NOTICE
OF PRIVACY PRACTICES
THIS NOTICE
DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THAT INFORMATION
PLEASE
REVIEW THIS NOTICE CAREFULLY.
This Practice
is committed to maintaining the privacy of your protected health information
("PHI"), which includes information about your health condition
and the care and treatment you receive from the Practice. The creation
of a record detailing the care and services you receive helps this office
to provide you with quality health care. This Notice details how your
PHI may be used and disclosed to third parties. This Notice also details
your rights regarding your PHI. The privacy of PHI in patient files
will be protected when the files are taken to and from the Practice
by placing the files in a box or brief case and kept within the custody
of a doctor or employee of the Practice authorized to remove the files
from the Practice's office. It may be necessary to take patient files
to a facility where a patient is confined or to a patient's home where
the patient is to be examined or treated.
NO CONSENT
REQUIRED
The Practice
may use and/or disclose your PHI for the purposes of:
(a) Treatment
- In order to provide you with the health care you require, the Practice
will provide your PHI to those health care professionals, whether on
the Practice's staff or not, directly involved in your care so that
they may understand your health condition and needs. For example, a
physician treating you for a condition or disease may need to know the
results of your latest physician examination by this office.
(b) Payment
- In order to get paid for services provided to you, the Practice will
provide your PHI, directly or through a billing service, to appropriate
third party payors, pursuant to their billing and payment requirements.
For example, the Practice may need to provide the Medicare program with
information about health care services that you received from the Practice
so that the Practice can be properly reimbursed. The Practice may also
need to tell your insurance plan about treatment you are going to receive
so that it can determine whether or not it will cover the treatment
expense.
(c) Health
Care Operations - In order for the Practice to operate in accordance
with applicable law and insurance requirements and in order for the
Practice to continue to provide quality and efficient care, it may be
necessary for the Practice to compile, use and/or disclose your PHI.
For example, the Practice may use your PHI in order to evaluate the
performance of the Practice's personnel in providing care to you.
1. The
Practice may use and/or disclose your PHI, without a written Consent
from you, in the following additional instances:
(a) De-identified
Information - Information that does not identify you and, even without
your name, cannot be used to identify you.
(b) Business
Associate - To a business associate if the Practice obtains satisfactory
written assurance, in accordance with applicable law, that the business
associate will appropriately safeguard your PHI. A business associate
is an entity that assists the Practice in undertaking some essential
function, such as a billing company that assists the office in submitting
claims for payment to insurance companies or other payers.
(c) Personal
Representative -To a person who, under applicable law, has the authority
to represent you in making decisions related to your health care
(d) Emergency
Situations -
(i) for
the purpose of obtaining or rendering emergency treatment to you provided
that the Practice attempts to obtain your Consent as soon as possible;
or
(ii) to
a public or private entity authorized by law or by its charter to assist
in disaster relief efforts, for the purpose of coordinating your care
with such entities in an emergency situation.
(e) Communication
Barriers - If, due to substantial communication barriers or inability
to communicate, the Practice has been unable to obtain your Consent
and the Practice determines, in the exercise of its professional judgment,
that your Consent to receive treatment is clearly inferred from the
circumstances.
(f) Public
Health Activities - Such activities include, for example, information
collected by a public health authority, as authorized by law, to prevent
or control disease and that does not identify you and, even without
your name, cannot be used to identify you.
(g) Abuse,
Neglect or Domestic Violence - To a government authority if the Practice
is required by law to make such disclosure; if the Practice is authorized
by law to make such a disclosure, it will do so if it believes that
the disclosure is necessary to prevent serious harm
(h) Health
Oversight Activities - Such activities, which must be required by law,
involve government agencies and may include, for example, criminal investigations,
disciplinary actions, or general oversight activities relating to the
community's health care system.
(i) Judicial
and Administrative Proceeding - For example, the Practice may be required
to disclose your PHI in response to a court order or a lawfully issued
subpoena.
(j) Law
Enforcement Purposes - In certain instances, your PHI may have to be
disclosed to a law enforcement official. For example, your PHI may be
the subject of a grand jury subpoena. Or, the Practice may disclose
your PHI if the Practice believes that your death was the result of
criminal conduct.
(k) Coroner
or Medical Examiner - The Practice may disclose your PHI to a coroner
or medical examiner for the purpose of identifying you or determining
your cause of death.
(l) Organ,
Eye or Tissue Donation - If you are an organ donor, the Practice may
disclose your PHI to the entity to whom you have agreed to donate your
organs.
(m) Research
- If the Practice is involved in research activities, your PHI may be
used, but such use is subject to numerous governmental requirements
intended to protect the privacy of your PHI and that does not identify
you and, even without your name, cannot be used to identify you.
(n) Avert
a Threat to Health or Safety - The Practice may disclose your PHI if
it believes that such disclosure is necessary to prevent or lessen a
serious and imminent threat to the health or safety of a person or the
public and the disclosure is to an individual who is reasonably able
to prevent or lessen the threat.
(o) Workers'
Compensation - If you are involved in a Workers' Compensation claim,
the Practice may be required to disclose your PHI to an individual or
entity that is part of the Workers' Compensation system.
The privacy of your health information is important to us. We will maintain the privacy of your health information and we will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to do so.
A new federal law commonly known as HIPAA requires that we take additional steps to keep you informed about how we may use information that is gathered in order to provide health care services to you. As part of this process, we are required to provide you with the attached Notice of Privacy Practices and to request that you sign the attached written acknowledgement that you received a copy of the Notice. The Notice describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This Notice also describes your rights regarding health information we maintain about you and a brief description of how you may exercise these rights.
Please take a moment to review our Notice of Privacy Practices. We also request that you sign and return the attached Acknowledgement of Receipt of Notice of Privacy Practices documenting that you received a copy of our Notice.
