We are required by law to provide you with this notice. It will describe to you what protected health information we collect about you and how that information might be used.
The Type Of Protected Health Information That We May Obtain About You:
DEMOGRAPHICS INFORMATION: including your name, address, date of birth, phone number(s), name of your employer, your spouse or other family members, and emergency contact.
INSURANCE INFORMATION: including your insurance carrier, the name of the insured person, insurance identification numbers, and benefits and eligibility information.
HEALTH INFORMATION: including your health history, past illnesses or injuries, family medical history, your social activities including use of tobacco, alcohol, or drugs, family life and living situation, your current and/or ongoing health problems, including medications, allergies, advised treatment and outcomes of that treatment.
PAYMENT INFORMATION: including your insurance carrier, your record of charges, adjustments, and payments to our organization.
How We May Use and Disclose Protected Health Information About You:
A. FOR TREATMENT:
We may use and disclose your health information to provide, coordinate or manage your health care and any related services. We may disclose information about you to doctors, dentists, nurses, technicians, office staff or other personnel who are involved in taking care of you and your health.
B. FOR PAYMENT:
We may use and disclose your information to obtain payment for services you receive.
C. FOR HEALTH CARE OPERATIONS:
We may use or disclose protected health information about you in order to evaluate our care for you or to meet a business need of the organization. These activities include quality assessment activities, employee review activities, training students, compliance audits by your insurance carrier, and conducting or arranging for other business activities.
We may also use or disclose protected health information to our Business Associates in the performance of health care operations. A Business Associate is an entity or person engaged by this organization to perform a business activity on behalf of the organization. Our Business Associates are obligated by contract to protect health information they receive or generate about you.
D. OTHER CONTACT SITUATIONS:
E. Special Situations:
EMERGENCIES: We may use or disclose protected health information in the case of a medical emergency.
REQUIRED BY LAW: We may use or disclose your protected health information if the disclosure is required by law.
PUBLIC HEALTH: We may disclose protected health information about you for public health activities. These activities generally include the following:
HEALTH OVERSIGHT: We may disclose protected health information to health oversight agencies that oversee our activities. These activities may include audits, investigations and inspections and are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.
LAWSUITS OR DISPUTES: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. Subject to legal requirements, we may also disclose medical information about you in response to a subpoena.
LAW ENFORCEMENT: We may disclose protected health information, so long as all applicable legal requirements are met, for law enforcement purposes.
Coroners, Medical Directors and Funeral Directors: We may disclose protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release information about patients to funeral directors as necessary to carry out their duties.
Workers Compensation: We may disclose medical information about you for programs that provide benefits for work-related injuries or illness.
Military Activities, National Security and Intelligence Activities: If you are a member of the armed forces, or part of the national security or intelligence communities, we may be required by military command or other government authorities to disclose protected health information about you. We may also disclose information about foreign military personnel to the appropriate foreign military authority.
ORGAN AND TISSUE DONATION: If you are an organ or tissue donor, we may disclose protected health information to organizations that handle organ or tissue procurement when necessary to facilitate organ or tissue donation or transplantation.
INMATES: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. The release would be necessary 1) for the institution to provide you with health care; 2) to protect your health and safety or the health and safety of others; or 3) for the safety and security of the correctional institution.
SERIOUS THREATS: As permitted by applicable law and standards of ethical conduct, we may use or disclose protected health information if we, in good faith, believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Information that is not personally identifiable: We may use or disclose information about you in a way that does not personally identify you.
FAMILY AND FRIENDS: We may disclose your protected health information to your family or friends or any other individual identified by you when they are involved in your care or the payment of your care. We will only disclose the protected health information directly relevant to their involvement in your care or payment. If you are available, we will give you an opportunity to object to these disclosures, and we will not make these disclosures if you object.
If you are not available, we will determine whether a disclosure to your family or friends is in your best interest, and we will disclose only the protected health information that is directly relevant to their involvement in your care.
Protected Health Information That Cannot Be Disclosed Without Your Specific Authorization:
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below.
You may revoke this authorization by notifying us in writing at any time.
YOUR RIGHTS AS A PATIENT:
Under federal law, however, you may not inspect or copy psychotherapy notes or information compiled in reasonable anticipation of a civil, criminal or administrative action or proceeding. Certain documents pertaining to laboratory services are also exempt under federal law.
Under certain circumstances, we may not grant your request. If we deny your request, then you may appeal our decision.
We require that requests to access your protected health information be made in writing. You can arrange to do this through our Privacy Officer.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency care.
In order to request a restriction, you must do so in writing. The request must specifically state what information is restricted and to whom the restriction applies.
You may request a restriction form from our Privacy Officer.
Please contact our Privacy Officer to make this request in writing. Your request must specify where or how the communication is to be directed.
We may not grant your request if we determine that the protected health information that is the subject of your request:
Amendment requests must be made in writing and must include a reason for requesting the amendment. If you wish to amend your record, you may contact our Privacy Officer for a form.
You are allowed one free disclosure per each twelve-month period. If you wish additional disclosures within that twelve-month period, we may charge you the cost of providing the disclosure list.
Your request for a disclosure accounting must be made in writing. Please contact our Privacy Officer to obtain a form.
If you believe that your privacy rights have been violated, you have a right to file a complaint in the form of a written letter with our office and with the Secretary of Health and Human Services without fear of retaliation.
A letter of complaint filed with this office should be sent to our Privacy Officer at the address listed below.
Revisions to Our Privacy Notice:
We are required to abide by the terms of this Privacy Notice. We may change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time.
Upon your request, we will provide you with a revised Privacy Notice. You may obtain this by calling our office and requesting that a revised copy be sent to you in the mail, or by asking for one at the time of your next appointment.
If you have questions about this document, or have questions about privacy or patient rights, please contact our Practice Administrator.
Practice Administrator: Jennie McCartney
Assistant Administrator: Jillian Carlile
900 NE 139th St, suite 206
Vancouver, WA 98685