CEEB TOOM TXOG TEJ YAM NTIAG

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1 TSAB CEEB TOOM NO QHIA TXOG COV TXHEEJ XWM COV TSHUAJ UAS TEJ ZAUM YUAV TAU SIV RAU KOJ THIAB NTHUAV TAWM THIAB KOJ YUAV NKAG RAU MUS SAIB COV TXHEEJ XWM NO LI CAS.THOV UA TWB ZOO NYEEM NWS KOM ZOO. Peb yuav tsum tau ua raws li kev cai lij choj rau: Kaws tej txheej xwm txog tshuaj uas yuav coj los kho koj tsis pub leej twg paub thiab zais cia. Muab tsab ceeb toom no rau koj kom koj paub txog peb txoj hauj lwm saum cai lij choj thiab tej yam ntiag tug uas yuav tau saib siab koj cov txheej xwm kev kho mob. Yeem ua raws li peb tsab ceeb toom hais txog Ntiag tug. Tham txhua yam kev hloov nyob rau hauv tsab ceeb toom rau koj. ntsuam koj cov kev kho mob. Leej Twg Thiaj Ua Raws Tsab Ceeb Toom No: Tag nrho cov rooj tsav xwm thiab txhua chav ua hauj lwm. Tag nrho cov neeg ua hauj lwm, cov tuav dej num thiab lwm tus neeg ua hauj lwm nyob hauv chav ua hauj lwm. Tag nrho txhua yam uas muaj cai, thaj chaw thiab cheeb tsam uas muaj qhov chaw saib xyuas mob nkeeg nyob rau chav ua hauj lwm no thiab siv tib tug laj txheej kev ua hauj lwm raws tsab ceeb toom no.ib qho ntxiv, cov kev muaj cai, thaj chaw thiab cheeb tsam no tej zaum kuj yuav sib qhia cov ntaub ntawv kho mob rau txhua qhov chaw paub kho mob, kev them nyiaj lossis hom phiaj kev phais mob raws qhov tau hais tseg hauv tsab ntawv ceeb toom. Txhua tus xyaum ua hauj lwm uas peb tso cai pab koj thaum koj tseem nyob hauv chav ua hauj lwm. Txhua tus tub ntxhais kawm kho mob, xyaum ua hauj lwm, cov sib pauv kawm kev paub uas peb tso cai pab koj thaum koj tseem nyob rau chav ua hauj lwm. Txhua tus sawv cev chaw lag luam ivsaslas, koom haum saib xyuas cov chaw saib xyuas, koom haum tshawb fawb kev kho mob nkeeg, Koom haum tshawb fawb txheej xwm, lossis koom haum txim kho kev zoo zuj zus uas koom rau kev soj

2 Siv thiab Nthuav tawm kev Kho mob, kev Them nyiaj thiab Kev Saib Xyuas Kev Kho Mob Kev kho mob:tej zaum peb kuj yuav siv koj cov txheej xwm kho mob mus muab rau, koom tes, thiab tsav tswj koj li kev saib xyuas thiab kho mob.piv txwv tias, Minnesota Gastroenterology, P.A. tus muab kev pab cuam tej zaum yuav faib koj cov txheej xwm nrog lwm tus kws kho mob txhawm rau kev sab laj.peb yuav thov koj tso cai uas yog muaj ntaub ntawv zias txhawm rau kev nthuav tawm sab nrauv dhau ntawm Minnesota Gastroenterology, P.A. txhawm rau kev kho mob, tshwj qhov yog muaj mob ti tes ti taw es tsis tuaj yeem thov tau koj li kev tso cai xwb. Kev them nyiaj:tej zaum peb kuj yuav siv thiab nthuav tawm koj cov txheej xwm kho mob yog li kev kho mob thiab kev pab cuam uas koj tau txais tej zaum yuav xa cov nqi tuaj, thiab kev them nyiaj tej zaum yuav sau los ntawm, koj, tuaj txhab ivsaslas, lossis lwm tus neeg thib peb.piv txwv