If you have any questions about this Notice please contact our Privacy Officer at:
Spinal Relief Clinic
16701 Cleveland St. Suite C
Redmond WA 98052
425-882-2488
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 applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, legal obligations, and your rights concerning your health information ("Protected Health Information" or "SRC"). We must follow the privacy practices that are described in this Notice (which may be amended from time to time).
For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.
I. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
A. Permissible Uses and Disclosures without Your Written Authorization
We may use and disclose SRC without your written authorization for certain purposes except as otherwise described in this Notice. The examples provided in each category are not meant to be exhaustive, but instead are meant to describe the types of uses and disclosures that are permissible under federal and state law.
1. Treatment: We may use and disclose SRC in order to provide treatment to you. For example, we may use SRC to diagnose, treat, and provide medical services to you. In addition, we may disclose SRC to other health care providers involved in your treatment.
2. Payment: Under federal law we may use or disclose SRC so that services you receive are appropriately billed to, and payment is collected from, your health plan. By way of example, we may disclose SRC to permit your health plan to take certain actions before it approves or pays for treatment services. Under Washington state law, releases of SRC to health plans require an authorization provided by you to us or to your health plan.
3. Health care Operations: We may use and disclose SRC in connection with our health care operations, including quality improvement activities, training programs, accreditation, certification, licensing or credentialing activities.
4. Required or Permitted by Law: We may use or disclose SRC when we are required or permitted to do so by law. For example, we may disclose SRC to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. In addition we may disclose SRC to the extent necessary to avert a serious threat to your health or safety or the health or safety of others. Other disclosures permitted or required by law include the following: disclosures for public health activities; health oversight activities including disclosures to state or federal agencies authorized to access SRC; disclosures to judicial and law enforcement officials in response to a court order or other lawful process; disclosures for research when approved by an institutional review board; and disclosures to military or national security agencies, coroners, medical examiners, and correctional institutions as otherwise as authorized by law.
5. Your Other Health Care Providers. We may also disclose SRC to your other health care providers when such SRC is required for them to treat you, receive payment for services rendered to you, or conduct certain health care operations, such as quality assessment and improvement activities.
B. Uses and Disclosures that May be Made Without Your Authorization, But for Which You have an Opportunity to Object.
1. Appointment Reminders. Unless you object, we may use or disclose SRC in order to provide you with appointment reminders such as voicemail messages, postcards, or letters.
2. Fundraising. We may contact you directly, or through the SRC, to raise funds for the SRC. If you do not want to be contacted for fundraising purposes, please notify The Spinal Relief Clinic 16701 Cleveland St. Suite C Redmond WA 98052
3. Other Services. We may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.
4. Family and Other Persons Involved in Your Care. We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. We may ask you to identify others to whom we may disclose your health information. If you are present, then prior to such use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person's involvement in your health care. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information.
C. Uses and Disclosures Requiring Your Written Authorization.
1. Other Uses and Disclosures: Uses and disclosures other than those described in Sections I.A and I.B. above will only be made with your written authorization. For example, you will need to sign an authorization form before we can send SRC to your life insurance company, to a school, or to your attorney. You may revoke any such authorization at any time.
2. Uses and Disclosures of Your Highly Confidential Information. In addition, federal and state law requires special privacy protections for certain highly confidential information about you ("Highly Confidential Information"), including the subset of your SRC that: (1) is maintained in psychotherapy notes; (2) is about mental health and developmental disabilities services; (3) is about alcohol and drug abuse prevention, treatment and referral; (4) is about HIV/AIDS testing, diagnosis or treatment; (5) is about venereal disease(s); (6) is about genetic testing; (7) is about child abuse and neglect; (8) is about domestic abuse of an adult with a disability; or (9) is about sexual assault. In order for us to disclose your Highly Confidential Information for a purpose other than those permitted by law, we must obtain your written authorization.
II. YOUR INDIVIDUAL RIGHTS
A. Right to Inspect and Copy. You may request access to your medical record and billing records maintained by us in order to inspect and request copies of the records. All requests for access must be made in writing. Under limited circumstances, we may deny access to your records. We may charge a fee for the costs of copying and sending you any records requested.
B. Right to Alternative Communications. You may request, and we will accommodate, any reasonable written request for you to receive SRC by alternative means of communication or at alternative locations.
C. Right to Request Restrictions. You have the right to request a restriction on SRC we use or disclose for treatment, payment or health care operations. You must request any such restriction in writing addressed to the Privacy Officer as indicated below. We are not required to agree to any such restriction you may request.
D. Right to Accounting of Disclosures. Upon written request, you may obtain an accounting of certain disclosures of SRC made by The Spinal Relief Clinic.This right applies to disclosures for purposes other than treatment, payment or health care operations, excludes disclosures made to you or disclosures otherwise authorized by you, and is subject to other restrictions and limitations.
E. Right to Request Amendment: You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances.
F. Right to Obtain Notice. You have the right to obtain a paper copy of this Notice by submitting a request to our Privacy Officer at any time.
G. Questions and Complaints. If you desire further information about your privacy rights, or are concerned that we have violated your privacy rights, SRC at 425-882-2488 You may also file a written complaint with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. We will not retaliate against you if you file a complaint with the Director or The SRC Privacy Officer.
III. EFFECTIVE DATE AND CHANGES TO THIS NOTICE
A. Effective Date. This Notice is effective on March 25th 2008
B. Changes to this Notice. We may change the terms of this Notice at any time. If we change this Notice, we may make the new notice terms effective for all SRC that we maintain, including any information created or received prior to issuing the new notice. If we change this Notice, we will post the revised notice in the waiting area of our office. You may also obtain a copy of any revised notice by contacting the SRC.
