaj kom peb muab. Piv li tias:<br />
• Lawv xav tshawb txog koj tiaj nyiaj txiag<br />
• Saib xyuas thiab soj ntsuam qhov kev pab cuam<br />
• Muab ntawv tso cai rau lub tsev kho mob<br />
• Muab ntawv pom zoo rau ib tug tib neeg twg<br />
Yog hais tias koj xuas nyiaj ntsuab them koj tej nuj nqi (tshwj yog tias koj nyob rau<br />
hauv tsev laus), koj xav kom rho koj npe tawm hauv kev qhia tawm koj cov PHI los<br />
yeej tau. Yog xav kom txhob siv, txhua txhua xyoo ces koj cia li siv <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong><br />
<strong>System</strong> daim ntawv Restriction Request Form es muab kos npe rau ces muab tuaj rau<br />
peb xwb.<br />
Chaw Kaw Neeg<br />
(Correctional Institutions/Department of Corrections)<br />
<strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav muab tus neeg raug txim tawd cov PHI rau cov neeg<br />
kho mob nyob rau hauv lub tsev raug txim ntawd, los rau lub chaw raug txim uas<br />
tseem yuav muab tus neeg raug txim ntawd xa mus nyob, los yog ib tus neeg uas raug<br />
xaiv los ntawm lub tsev kaw neeg ntawd los tuav tus neeg raug txim ntawd cov ntaub<br />
ntawv kuaj mob. Yuav ua qhov nov los yuav tsum yog pom hais tias qhov ntawd yeej<br />
tseem ceeb rau:<br />
• Cov chaw pab txog kev kho mob (Provision of health care)<br />
• Tus neeg ntawd kev noj qab nyob zoo thiab kev tsis txhob muaj teeb meem rau<br />
nws tus kheej thiab rau lwm tus tib neeg<br />
• Tus neeg ntawd kev noj qab nyob zoo thiab kev tsis txhob muaj teeb meem rau<br />
nws tus kheej los yog tus neeg uas nyaib nws ntawm ib qho chaw rau ib qho chaw<br />
• Cov tub ceev xwm uas nyob rau hauv lub tsev kaw neeg ntawd<br />
• Kev tsis muaj teeb meem rau cov neeg ua hauj lwm hauv lub tsev ntawd<br />
9
Tej zaum <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav muab koj cov ntaub ntawv kho cwj<br />
pwm (behavioral health treatment records) tawm raws li nram qab no:<br />
• Rau (Department of Correction) hais txog kev uas ib tus tib neeg lam mos lwm tus<br />
neeg ua es yuav muab sau rau hauv ntaub ntawv tawm<br />
• Rau hauv (Department of Corrections) yog hais tias tus neeg ntawd<br />
• Rau hauv cov tsev kaw cov neeg uas muaj teeb meem txog (behavioral health<br />
treatment)<br />
• Rau cov (parole officers) uas saib xyuas ib tus neeg uas muaj teeb meem<br />
(behavioral health treatment).<br />
• Rau tus tub ceev xwm uas nws muaj cai saib tus neeg uas nyuam qhuav tawm<br />
hauv lub tsev kho neeg los<br />
Nyiaj Raug Mob Tom Hauj Lwm (Workers’ Compensation)<br />
Yog hais tias koj ua ntawv raug mob mus rau hauv (Department of Workforce) no yog<br />
thaum twg lawv sau ntawv tuaj no ces peb yuav tsum tau muab koj cov PHI mus rau<br />
lawv lub sijhawm lawv ua qhov haujlwm no. <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav tsum<br />
tau muab koj cov PHI uas hais txog cov mob uas mob ze ze li ntawm cov ua koj hais<br />
tias yog raug tom hauj lwm rau lawv.<br />
Lub Hom Phiaj Ntawm Pej Xeem Txoj Kev Noj Qab Haus Huv<br />
(Public <strong>Health</strong> Purposes)<br />
Tej zaum <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav muab koj cov PHI no rau cov chaw kho<br />
mob yog hais tias lawv sau ntawv tuaj rau peb. Cov hom phiaj ntawm cov kev no yog<br />
raws li nram no:<br />
• Yuav qhia txog cov neeg uas yus xoom xaim hais tias lawv tsim me nyuam thiab<br />
tsis saib me nyaum thiab pab kom muab cov neeg ntawd coj mus rau txim. Cov<br />
zoo li nov mas yuav muab tas nrho tej nyuag ntaub ntawv hais txog (behavioral<br />
treatment records) tib si.<br />
• Qhia rau ib tus tib neeg uas tej zaum nws tau nrog cov neeg uas mob ej (HIV) dua<br />
lawm<br />
• Qhia txog tej yam kab mob rau hauv (State epidemiologist)<br />