tias, tej zaum peb kuj yuav muab koj cov phiaj xwm kho mob tej txheej xwm kho mob uas koj tau txais nyob rau ntawm Minnesota Gastroenterology, P.A.yog li koj qhov phiaj xwm kho mob yuav them peb lossis rov thim koj li nyiaj kho mob.tej zaum peb kuj yuav qhia koj qhov phiaj xwm kho mob txog kev kho mob uas tab tom yuav mus kho koj txhawm rau tau kev tso cai lossis xam seb koj qhov phiaj xwm kho mob puas duav tau qhov kev kho mob no.peb yuav thov kev tso cai ua ntej txhawm rau nthuav tawm tej kev them nyiaj. Kev Leg Hauj Lwm Kho Mob:Tej zaum peb yuav siv thiab nthuav tawm koj cov txheej xwm kho mob rau Minnesota Gastroenterology, P.A. cov kev leg hauj lwm kho mob.kev leg hauj lwm kho mob yog kev siv thiab nthuav tawm tej txheej xwm uas nwv yuav tsum tau khiav rau Minnesota Gastroenterology, P.A. thiab ua txhua yam txhawm rau cov neeg mob tau txais kev kho mob zoo.piv txwv tias, tej zaum peb yuav siv cov txheej xwm kho mob los kho peb cov kev kho mob thiab kev pab cuam, thiab txhawm rau soj ntsuam lub peev xwm ntawm peb cov neeg ua hauj lwm thiab kws kho mob uas saib xyuas koj.peb yuav thov ntawv tso cai ua ntej nthuav tawm tej txheej xwm mus rau sab nrauv dhau ntawm Minnesota Gastroenterology, P.A. txhawm rau lub hom phiaj kev leg hauj lwm kho mob nkeeg. 1

3 Tej zaum peb yuav nthuav tawm cov txheej xwm kho mob rau cov hauj lwm hauv qab no: Ceeb Toom Teem Caij thiab Lwm Yam Txheej Xwm Kho Mob:Tej zaum peb yuav siv koj cov txheej xwm kho mob los ua txog qhov yam mob tshiab lossis lwm txoj kev xaiv rau kev kho mob lossis kev pab cuam kho mob lwm yam.tej zaum peb kuj yuav tiv tauj koj txog tej yam mob tshiab lossis lwm txoj kev xaiv rau kev kho mob lossis kev pab cuam kho mob lwm yam. Txhawm Rau Tsis Pub Xeeb Muaj Mob Nyhav lossis Kev Nyab Xeeb:Tej zaum peb yuav siv thiab nthuav tawm cov txheej xwm kho mob thaum yuav tsum tau coj los kho koj uas yog thaum koj muaj mob nyhav lawm thiab txhawm rau kev nyab xeeb lossis kev nyab xeeb rau neeg sab nrauv lossis lwm tus neeg.txhua yam kev nthuav tawm yuav tsum yog tias pab tiv thaiv tau qee tus ntawm txoj kev mob nkeeg.ib qho ntxiv, Minesota cov kev cai lij choj feem ntau tsis tso cai cov kev nthuav tawm no tshwj tsis yog tias peb tau kev tso cai ua ntaub ntawv zias kom ua li lossis kev nthuav tawm yog tau kev tso cai los ntawm kev cai lij choj, nrog rau cov cwj ciam nyob rau hauv Minnesota Gastroenterology, P.A. cov neeg kho mob muaj "txoj hauj lwm ceev faj". tawm cov txheej xwm kho mob rau koj tsev neeg lossis lwm tus neeg uas tsob zeem yog peb xav tias yuav yog qhov koj nyiam tshaj, nrog rau thaum ti tes ti taw. Raws Li Cai Lij Choj Ntos Tseg:Peb yuav nthuuav tawm cov txheej xwm kho mob txog koj thaum peb rau tsoom fwv, xeev, lossis kev cai lij choj. Txhawm Rau Tus Neeg Pab Kho Mob Rau