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 collect and create personal information about you and your health. State and federal law protects your privacy by limiting me in how we may use and disclose such information. Protected health information (“PHI”) is information about you, including demographic information, that may identify you or be used to identify you, and that relates to your past, present or future physical or mental health or condition, the provision of health care services, or the past, present or future payment for the provision of health care.
Your Rights Regarding Your PHI. The following are rights you have regarding PHI that we maintain about you:
Right of Access to Inspect and Copy. You have the right, which may be restricted only in certain limited circumstances, to inspect and receive a copy of the PHI that we maintain. We may charge a reasonable, cost-based fee for the copying process. As to your PHI that we maintain in electronic form and format, you may request a copy to which you are otherwise entitled in that electronic form and format if it is readily producible, but if not, then in any readable form and format as we may agree (e.g., PDF). Your copy request may also include transmittal directions to a third party.
Right to Amend. If you feel the PHI we have about you is incorrect or incomplete, you may ask us in writing to amend the information although we are not required to agree to the amendment. You may write a statement of disagreement if your request is denied. The statement will be maintained as part of your PHI and will be included with any disclosure.
Right to Request an Accounting of Disclosures. We are required to create and maintain a prescribed accounting of certain disclosures we may have made of your PHI. You have the right to request a copy of such an accounting.
Right to Request Restrictions. You have the right to request in writing a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. We are generally not required to agree to such a request. If we have been paid in full for all of the services covered by such a request, then we will honor a request to restrict disclosure to your insurance.
Right to Request Confidential Communication. You have the right to request that we communicate with you in a certain way or at a certain location. We will accommodate reasonable requests and will not ask why you are making the request.
Right to Request a Copy of this Notice. You have the right to obtain a paper copy of this notice upon request.
Right to Complain. You have the right to file a complaint in writing with us or with the Secretary of Health and Human Services if you believe we have violated your privacy rights. We will not retaliate against you for filing a complaint.
Our Uses and Disclosures of PHI for Treatment, Payment and Health Care Operations
Treatment. We may use your PHI for the purpose of providing you with health care treatment. To coordinate and manage your care, but with your authorization, we may disclose your PHI to other health care providers who become involved in your care.
Payment. We may use your PHI in connection with billing statements we send you and in connection with tracking charges and credits to your account. In addition, but with your authorization, we may disclose your PHI to third party payers to obtain information concerning benefit eligibility, coverage, and remaining availability, as well as to submit claims for payment and for medical necessity and utilization reviews.
Health Care Operations. We may use and disclose your PHI for the health care operations of our program in support of the functions of treatment and payment. Such disclosures would be to facilitate receipt of services for the program and its patients for data processing, bill collecting, dosage preparation, laboratory analyses, or legal, medical, accounting, or other professional services.
Other Uses and Disclosures That Do Not Require Your Authorization or Opportunity to Object
Required by Law. We may use or disclose your PHI to the extent that the use or disclosure is required by law, made in compliance with the law, and limited to the relevant requirements of the law. Examples are public health reports, abuse and neglect reports, law enforcement reports, and reports to coroners and medical examiners in connection with investigation of deaths. We also must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining my compliance with the requirements of the Privacy Rule.
Health Oversight. We may disclose your PHI to a health oversight agency for activities authorized by law, such as our agency licensure. Oversight agencies also include government agencies and organizations that audit their provision of financial assistance to me (such as third-party payers).
Threat to Health or Safety. We may disclose your PHI when necessary to minimize an imminent danger to the health or safety of you or any other individual.
Business Associates. We may disclose your PHI to the extent minimally necessary to Business Associates that are contracted by us to perform health care operations or payment activities on our behalf which may involve receipt, use or disclosure of your PHI.
Compulsory Process. We will disclose your PHI if a court issues an appropriate order.
Uses and Disclosures Requiring Your Opportunity to Agree or Object
Prior Providers. We may disclose your PHI to your prior health care providers unless we have given you the opportunity to agree or object, and you have objected in writing.
Close Personal Relationships. In accordance with good professional practice, we may disclose your PHI to your person(s) who are close to you that are involved with your care, unless we have given you the opportunity to agree or object, and you have objected. When you are not present or in situations of your incapacity or in an emergency, and where disclosure, in our clinical judgment would be in your best interests, we will disclose your PHI as minimally necessary.
Disaster Relief Purposes. In situations of your absence, incapacity or emergency and in accordance with good professional practice, we may disclose your PHI to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, which are directly relevant to your identification and care.
Uses and Disclosures of PHI with Your Written Authorization. We may make other uses and disclosures of your PHI but only with your written authorization. Unless we have taken a substantial action in reliance on the authorization such as providing you with health care services for which we must submit a subsequent claim(s) for payment, you may revoke an authorization in writing at any time. We will honor verbal revocations upon authenticating your identity.
Certain Uses and Disclosures of PHI that We Do Not Make. We do not engage in academic or commercial research involving client PHI. We do not engage in marketing activities using client PHI. We do not engage in the sale of client PHI. We do no fundraising using client PHI. We do not maintain directory information for public disclosure. We do not receive compensation for recommending any health care product or service.
This Notice of Privacy Practices informs you how we may use and disclose your PHI and your rights regarding your PHI. We are required by law to maintain the privacy of your PHI and to provide you with notice of my legal duties and privacy practices with respect to your PHI, and to notify you following a breach of unsecured PHI related to you. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of this Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for PHI that we maintain at that time. We will make available a revised Notice of Privacy Practices by providing you a copy upon your request or by providing you a copy at your next appointment.
We have designated Mark Loes as the Privacy/Security Official. So, if you have any questions about this Notice of Privacy Practices or complaints about how your PHI has been utilized, please contact us. Our contact information is:
PO BOX 217
Selah, WA 98942
We will not retaliate against you for filing a complaint. You may also file a complaint with the Secretary of the Department of Health and Human Services.
The effective date of this Notice is September 16, 2013