• Qhia txog qhov uas nws tsis saib thiab tsis tu cov me nyuam uas tseem nyob rau<br />
hauv plab<br />
• Qhia txog qhov uas nws tsim txom cov laus thiab tsis saib tsis xyuas cov laus, los<br />
yog los mus pab rau thaum uas hais txog qhov uas tsim txom cov laus<br />
Cov Dej Num Ntawm Kev Saib Xyuas Txoj Kev Noj Qab Haus Huv<br />
(<strong>Health</strong> Oversight Activities)<br />
Tej zaum <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav tau qhia koj cov PHI rau cov koom haum<br />
(health oversight) yog hais tias tau kev tso cai los ntawm tseem fwv thiab yog hais<br />
tias lawv sau ntawv tuaj rau peb. Cov ntawd muaj zoo xws li (licensure, accreditation,<br />
audits and investigations). Ib qho uas yeej yuav tsum muaj mas yog hais tias cov<br />
chaw xws li The Joint Commission nyob rau hauv cov chaw kho mob (health care<br />
organizations) lawv yeej xav tau koj ib daim ntawv uas peb tu koj ntawd mus saib seb<br />
10
tsev kho mob tu koj zoo npaum li cas. Lwm lub caij uas <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong><br />
yuav muab koj cov PHI rau Wisconsin Department of <strong>Health</strong> and Family Services los<br />
yog cov koom haum tub ceev xwm ces yog:<br />
• Yog hais tias lawv ntseeg hais tias qhov uas tus neeg mob ntawd tau tuag lawm<br />
vim yog muaj neeg siv lub zog yuam, siv tshuaj (psychotropic medication) los yog<br />
nws tua nws tus kheej. Thaum zoo li nov mas yuav muab cov ntaub ntawv hais<br />
txog (behavioral treatment records) tib si.<br />
• Yog hais tias cov me nyuam uas tau nyob rau hauv cov tsev uas tseem fwv<br />
(welfare) ua tus saib, cov tsev (community-based residential facility), cov tsev laus,<br />
los yog cov tsev neeg vwm ntawd tas sim neej es yuav tshawb nrhiav saib tus me<br />
nyuam ntawd tuag li cas no ces peb yuav tau muab koj cov PHI rau.<br />
Yog hais tias koj xuas nyiaj ntsuab them koj tej nuj nqi, (tshwj xeeb koj tsis nyob rau<br />
hauv tsev laus), koj xav kom tshem koj cov PHI los yeej tau. Yog xav kom txhob siv,<br />
txhua txhua xyoo ces koj cia li siv <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> daim ntawv (Restriction<br />
Request Form) es muab kos npe rau ces muab tuaj rau peb xwb.<br />
Yog hais txog kev kho cov mob (behavioral health treatment) no ces <strong>Mayo</strong> <strong>Clinic</strong><br />
<strong>Health</strong> <strong>System</strong> yuav muab yam puav cov ntaub ntawv tawm sab nraud raws li nram<br />
qab no.<br />
• Muab rau DHFS los yog tus (director) uas nyob rau hauv (county department) los<br />
thiaj saib xyuas tau txoj kev kho nov<br />
• Muab rau cov tib neeg uas ua hauj lwm nyob rau hauv lub DHFS kom lawv thiaj<br />
li ua tau hauj lwm<br />
• Muab rau (county department) nws thiaj li npaj tau kev pab rau cov neeg uas tau<br />
txais kev pab rau lawv cov teeb meem xws li mob hlwb (mental health), loj hlo tsis<br />
zoo (development disability), quav dej quav cawv 6 lub hlis ua ntej uas lawv sau<br />
ntawv tuaj kom peb muab cov ntaub ntawv nov rau lawv<br />
Kev Sib Foob thiab Lwm Rooj Plaub Ntug<br />
(Lawsuits and Other Judicial Proceedings)<br />
<strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav muab koj cov PHI thiab cov ntaub ntawv txog<br />
(behavioral health treatment) tib si raws li uas nram tsev hais plaub (court) tau hais<br />
tuaj.<br />
Tub Ceev Xwm Cov Dej Num (Law Enforcement Activities)<br />
<strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav muab koj cov PHI rau tub ceev xwm:<br />
• Qhia txog kev neeg xuas phom tua raug neeg<br />
• Qhia txog kev kub nyhiab thiab to yog hais tias <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> pom<br />