Koj:Minnesota Gastroenterology, P.A. tsuas yog nthuav tawm cov txheej xwm kho mob rau cov uas los kho koj, cov pab koj them koj cov nqi, lossis lwm tus neeg hauv tsev uas ze koj lossis phooj ywg zoo yog cov neeg no xav paub cov txheej xwm no los pab koj, thiab ces tsuas yog muab kev tso cai raws li kev cai lij choj.tej zaum peb kuj, piv txwv tias, muab ib txhia cov txheej xwm kho mob qhia rau cov neeg hauv tsev kom paub mus nqa tshuaj rau koj.feem ntau, peb yeej yuav thov kev tso cai ua ntaub ntawv zias txhawm rau kev nthuav tawm txog koj rau koj tsev neeg lossis cov phooj ywg.yog tias koj tsis tuaj yeem yuav pab tau koj tus kheej txog kev txiav txim siab, Minnesota Gastroenterology, P.A. yuav thov kev tso cai ua ntej siv koj cov txheej xwm kev kho mob rau cov hom phiaj uas hais no.yog tias koj tsis tuaj yeem yuav pab tau koj tus kheej txiav txim siab, Minnesota Gastroenterology, P.A. yuav nthuav 2

4 Tshawb Fawb:Tsoom fwv tsab cai lij choj tso cai rau Minesota Gastroenterology, P.A. los siv koj cov txheej xwm kho mob rau lub hom phiaj los ua kev tshawb fawb, tab txawm yog koj tshwj xeeb, sau ntawv tso cai lossis thaum qhov kev tshawb fawb tau rov saib xyuas kev tiv thaiv ntiag tug los ntawm Tsoom Thawj Coj Qhov Kev Saib Xyuas lossis Cov Thawj Coj Saib Kev Tswj Ntiag tug ua ntej pib qhov kev tshawb fawb.nyob rau qee zaum, cov tub tshawb fawb tej zaum kuj yuav tau kev tso cai siv cov txheej xwm yam muaj cwj ciam txhawm rau kev tshawb fawb lossis cov neeg koom tes yam tsim nyog.minesota tsab cai lij choj feem ntau yuav tsum tau ua yog peb yuav tsum tau kev tso cai ua ntej peb nthuav tawm koj cov txheej xwm kho mob rau lwm tus tub tshawb fawb sab nrauv.peb yuav ua twb zoo mob siab thov kev tso cai ntawm koj lossis tsis kam koom rau kev tshawb fawb, raws li kev cai lij choj, ua ntej yuav tso tawm tej yam txheej xwm qhia tau tias yog koj rau lwm tus tub tshawb fawb sab nrauv. Txhawm Rau Koom Haum Kev Lag Luam:Ib txhia kev pab cuam yog muab los ntawm lossis rau Minnesota Gastroenterology, P.A. los ntawm kev ua ntawv cog lus nrog cov koom haum kev lag luam.piv txwv muaj nrog Minnesota Gastroenterology, P.A. cov kws lij choj, neeg sab laj, koom haum sau nqi thiab koom haum ntaus nqi lub koob npe.tej zaum peb kuj yuav nthuav tawm koj tej txheej xwm rau peb cov koom haum kev lag luam yog li kom lawv thiaj ua tau lawv cov hauj lwm uas tau muaj ntawv cog lus nrog lawv. Txhawm rau tiv thaiv cov txheej xwm uas nthuav tawm, txhua lub koom haum kev lag luam yuav tsum kos npe cog lus ceev tej txheej xwm cia kom zoo tsim nyog thiab tsis txhob nthuav tawm cov txheej xwm ntxiv tshwj tsis yog tias kev cai lij choj tso cai. Kev Pub Khoom Nruab Nrog Cev:Yog tias koj yog ib tug neeg pub koom nruab nrog cev, tej zaum peb yuav tso tawm koj cov txheej xwm kho mob