NOTICE OF PRIVACY PRACTICES
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1 NOTICE OF PRIVACY PRACTICES This Notice is effective March 26, 2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY WE ARE REQUIRED BY LAW TO PROTECT MEDICAL INFORMATION ABOUT YOU We are required by law to protect the privacy of medical information about you and that identifies you. This medical information may be information about healthcare we provide to you or payment for healthcare provided to you. It may also be information about your past, present, or future medical condition. We are also required by law to provide you with this Notice of Privacy Practices explaining our legal duties and privacy practices with respect to medical information. We are legally required to follow the terms of this Notice. In other words, we are only allowed to use and disclose medical information in the manner that we have described in this Notice. We may change the terms of this Notice in the future. We reserve the right to make changes and to make the new Notice effective for all medical information that we maintain. If we make changes to the Notice, we will: Post the new Notice in our waiting area. Have copies of the new Notice available upon request. Please contact our Privacy Officer at to obtain a copy of our current Notice). The rest of this Notice will: Discuss how we may use and disclose medical information about you. Explain your rights with respect to medical information about you. Describe how and where you may file a privacy-related complaint If, at any time, you have questions about information in this Notice or about our privacy policies, procedures or practices, you can contact our Privacy Officer at WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU IN SEVERAL CIRCUMSTANCES
2 We use and disclose medical information about patients every day. This section of our Notice explains in some detail how we may use and disclose medical information about you in order to provide healthcare, obtain payment for that healthcare, and operate our business efficiently. This section then briefly mentions several other circumstances in which we may use or disclose medical information about you. For more information about any of these uses or disclosures, or about any of our privacy policies, procedures or practices, contact our Privacy Officer Treatment We may use and disclose medical information about you to provide healthcare treatment to you. In other words, we may use and disclose medical information about you to provide, coordinate or manage your healthcare and related services. This may include communicating with other healthcare providers regarding your treatment and coordinating and managing your healthcare with others. Example: Jane is a patient at the health department. The receptionist may use medical information about Jane when setting up an appointment. The nurse practitioner will likely use medical information about Jane when reviewing Jane s condition and ordering a blood test. The laboratory technician will likely use medical information about Jane when processing or reviewing her blood test results. If, after reviewing the results of the blood test, the nurse practitioner concludes that Jane should be referred to a specialist, the nurse may disclose medical information about Jane to the specialist to assist the specialist in providing appropriate care to Jane. Payment We may use and disclose medical information about you to obtain payment for healthcare services that you received. This means that, within the health department, we may use medical information about you to arrange for payment (such as preparing bills and managing accounts). We also may disclose medical information about you to others (such as insurers, collection agencies, and consumer reporting agencies). In some instances, we may disclose medical information about you to an insurance plan before you receive certain healthcare services because, for example, we may need to know whether the insurance plan will pay for a particular service.
3 Example: Jane is a patient at the health department and she has private insurance. During an appointment with a nurse practitioner, the nurse practitioner ordered a blood test. The health department billing clerk will use medical information about Jane when he prepares a bill for the services provided at the appointment and the blood test. Medical information about Jane will be disclosed to her insurance company when the billing clerk sends in the bill. Example: The nurse practitioner referred Jane to a specialist. The specialist recommended several complicated and expensive tests. The specialist s billing clerk may contact Jane s insurance company before the specialist runs the tests to determine whether the plan will pay for the test. Healthcare Operations We may use and disclose medical information about you in performing a variety of business activities that we call healthcare operations. These healthcare operations activities allow us to, for example, improve the quality of care we provide and reduce healthcare costs. For example, we may use or disclose medical information about you in performing the following activities: Reviewing and evaluating the skills, qualifications, and performance of healthcare providers taking care of you. Providing training programs for students, trainees, healthcare providers or nonhealthcare professionals to help them practice or improve their skills. Cooperating with outside organizations that evaluate, certify or license healthcare providers, staff or facilities in a particular field or specialty. Reviewing and improving the quality, efficiency and cost of care that we provide to you and our other patients. Improving healthcare and lowering costs for groups of people who have similar health problems and helping manage and coordinate the care for these groups of people. Cooperating with outside organizations that assess the quality of the care others and we provide, including government agencies and private organizations. Planning for our organization s future operations. Resolving grievances within our organization.
4 Reviewing our activities and using or disclosing medical information in the event that control of our organization significantly changes. Working with others (such as lawyers, accountants and other providers) who assist us to comply with this Notice and other applicable laws. Reviewing and evaluating the skills, qualifications, and performance of healthcare providers taking care of you. Providing training programs for students, trainees, healthcare providers or nonhealthcare professionals to help them practice or improve their skills. Cooperating with outside organizations that evaluate, certify or license healthcare providers, staff or facilities in a particular field or specialty. Reviewing and improving the quality, efficiency and cost of care that we provide to you and our other patients. Improving healthcare and lowering costs for groups of people who have similar health problems and helping manage and coordinate the care for these groups of people. Cooperating with outside organizations that assess the quality of the care others and we provide, including government agencies and private organizations. Planning for our organization s future operations. Resolving grievances within our organization. Reviewing our activities and using or disclosing medical information in the event that control of our organization significantly changes. Working with others (such as lawyers, accountants and other providers) who assist us to comply with this Notice and other applicable laws. The following uses and disclosures of medical information about you will only be made with your authorization (signed permission): Uses and disclosures for marketing purposes. Uses and disclosures that constitute the sales of medical information about you. Most uses and disclosures of psychotherapy notes, if we maintain psychotherapy notes.