hais tias qhov uas to ntawd yog lwm tus neeg lim hiam ua rau nws<br />
• Peb yuav hais qhia rau tub ceev xwm yog hais tias tub ceev xwm nrhiav cov neeg<br />
uas lawv xav hais tias nws muaj txim txhaum, cov neeg uas ua txhaum es khiav<br />
lawm, nrhiav ua pov thawj los yog cov neeg pawv lawm. Peb yuav qhia nws lub<br />
npe, chaw nyob, hnub yug thiab lub zos uas nws yug, nws tus (social security<br />
number) thiab seb tus neeg ntawd nws lub cev ntaj ntsug zoo li cas<br />
• Peb yuav muab nws cov ntaub ntawv uas muaj nyob rau hauv nws cov<br />
(behavioral health treatment record) yog hais tias muaj teeb meem ua txhaum cai<br />
lij choj nyob rau hauv <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> cov chaw, thiab yuav tsum yog<br />
11
hais tias <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yeej ntseeg hais tias cov ntaub ntawv ntawd<br />
yeej yog pov thawj rau qhov teeb meem ua txhaum cai lij choj ntawd. Cov ntaub<br />
ntawv uas yuav muab tawm ntawd tsuas yog nws lub npe thiab lwm yam uas<br />
tseem ceeb rau qhov teeb meem ua txhaum cai lij choj ntawd nkaus xwb.<br />
• Tsuas qhia txog tug neeg ntawd qhov uas nws tawm ntawm lub tsev (behavioral<br />
health unit) mus yam tsis tau kev tso cai<br />
• Nrhiav seb muaj tej tus tib neeg tuag yog vim li cas raws li tau hais nyob rau saum<br />
nqe (health oversight activities) uas nyob rau hauv daim ntawv no<br />
• Yog thaum twg peb saib yog tsim nyog no peb yuav muab cov ntaub ntawv hauv<br />
(behavioral health treatment records) rau<br />
Cov Neeg Tshawb Fawb Seb Yog Vim Li Cas Tus Neeg Ho Tuag, Cov<br />
Kws Soj Ntsuam Mob thiab Cov Thawj Coj Ntawm Lub Tsev Txias<br />
(Coroners, Medical Examiners and Funeral Directors)<br />
<strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav muab koj cov PHI rau tus (coroner) los yog tus uas<br />
kuaj mob yog hais tias tus neeg ntawd tuag lawm es yuav yuav cov ntaub ntawv<br />
ntawd mus ua daim ntawv tuag log yog coj mus kuaj seb yog vim li cas nws thiaj li<br />
tuag. Peb yuav muab tau cov PHI nov tawm yog lawv sau ntawv tuaj rau tus thawj<br />
ntawm lub tsev pam tuag (funeral director) seb yuav npaj li cas tom qab uas tus neeg<br />
ntawd tuag lawm. Tiam sis, <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> kuj yuav muab rau tus thawj<br />
ntawm lub tsev pam tuag los yog lwm tus tib neeg uas nws npaj tus neeg tuag ntawd<br />
lub cev coj mus faus los yog kuaj tus neeg ntawd lub cev txog:<br />
• Kab mob HIV<br />
• Tej yam kab mob uas kis tau rau lwm tus tib neeg thaum (droplet), sib chwv los<br />
yog (airborne transmission)<br />
• Seb tus tuag ntawd puas tau siv cov khoom (radioactive materials) los kho nws<br />
• Kev muab nroj ntsha los yog nqaij tawv rau lwm tus neeg<br />
• Seb puas tsim nyog yuav ua ib qho kev soj ntsuam tom qab tus neeg tuag lawm<br />
Niam Txiv Cov Cai Hais Txog Ntawn Cov<br />
Muaj Cai Tuaj Mus Kuaj Thiab Luam<br />
Koj muaj cai kuaj thiab luam koj daim PHI thiab (behavioral health treatment record)<br />
uas nyob rau hauv <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> nov. Muaj tej yam mas lub xeev<br />
(Wisconsin) thiaj li tsis tso cai xwb.<br />
Yog hais tias nej hais rau peb ua ntej es muab caij kom txaus rau peb lawd, koj los<br />
yog tus tib neeg uas koj tso cai rau ntawd muaj cai tuaj kuaj los yog tuaj saib tau koj<br />
cov PHI ntawd txhua txhua lub caij thaum peb lub tsev no qhib ua hauj lwm. Feem<br />
coob ntawm cov neeg yeej tuaj saib tau tas nrho lawv cov ntaub ntawv tsis tshuav ib<br />
yam li. Yog koj xav tuaj kuaj koj cov PHI no, koj yuav tau teem caij nrog rau peb cov<br />
neeg ua hauj lwm uas nyob rau hauv <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> <strong>Health</strong> Information<br />