rau lub koom haum uas yuav phais koj cov khoom nruab nrog cev, hloov qhov muag, hloov nqaij lossis rau lub tuam txhab khaws tej khoom nruab nrog cev, txhawm rau thiaj paub khaws tej khoom nruab nrog cev kom zoo yam tsim nyog. Tub rog thiab Qub tub nrog:og tias koj yog ib tug tub rog, peb yuav nthuav tawm koj cov txheej xwm raws li kev tso cai ntawm kev tsav tswj tsoom tub rog yog tias peb yuav tsum tau ua li ces ua raws cai lij chojxwb, lossis yog thaum peb tau ntawv tso cai los ntawm koj.tej zaum peb kuj yuav tso tawm cov tsheej xwm kho mob txog cov ua hauj lwm tub rog txawwv teb chaws kom raws li cov cai nrawm feem tub rog txawv teb chaws ntawv raws li kev cai lij choj, lossis sau ntawv thov kev tso cai. 3

5 Kev Kho Mob Neeg Sab Nrauv:Tej zaum peb kuj yuav nthuav tawm koj tej txheej xwm kho mob rau tej hauj lwm kho mob neeg sab nrauv.cov hauj lwm no feem ntau muaj xws li hauv qab no: o Txawm rau thiv thaiv lossis tswj kab mob, raug mob lossis xiam oob khab o Txhawm rau qhia kev yug thiab tag lub neej txoj sia o Txhawm rau qhia txog kev ua phem rau me nyuam yaus thiab ciav cais o Txhawm rau qhia kev tsis haum tshuaj lossis kev muaj teeb meem txog ib hom tshuaj twg o Txhawm rau ceeb toom rau neeg txog kev hu rov qab ib hom tshuaj uas lawv tab tom yuav siv o Txhawm rau ceeb toom qhia tus neeg uas nws tau tus kab mob lossis tej zaum yuav phom sij txog kev nthuav txav lossis kis kab mob lossis muaj tus yam ntxwv o Txhawm rau ceeb toom qhia tsoom fwv yog peb ntseeg ib tug neeg raug ua phem, quab yuam lossis kev ua phem hauv sim neej.peb tsuas yog nthuav tawm yog koj pom zoo lossis yog kev cai lij choj tso cai Them Nqi Zog:Tej zaum peb kuj yuav nthuav tawm txheej xwm kev khoo mob rau cov tes dej num them nyiaj nqi zog thiab tes hauj lwm uas muaj ntsis thooj li.cov tes dej num no muab txiaj ntsim ntsig txog rau cov hauj lwm raug mob lossis muaj mob. Hauj lwm Tsom Kwm Kev Mob Nkeeg:Tej zuam peb kuj yuav nthuav tawm koj cov txheej xwm kho mob rau koom haum tsom kwm kev mob nkeeg raws li kev tso cai los ntawm kev cai lij choj.cov hauj lwm tsom kwm no muaj, piv txwv, kev tshawb xyuas, kev ntxig nug, kev saib xyuas, thiab kev tso cai.cov tes dej num no yuav tsum yog tsoom fwv los soj ntsuam tej txheej txheem kev kho mob nkeeg, tsoom fwv cov tes dej num, thiab raug raws tsab cai saib kev ncaj ncee rau tib neeg. mob raws ntawv txib, ntawv thov tshawb, lossis lwm yam txheej txheem kev cai los ntawm lwm tus uas koom hauv kev txiav txim, tiam sis tsuas yog tias yog muaj peev xwm qhia koj txog cov kev thov lossis thov kom tiv thaiv cov txheej xwm uas thov mus ntawv. Hauj Lwm Kev Ruaj Ntseg thiab Kev Txawj Ntse:Tej zaum peb yuav tso tawm koj cov txheej xwm kho mob tawm rau cov tsoom fwv raug raws kev cai rau fab kev txawj ntse, suav xam kev txawj ntse thiab lwm txoj hauj lwm kev ruaj ntseg hauv teb chaws uas tau kev tso cai los ntawm kev cai lij choj. Hais plaub thiab Kev muaj lus:yog tias koj raug plaub ntug lossis kev muaj lus, tej zaum peb yuav nthuav tawm koj cov txheej xwm kev kho mob raws li tsev hais plaub thov lossis tsab ntawv tuaj hauv tsev hais plaub tuaj kom nthuav tawm.peb kuj yuav tau nthuav tawm koj cov txheej xwm kho 4

