The URL can be used to link to this page

Home My WebLink AboutVeterans Affairs Mandated Reporting Releases 41 � DEPARTMENT OF VETERANS AFFAIRS Medical Center 4601 Veterans Drive St. Cloud MN 56303 ®2099 July 25, 2012 656/136P CHIEF OF POLICE In Reply Refer To: bAK PARK HEIGHTS POLICE DEPT 14168 OAK PARK BLVD PO BOX 2007 OAK PARK, MN 55082 Dear CHIEF OF POLICE, The purpose of this letter is to facilitate the process of reieasing reportable information by St. Cloud VA Health Care System (HCS) to the OAK PARK HEIGHTS POLICE DEPT. In order for the St. Cloud VA HCS to initiate a report of patient information required by Minnesota State law § 626.556, Subd. 3; § 626.557, Subd. 9; § 390.32; and § 626.52, VA must have authority under all federal privacy laws and regulations to disclose patient information. In order to cooperate with Minnesota State reporting requirements VA needs a "standing request" for this information from you in the form of a letter. The Health Insurance Portability and Accountability Act (HIPAA) of 1996, implemented under Title 45 CFR Parts 160 and 164, HIPAA does not require such "standing request ". it is, however, mandated by Title 38 U.S.C. 5701 and the federal Privacy Act of 1974, 5 U.S.C. Section 552a(b)(3). The request will be valid for a period of three years starting on the date we receive it. With your request on file, St. Cloud VA HCS will then have authority to contact you and transmit information under applicable State reporting laws. This standing request will not authorize disclosure of information needed in the pursuit of a focused (individual specific and /or incident specific) activity such as a civil or criminal law enforcement investigation. It is solely designed to authorize routine disclosure of repetitively occurring medical conditions or events that are mandated by State law for a provider to report, i.e. gunshot/suspicious wounds, violent death, child /elderly abuse, communicable diseases, etc.. Our authority to disclose drug abuse, alcoholism, sickle cell anemia or HIV - related information is prohibited with minimal exceptions under 38 U.S.C. 7332. Your written request for reportable information must state that the names, addresses and other information will be used for a purpose authorized by law, in accordance with 38 U.S.C. §5701 and 7332, that it will not be used for any other purpose than that stated in the request, and that the requesting agency is aware of the penalty provision of 38 U.S.C. § 5701(f)(2). This is a misdemeanor penalty carrying a fine of not more than $5,000 for a first offense and not more than $20,000 for a subsequent offense. To assist you in completing such a "standing request," we have prepared and enclosed a proposed letter that complies with our requirements. Be sure the letter is on your agency letterhead, dated, and that it is signed by the director or the head of your agency. Return it to the address listed above with the mailing code `656/136P'. Upon receipt of a current written request from your agency, St. Cloud VA HCS will have the legal authority it needs under federal release of information laws to contact you and provide information required by the State of Minnesota. If you need additional information about VA's release of information procedures, please contact Karen J. Rupp, St Cloud VA HCS Privacy /FOIA Officer at (320)255 -6408. Sincerely, BARRY I. AAHL Director St. Cloud VA Health Care System Enclosures: Standing Request Letters for: Maltreatment of Minors and Adults; Suspicious Wounds & Violent Death LICE DEPARTMENT 6 CITY OF OAK PARK HEIGHTS R <' 14168 Oak Park Blvd. N. ® P.O. Box 2007 Brian DeRosier Oak Park Heights, Minnesota 55082 Chief of Police Telephone: (651) 439 -4723 Fax: (651) 439-3639 Emergency: 911 REQUEST FOR REPORT OF SUSPICIOUS WOUNDS INCLUDING GUNSHOT WOUNDS AND VIOLENT DEATH I herby certify that I am l'`/ -3i' a fi'� (Title) of (Agency / Employer). My agency is required to investigate cases of suspicious wounds including gunshot wounds and violent death as defined in Minn. § 390.32 which may have occurred in the city of ��kk A" '/k, or �� `� an County. Additionally I am the proper authority as term is defined by Minn. § 626.52 to receive reports from health professionals regarding suspicious wounds. I hereby request that the St. Cloud VA Health Care System of the United States Department of Veterans Affairs report to my office any case involving any suspicious wounds or violent deaths. This request includes a request for the name and