Management Department.<br />
Muaj qee zaus, <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> kuj tsis kam neeg tuaj kuaj thiab luam lawv<br />
cov PHI thiab. Piv txwv hais tias tus niam los yog tus txiv raug tsev hais plaub tsis pub<br />
tus me nyuam nrog nws nyob saib xyuas (physical placement). <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong><br />
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<strong>System</strong> yuav tsis txais tus niam txiv ntawd qhov kev thov nws tus me nyuam cov<br />
ntaub ntawv kuaj mob.<br />
Yog koj xav tau ib daim qauv (copy) ntawm koj cov ntaub natwv kho mob (medical<br />
record) no, koj yuav tsum tau hu tuaj rau ntawm <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> qhov<br />
chaw pab cov neeg mob (Patient Services Department) es kom lawv xa daim ntawv tso<br />
cai tuaj rau koj muab ua. Koj yuav tau them nqi me ntsis rau peb txog ntawm qhov uas<br />
peb tau luam daim ntawv ntawd tuaj rau koj.<br />
Yog hais tias peb tsis kam muab koj cov ntaub ntawv PHI ntawd rau koj no, koj muaj<br />
cai hais kom peb rov qab muab koj cov ntaub ntawv los saib dua seb yog vim li cas<br />
tiag. Thaum ntawd, lwm lub chaw kho mob uas tsis muaj feem xyuam dab tsi nrog<br />
rau hauv <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> nov mam li rov qab los saib dua ib lwm. Thaum<br />
lawv txiav txim li cas ces zaum no yog zaum kawg, lawv yuav tsis hloov lawm.<br />
Muaj Cai Thov Kom Muab Hloov (Right to Request Amendment)<br />
Koj muaj cai sau ntawv tuaj rau hauv (Privacy Office) uas nyob rau hauv <strong>Mayo</strong> <strong>Clinic</strong><br />
<strong>Health</strong> <strong>System</strong> no kom muab koj cov ntaub ntawv PHI thiab cov ntaub ntawv txog kev<br />
kho mob uas nyob rau hauv lub chaw kho mob <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> no hloov.<br />
Thaum koj hais kom hloov no, koj yuav tsum qhia hais tias yog vim li cas thiaj yuav<br />
tsum muab hloov. Tej zaum <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> kuj yuav tsis kam thiab los<br />
muaj. Yog hais tias <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> tsis kam no, <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong><br />
yuav sau ib tsab ntawv tuaj qhia rau koj hais tias yog vim li cas thiaj tsis kam, thiab<br />
yuav piav txog koj txoj cai rau koj thiab.<br />
Muaj Cai Rau Ib Daim Ntawv Teev Txog Tej Yam Uas Qhia Tawm<br />
Koj muaj cai sau ntawv tuaj rau hauv (Privacy Office) uas nyob rau hauv <strong>Mayo</strong> <strong>Clinic</strong><br />
<strong>Health</strong> <strong>System</strong> no kom lawv muab cov ntaub ntawv los yog cov npe ntawm cov chaw<br />
uas <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> muab tawm tau rau sab nraud rau koj.<br />
Muaj Cai Thov Kom Txwv<br />
Koj muaj cai hais kom <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> tsuas siv thiab muab koj cov PHI<br />
tawm raws li koj nyiam xwb:<br />
• Cov neeg kho koj, siv rau cov chaw yuav them koj cov nuj nqi kho koj<br />
• Kom kev tham txog koj tus mob thiab seb yuav kho koj li cas ntawd tsuas pub<br />
tham rau koj thiab koj tus kws kho mob nkaus xwb<br />
• Tsuas pub qhia rau koj tsev neeg thiab cov tib neeg uas kho koj ntawd nkaus xwb<br />
Koj yuav tsum sau ntawv tuaj rau hauv (Privacy Office) uas nyob rau hauv <strong>Mayo</strong><br />
<strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> no. Feem ntau mas <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yeej tsis tso cai<br />
rau koj yuav txiav tsi pub muab koj tej ntaub ntawv rau cov neeg uas ua hauj lwm<br />