6 Ua Raws Kev Cai Lij Choj:Tej zaum peb kuj yuav tso tawm cov tsheej xwm kho mob yog muaj neeg thov kom muab uas yog raug raws kev cai lij choj: o Ua raws ntawv txiv hauv tsev hais plaub, kev txiav txim, kev lav, ntawv hu lossis cov txheej txheem sib thooj li o Txhawm rau qhia lossis txheeb thaj chaw tus neeg ntxim li yog, tus khiav nkaum, tej khoom pov thawj, lossis tus neeg uas ploj lawm o Hais txog tus neeg phem yog tias, nyob rau qee tus cwj ciam, peb tsis tuaj yeem yuav thov tau kev pom zoo o Hais txog ib tug neeg tag sim neej uas ntseeg tias yog muaj neeg phem tua o Hais txog chav ua hauj lwm saib kev ua phem lossis yeej saib xyuas kev mob ti tes ti taw o Thaum tites ti taw uas qhia ib tug neeg phem; thaj chaw ntawm tus neeg phem lossis neeg raug ua phem; lossis qhia tus kheej, qhia lossis thaj chaw tus neeg uas nws hawv yuav ua phem Cov tub ceev xwm nrhiav pov thawj cov neeg raug tua, Cov kws kho mob tus Thawj Coj hauv Chav cia qauv:tej zaum peb yuav tso tawm cov txheej xwm kho mob rau tus neeg tshawb nrhiav pov thawj neeg tuag lossis tus neeg kuaj cov neeg mob.qhov no tej zaum yuav tsum tau, piv txwv tias, txhawm rau nrhiav qee tus neeg tus yam kab mob lossis nrhiav seb vim li cas thiaj tag sim neej.tej zaum peb kuj yuav tso tawm cov txheej xwm kho mob rau tus thawj tswj hauv tsev txias txhawm rau lawv yuav ua lawv txoj hauj lwm. Neeg raug txim:yog tias koj yog ib tug neeg raug txim kho kom rov zoo lossis raug txiav txim raws kev cai lij choj, tej zaum peb kuj yuav tso tawm koj cov txheej xwm kho mob rau tsev teem txim lossis chav ua hauj lwm txiav txim.qhov no yuav muaj qhov zoo (1) rau tsev teem txim tau muab kev saib xyuas mob nkeeg rau koj; (2) txhawm rau tiv thaiv thiab ua kev nyab xeeb lossis kev mob nkeeg thiab kev nyab xeeb rau lwm tus; (3) txhawm rau kev nyab xeeb thiab ruaj ntseg ntawm tsev teem txim. Kev pab cuam nquag plias rau Tus tuam thawj thiab lwm tus:tej zaum peb yuav nthuav tawm cov txheej xwm kho mob rau tsoom fwv uas tau kev tso cai txhawm rau ua kev tiv thaiv tus tuam thawj, lwm tus neeg tau kev tso cai lossis tus thawj tswv xeev txawv teb chaws, lossis yuav tau ua kev tshawb nrhiav tshwj xeeb.tej zaum peb yuav siv koj cov txheej xwm kho mob los ua kev txiav txim siab kev kho mob rau koj kom muaj kev ruaj ntseg lossis pab rau koj mus txawv teb chaws.peb kuj yuav tau tso tawm koj cov kev kho mob txhawm rau kev suav xam rau tsoom fwv cov rooj tsav xwm hauv xeev uas xav tau cov txheej xwm rau cov hom phiaj no. 5