5 Any other uses and disclosures not described in this Notice. YOU HAVE RIGHTS WITH RESPECT TO MEDICAL INFORMATION ABOUT YOU You have several rights with respect to medical information about you. This section of the Notice will briefly mention each of these rights. If you would like to know more about your rights, please contact our Privacy Officer at Right to a Copy of This Notice You have a right to have a paper copy of our Notice of Privacy Practices at any time. In addition, a copy of this Notice will always be posted in our waiting area. If you would like to have a copy of our Notice, ask the receptionist for a copy or contact our Privacy Officer at Right of Access to Inspect and Copy You have the right to inspect (which means see or review) and receive a copy of medical information about you that we maintain in certain groups of records. If we maintain your medical records in an Electronic Health Record (EHR) system, you may obtain an electronic copy of your medical records. You may also instruct us in writing to send an electronic copy of your medical records to a third party. If you would like to inspect or receive a copy of medical information about you, you must provide us with a request in writing. You may write us a letter requesting access or fill out an Access Request Form. Access Request Forms are available from our Privacy Officer.We may deny your request in certain circumstances. If we deny your request, we will explain our reason for doing so in writing. We will also inform you in writing if you have the right to have our decision reviewed by another person. If you would like a copy of the medical information about you, we will charge you a fee to cover the costs of the copy. Our fees for electronic copies of your medical records will be limited to the direct labor costs associated with fulfilling your request. We may be able to provide you with a summary or explanation of the information. Contact our Billing Office at for more information on these services and any possible additional fees.
6 Right to Have Medical Information Amended You have the right to have us amend (which means correct or supplement) medical information about you that we maintain in certain groups of records. If you believe that we have information that is either inaccurate or incomplete, we may amend the information to indicate the problem and notify others who have copies of the inaccurate or incomplete information. If you would like us to amend information, you must provide us with a request in writing and explain why you would like us to amend the information. You may either write us a letter requesting an amendment or fill out an Amendment Request Form. Amendment Request Forms are available from our Privacy Officer.We may deny your request in certain circumstances. If we deny your request, we will explain our reason for doing so in writing. You will have the opportunity to send us a statement explaining why you disagree YOU HAVE RIGHTS WITH RESPECT TO MEDICAL INFORMATION ABOUT YOU with our decision to deny your amendment request and we will share your statement whenever we disclose the information in the future. Right to an Accounting of Disclosures We Have Made You have the right to receive an accounting (which means a detailed listing) of disclosures that we have made for the previous six (6) years. If you would like to receive an accounting, you may send us a letter requesting an accounting, fill out an Accounting Request Form, or contact our Privacy Officer. Accounting Request Forms are available from our Privacy Officer. The accounting will not include several types of disclosures, including disclosures for treatment, payment or healthcare operations. If we maintain your medical records in an Electronic Health Record (EHR) system, you may request that include disclosures for treatment, payment or healthcare operations. The accounting will also not include disclosures made prior to April 14, If you request an accounting more than once every twelve (12) months, we may charge you a fee to cover the costs of preparing the accounting. Right to Request Restrictions on Uses and Disclosures You have the right to request that we limit the use and disclosure of medical information about you for treatment, payment and healthcare operations. Under federal law, we must agree to your request and comply with your requested restriction(s) if:
7 Except as otherwise required by law, the disclosure is to a health plan for purpose of carrying out payment of healthcare operations (and is not for purposes of carrying out treatment); and, The medical information pertains solely to a healthcare item or service for which the healthcare provided involved has been paid out-of-pocket in full.once we agree to your request, we must follow your restrictions (except if the information is necessary for emergency treatment). You may cancel the restrictions at any time. In addition, we may cancel a restriction at any time as long as we notify you of the cancellation and continue to apply the restriction to information collected before the cancellation.you also have the right to request that we restrict disclosures of your medical information and healthcare treatment(s) to a health plan (health insurer) or other party, when that information relates solely to a healthcare item or service for which you, or another person on your behalf (other than a health plan), has paid us for in full. Once you have requested such restriction(s), and your payment in full has been received, we must follow your restriction(s). Right to Request an Alternative Method of Contact You have the right to request to be contacted at a different location or by a different method. For example, you may prefer to have all written information mailed to your work address rather than to your home address.we will agree to any reasonable request for alternative methods of contact. If you would like to request an alternative method of contact, you must provide us with a request in writing. You may write us a letter or fill out an Alternative Contact Request Form. Alternative Contact Request Forms are available from our Privacy Officer. Right to Notification if a Breach of Your Medical Information Occurs You also have the right to be notified in the event of a breach of medical information about you. If a breach of your medical information occurs, and if that information is unsecured (not encrypted), we will notify you promptly with the following information A brief description of what happened; A description of the health information that was involved;
8 Recommended steps you can take to protect yourself from harm; What steps we are taking in response to the breach; and, Contact procedures so you can obtain further information. Right to Opt-Out of Fundraising Communications If we conduct fundraising and we use communications like the U.S. Postal Service or electronic for fundraising, you have the right to opt-out of receiving such communications from us. Please contact our Privacy Officer to opt-out of fundraising communications if you chose to do so. YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES If you believe that your privacy rights have been violated or if you are dissatisfied with our privacy policies or procedures, you may file a written complaint either with us or with the federal government. We will not take any action against you or change our treatment of you in any way if you file a complaint. To file a written complaint with us, you may bring your complaint directly to our Privacy Officer, or you may mail it to the following address: 125 N.18th Street, Suite C, Mount Vernon, WA To file a written complaint with the federal government, please use the following contact information: Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Room 509F, HHH Building Washington, D.C Toll-Free Phone: 1-(877) Website: OCRComplaint@hhs.gov
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