nyob rau hauv <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> no vim hais tias yog koj txiav tsis pub lawv<br />
paub ces lawv yuav kho tsis tau koj.<br />
Muaj Cai Thov Seb Kom Siv Hom Kev Sib Txuas Lus Twg<br />
Seb yog koj nyiam kom <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> nrog koj sib tiv toj li cas no ces koj<br />
muaj cai hais rau <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> kom lawv ua li ntawd (xws li sau ntawv<br />
rau koj xwb poj) los yog seb koj xav kom lawv ntsib koj rau qhov twg. Piv txwv tias,<br />
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tej zaum koj xav kom lawv ntsib koj tom tsev los yog xa ntawv tuaj tom tsev nkaus<br />
xwb. Yog koj xav kom lawv ua li nov no koj yuav tsum tau sau ntawv tuaj rau ntawm<br />
(Privacy Office) seb koj nyiam kom lawv ua li cas.<br />
Muaj Cai Tau Ib Daim Qauv Ntawm Daim Ntawv<br />
(Notice of Privacy Practices)<br />
Yog koj xav tau daim ntawv Notice of Privacy Practices ua qauv no koj sau ntawv tuaj<br />
rau ntawm (Privacy Office) nyob rau hauv <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> no txhua txhua<br />
lub caij.<br />
Kev Tsis Txaus Siab (Complaints)<br />
Yog hais tias koj ntseeg hais tias <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> ua tsis raws cai rau tej yam<br />
twg lawm no koj sau tau ntawv tuaj rau: Privacy Office at <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong>,<br />
1400 Bellinger St. P.O. Box 1510, Eau Claire, WI 54702-1510 los yog xa rau Secretary<br />
of the Department of <strong>Health</strong> and Human Services, 200 Independence Avenue, S. W.,<br />
Washington, D.C. 20201<br />
<strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> txaus siab fwm koj txoj cai uas koj tsis txaus siab. <strong>Mayo</strong><br />
<strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav tsis lam, thiaj yuav tsis muaj cai lam foob koj vim koj kev<br />
tsis txaus siab rau <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong>. <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> yuav tuav<br />
nws txoj cai uas yuav ua kom tus tib neeg mob thiab cov chaw kho mob muaj kev yeej<br />
tib si.<br />
Tus Neeg Ua Hauj Lwm Xyuas Txog Qhov Tsis Pub Neeg Sab<br />
Nraud Paub thiab Cov Neeg Raug Xaiv Rau Ntawm Qhov Chaw<br />
(Privacy Official and Site Designees)<br />
Yog hais tias koj muaj lus nug dab tsi hais txog cov lus nyob rau hauv no, hu tau tuaj<br />
rau peb tus xov tooj 715-838-3221, los yog sau ntawv tuaj rau peb. Npe thiab chaw<br />
nyob yog, <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong>, 1400 Bellinger St., P.O. Box 1510, Eau Claire, WI<br />
54702-1510. Yog hais tias koj ho xav tiv tauj <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> lwm lub qhov<br />
chaw los koj hu tau rau cov xov tooj raws li nram qab no:<br />
• Barron. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .715-537-9942<br />
• Bloomer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .715-568-6179<br />
• Osseo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .715-597-8732<br />
• <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> – Pharmacy<br />
& Home Medical and Medical Store . . . . . . . . . . . . . . . . . . . . . . . . . . .715-838-5800<br />
• <strong>Mayo</strong> <strong>Clinic</strong> <strong>Health</strong> <strong>System</strong> – Supportive Home Care<br />
and Home <strong>Health</strong> & Hospice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .715-831-0100<br />
• Pain <strong>Clinic</strong> of Northwestern Wisconsin, S.C . . . . . . . . . . . . . . . . . . . .715-838-6562<br />
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HMONG 4739 PA 6/12
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