7 Siv thiab Nthuav tawm uas tau kev tso cai los ntawm koj: Siv thiab Nthuav tawm uas tau kev tso cai los ntawm koj:tshwj qhov li hais los sab sauv, Minnesota Gastroenterology, P.A., yuav tsis siv lossis nthuav tawm koj cov txheej xwm kev kho mob uas tsim nyov tiv thaiv uas tsis tau kev tso cai sau ua ntaub ntawv zias los ntawm koj.piv txwv tias saib xyuas uas yog kev ntseeg, kiab khw kev sib txuas ncauj txuas lus thiab muag PHI tag nrho tsis tau kev tso cai yog tsis tau kev tso cai ua ntaub ntawv zias.yog tias koj muab kev tso cai rau peb uas yog muaj ntaub ntawv zias tso cai peb siv cov txheej xwm kho mob, koj kuj tuaj yeem yuav thim tau, sau ntawv thim, tau txhua lub sij hawm.yog koj thim koj li kev tso cai, peb yuav tsis siv lossis nthuav tawm koj cov txheej xwm kev kho mob txij li cov uas koj tau sau tso cai, txhwj qhov cwj ciam uas peb tau siv koj qhov kev tso cai tag lawm xwb.peb tsis tuaj yeem yuav thiv cov uas peb twb muab nthuav tawm tag lawm uas yog tau kev tso cai los ntawm koj, thiab peb yuav tau khaws tej ntaub ntawv kev saib xyuas uas peb muaj rau koj. Koj Txoj Cai Txog Cov Txheej Xwm Kho Mob: Cai Hais Txog Lub Npe Kev Nthuav Tawm:Koj muaj cai thov ib "lub npe nthuav tawm."nov yog cov npe nthuav tawm peb ua txog cov txheej xwm nthuav tawm txog koj. o Txhawm rau thov cov npe no lossis lub npe nthuav tawmm, koj yuav tau xa koj qhov ntawv thov mus rau Minnesota Gastroenterology, P.A.Attn:Privacy Officer, PO Box Minneapolis, MN Koj qhov kev thov yuav tsum qhia ncua sij hawm uas tsis ntev tshaj rau lub xyoo thiab yuav tsum tsis muaj lub sij hawm ua ntej lub Plaub Hlis 14, 2003.Koj qhov kev thov yuav tsum qhia tias koj xav tau hom twg ntawm cov npe (piv txwv tias, ua ntawv, islevtausniv)thawj daim npe koj thov tsis dhau 12-hlis yog yuav tau dawb.yog xav tau cov npe ntxiv, peb yuav tau kom koj them nyiaj tus nqi uas peb muab rau koj.peb yuav qhia rau koj txog tus nqi thiaj koj kuj tuaj yeem thim lossis kho koj qhov kev thov thaum lub sij hawm ntawv ua ntej yuav tau them nyiaj. Cia Ceeb Toom Rau Cov Caj Ceg:Minnesota Gastroenterology, P.A. raws li cai lij choj yuav tau ceeb toom rau tus neeg uas raug kev nthuav tawm txhheej xwm kho mob tab txawm yuav nyob rau cov caj ceg ntawm. 6

8 Cai Saib thiab Luam Tawm:Koj muaj cai saib thiab luam cov txheej xwm kho mob uas tej zaum yuav tau siv coj los txiav txim siab txog koj li kev saib xyuas.feem ntau, yog cov tshuaj thiab ntawv nuj nqis. o Yog koj xav saib thiab luam koj cov txheej xwm kho mob, koj yuav tsum xa ib daim ntawv tuaj thov ua ntaub ntawv zias:minnesota Gastroenterology, P.A.; Attn:Privacy Officer, PO Box 14909; Minneapolis, MN o Yog koj thov luam ib co txheej xwm, peb yuav