address of the injured or deceased person(s) and any relevant medical information considering said person(s). I understand that this is a continuing request that must be renewed every three years. I further understand that the authority for VA to release this information is found in 5 U.S.C. § 552a and 38 U.S.C. § 5701(f), and is intended to be a continuous request is valid for a period of three years starting on the date we receive it, or until changed or rescinded. I also understand that this request is not sufficient to enable release of information concerning patients having any of the following conditions: drug abuse, alcoholism, alcohol abuse, infection with the human immunodeficiency virus, and sickle cell anemia. I understand that release of that information requires compliance with 38 U.S.C. § 7332. Dated: (Signature) J / / (Printed Name) (Title) (Agency /Employer) POLICE DEPARTMENT CITY Of OAK PARK HEIGHTS 14168 Oak Park Blvd. N. • PO. Box 2007 Brian DeRosier Oak Park Heights, Minnesota 55082 Chief of Police Telephone: (651) 439 -4723 Fax: (651) 439 -3639 Emergency: 911 REQUEST FOR REPORT OF SUSPECTED CASES OF MALTREATMENT OF MINORS I hereby certify that I am Clit" C (Title) of T/ a2Lk AO /cC L S (Agency /Employer). My agency serves as the common entry point for reporting cases of suspected maltreatment of minors as defined in Minn. § 626.556, which may have occurred in city -aodC �ar k A or County pursuant to Minn. § 626.556, Subd. 3. I hereby request that the St. Cloud VA Health Care System of the United States Department of Veterans Affairs report to my office any case involving actual or suspected abuse, neglect and/or exploitation of minors along with possible concerns of self - neglect, which may have occurred in the above county. This request includes a request for the name and address of the affected minor(s) and any relevant medical information considering said person(s). I understand that this is a continuing request that must be renewed every three years. I further understand that the authority for VA to release this information is found in 5 U.S.C. § 552a and 38 U.S.C. § 5701(f), and is intended to be a continuous request is valid for a period of three years starting on the date we receive it, or until changed or rescinded. I also understand that this request is not sufficient to enable release of information concerning patients having any of the following conditions: drug abuse, alcoholism, alcohol: abuse, infection with the human immunodeficiency virus, and sickle cell anemia. I understand that release of that information requires compliance with M U.S.C. § 7332. Dated. (Signature) (Printed Name) (Title) (Agency /Employer) ., POLICE DEPARTMENT n CITY OF OAK PARK HEIGHTS w' 14168 Oak Park Blvd. N. • P.O. Box 2007 Brian DeRosier Oak Park Heights, Minnesota 55082 Chief of Police Telephone: (651) 439 -4723 Fax: (651) 439 -3639 Emergency: 911 REQUEST FOR REPORT OF SUSPECTED CASES OF MALTREATMENT OF VULNERABLE ADULTS I herby certify that I am (Title) of �1a Z /YC 1,?!) (Agency / Employer). My agency serves as the common entry point for reporting cases of suspected abuse of vulnerable adult(s) as defined in Minn. § 626.557 which may have occurred in city of 4/' k 4 9 '1 i' fS or County pursuant to Minn. § 626.557, Subd. 9: I hereby request that the St. Cloud VA Health Care System of the United States Department of Veterans Affairs report to my office any case involving actual or suspected abuse, neglect and/or exploitation of vulnerable adults along with possible concerns of self which may have occurred in the above county. This request includes a request for the name and address of the affected person(s) and any relevant medical information considering said person(s). I understand that this is a continuing request that must be renewed every three years. I further understand that the authority for VA to release this information is found in 5 U.S.C. § 552a and 38 U.S.C. § 570I(f), and is intended to be a continuous request is valid for a period of three years starting on the date we receive it, or until changed or rescinded. I also understand that this request is not sufficient to enable release of information concerning patients having any of the following conditions: drug abuse, alcoholism, alcohol abuse, infection with the human immunodeficiency virus, and sickle cell anemia. I understand that release of that information requires compliance with 38 U.S.C. § 7332. Dated. G (Signature) (Printed Name) (Title) (Agency /Employer)