kom them nqi raws li tus nqi luam hauv toj kev cai lij choj, txog kev xa lossis lwm yam nqi ntsig txog kev muab cov ntaub ntawv raws li qhov koj thov. o Tej zaum koj cov kev thov saib thiab luam yuav tsis tau lossis nyob rau tus cwj ciam qee zaus.yog koj thov tsis tau koj cov txheej xwm kho mob, koj tuaj yeem thov kom rov saib dua seb yog li cas thiaj thov tsis tau.peb yuav qhia tias kev rov saib dua yog li cas. Cai thov Ntxiv:Yog tias koj hnov tias koj cov txheej xwm kho mob tsis raug lawmm lossis tsis muaj tsis txhua, koj tuaj yeem hais kom peb ntxiv rau.koj muaj cai thov ntxiv cov txheej xwm mus ntev li ntev tau yog tias cov ntaub ntawv tseem cia nyob hauv peb qhov chaw ua hauj lwm. Raug thiab ua tiav lawm o o Thov ntxiv, koj qhov ntawv thov ntxiv yuav tsum xa mus rau:minnesota Gastroenterology, Attn:Privacy Officer, PO Box 14909; Minneapolis, MN Ib qho ntxiv, koj yuav tau npaj pov thawj tias vim li cas koj thiaj xav ntxiv. Tej zaum peb yuav tsis kam li koj thov yog tsis sau ua ntaub ntawv zias lossis tsis muaj pov thawj txaus.ib qho ntxiv, tej zaum peb kuj yuav tsis kam yog koj kom peb ntxiv cov txheej xwm uas: Tsis yog tsim los ntawm peb, tshwj tsis yog tias tus neeg lossis qhov chaw tsim cov txheej xwm ntawv tsis nyob lossis tsis muaj yuav ntxiv tau lawm Tsis yog ib feem ntawm kev kho mob khaws cia rau chav ua hauj lwm Tsis yog feem uas koj muaj cai saib thiab luam tawm tau 7

9 Cai Thov Kev Sib Txuas Lus Tsis Pub Neeg Paub: Koj muaj cai thov kev sib txuas lus tsis pub neeg paub.piv txwv tias, koj tuaj yeem thov tias peb yuav tsum tiv tauj koj ntawm hauj lwm lossis sau ntawv xwb.koj yuav tsum sau ntawv thov xa mus rau Minnesota Gastroenterology, P.A., Attn:Privacy Officer, PO Box Minneapolis, MN Peb yuav tsis nug koj tias yog vim li cas koj ho thov kom ua li ntawv.peb yuav pab ua li hais yam tsim nyog ua.koj qhov kev thov yuav tsum qhia meej tias yuav tiv tauj li cas thiab qhov chaw twg uas koj xav teem. Cai Thov Txwv:Koj muaj cai thov txwv koj cov txheej xwm kho mob uas peb siv lossis nthuav tawm, kev them nyiaj lossis kev khiav hauj lwm saib kev mob nkeeg.piv txwv tias, koj tuaj yeem thov tias peb tsis txhob siv lossis nthuav tawm cov txheej xwm phais koj tus mob.peb kuj yuav tsis tas yuav tsum pom zoo li koj thov.yog tias peb pom zoo, peb yuav ua li koj thov tshwj tsis yog tias yuav tsum tau siv cov txheej xwm thaum muaj qhov ti tes ti taw es yuav tau siv kho mob rau koj.yog tias koj them tag nrho koj tus nqi kho mob lossis cov khoom tawm hauv hnab ris, li cas los xij, peb yuav thov txwv kev nthuav tawm rau phiaj xwm kho mob lossis cov ivsaslas rau lub hom phiaj kev them nyiaj lossis kev leg hauj lwm kev mob nkeeg tshwj tsis yog tias tso cai los ntawm kev cai lij choj lossis siv rau lub hom phiaj kho mob. o Txhawm rau thov txwv, koj yuav tau sau ntawv thov txwv mus rau Minnesota Gastroenterology, P.A.Attn:Privacy Officer, PO Box Minneapolis, MN Nyob rau koj qhov kev thov, koj yuav tsum qhia peb (1) yam txheej xwm dab tsi koj xav kom txwv; (2) tab txawm koj xav kom txwv tsis pub peb siv, thiab txwv nthuav tawm tib si; thiab (3) rau cov koj xav kom txwv, piv txwv li tias kev nthuav tawm rau koj tus txij nkawm. Cai Luam Daim Ceeb Toom No:Koj tuaj yeem thov kom peb luam daim ceeb toom no rau koj ib tsab tau txhua lub sij hawm.tab txawm tias koj yuav tau pom zoo txaus tsab ceeb toom no hauv eslevtausniv lawm, koj kuj yeej tseem muaj cai tau txais tsab ceeb toom ua ntawv luam rau koj. toom no uas yog mus rub hauv peb lub vas sab: o Txhawm rau tau txais tsab ceeb toom no ua ntawv, tiv tauj rau Minnesota Gastroenterology, P.A.: Mail- Attn:Privacy Officer, PO Box 14909; Minneapolis, MN Xov tooj , opt 2 o Koj tej zaum kuj yuav tau txais tsab ceeb 8

10 Lus nug thiab Lus tsis txaus siab Hais kev tsis txaus siab:yog koj ntseeg tias koj raug quab yuam los ntawm ntiag tug, koj tuaj yeem hais kev tsis txaus siab nrog peb chav ua hauj lwm, lossis nrog Rooj Tsav Xwm Kev Noj Qab Haus Huv thiab Pab Cuam Tib Neeg.Peb yuav tsis rau txim vim yog hais kev tsis txaus siab.tag nrho cov kev tsis txaus siab yuav tsum hais uas yog sau ua ntaub ntawv zias. Txhawm rau hais kev tsis txaus siab nrog: Peb Chav Hauj Lwm: Minnesota Gastroenterology, P.A.Attn:Patient Advocate Box P.O Minneapolis, MN Kev Noj Qab Haus huv thiab Pab Cuam Tib Neeg: US Rooj Tsav Xwm Pab Cuam Tib Neeg Attn.:Office of Civil Rights 200 Independence Ave.SW Washington, D.C txais rau yav tom ntej.peb yuav lo ib tsab ceeb toom tam sim no rau ntawm peb chav ua hauj lwm.tsab ceeb toom no yuav muab rau koj thaum pib qhov kev kho mob thawj zaug thiab ib xyoos ib zaug yog li ntawv. Koom Haum Koom Hauv Tsab Ceeb Toom no Tsab ceeb toom no siv rau kev siv lwm tus ntiag tug hauv Minnesota Gastroenterology P.A. thiab cov muab kev saib xyuas mob thiab cov chaw muaj npe hauv qab no, thiab lawv cov chaw ua hauj lwm. o Kws Tso Tshuaj Loog hauv Community o Yeej East Metro Endoscopy o Minnesota Gastroenterology ASC, LLC Lus nug thiab Txheej xwm ntau ntxiv:yog koj muaj lus nug lossis xav paub txheej xwm ntau ntxiv txog peb ltej kev cev txheej xwm ntiag tug tshwj xeeb ntsig txog tsab ceeb toom no thov tiv tauj rau Feem Tswj Txheej Xwm Kho Mob (HIM) btawm , opt 2. Kev Hloov Tsab Ceeb Toom No:Peb txwv tsis pub hloov tsab ceeb toom notsab ceeb toom no pib siv tau txij lub Plaub Hlis 14, 2003 thiab nws yuav siv tau mus kom txog thaum peb hloov nws.peb txwv tsis pub hloov lossis kho tsab ceeb toom siv thoob plaws raug tag nrho cov txheej xwm kho mob uas peb twb muaj koj nyob hauv thiab nrog rau cov txheej xwm uas peb tseem yuav tau 9