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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.
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Family Health Centers is required by law to maintain the privacy of your
health information and to provide you with notice of its legal duties
and privacy practices with respect to your health information. If you
have questions about any part of this notice or if you want more
information about the privacy practices at Family Health Centers please
contact:
Family Health Centers
Privacy Officer
P.O. Box 1340
Okanogan, WA 98840
1-800-660-2129
Effective Date of This Notice: April 14, 2003
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Following is a description of how we may use or disclose the health
information Family Health
Centers collects about you and how we may store it in a chart
and on a computer. The information we collect about you is your medical record. The medical record is
the property of Family Health Centers, but the information in the
medical record belongs to you. Family Health Centers protects the
privacy of your health information. The law permits Family Health
Centers to use or disclose your health information for the following
purposes:
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I. When Family Health Centers May Use or Disclose
Your Health Information
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1. Treatment: We may disclose your Private Health Information (PHI) to
physicians, nurses, medical students, and other health care personnel
who provide you with health care services or are involved in your care.
For example, if you're being treated for a knee injury, we may disclose
your PHI to the physical therapist in order to coordinate your care.
Information obtained by pharmacy personnel will be used to dispense
prescription medications to you.
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2. Payment:
2.1. Insurance: To receive payment from an insurance company, a claim is
sent either electronically or on paper which contains all the
demographic information on the patient (for example, name, date of
birth, address and social security number), insurance information, date
seen, services provided and the charges for these services, and
diagnoses. We may also send copies of chart notes if further
information is required by the insurance company to pay the claim.
Pharmacy personnel will contact your insurer or pharmacy benefit manager
to determine whether it will pay for your prescription and the amount of
your co-payment.
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2.2. Patient: To receive payment from a patient, a statement is sent to
the household which lists dates of office visits, services provided to
all family members, and amounts owed. If a patient’s bill remains
unpaid, and our attempts at collection are unsuccessful, patient
information may be sent to an outside collection agency. This would
include demographic information, dates of service, services provided and
amount due.
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3. Regular Health Care Operations: We may disclose your PHI in order to
operate this facility. For example, we may use your PHI in order to
evaluate the quality of health care that you received via use of a
patient satisfaction survey that is complied by an outside source. We
may also disclose PHI to evaluate the performance of the health care
professionals who provided health care services to you. We may also
provide your PHI to our accountants, attorneys, consultants, and others
in order to make sure we're complying with the laws that affect us. We
also routinely enter childhood immunization status into a State-wide
data base called CHILD Profile. The reason for this is that immunization
records are sometimes misplaced by parents, and this ensures, that no
matter where you live in Washington State, you medical provider will
have access to these records. This may prevent your child from being
revaccinated.
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4.
Information provided to you:
5. Notification and communication with family: We may disclose your
health information to notify or assist in notifying a family member,
your personal representative or another person responsible for your care
about your location, your general condition or in the event of your
death. If you are able and available to agree or object, we will give
you the opportunity to object prior to making this notification. If you
are unable or unavailable to agree or object, our health professionals
will use their best judgment in communication with your family and
others.
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6. When required by law, judicial or administrative proceedings or law
enforcement: As required by law, we may use and disclose your health
information. For example, we make disclosures when a law requires that
we report information to government agencies and law enforcement
personnel about victims of abuse, neglect, or domestic violence; when
dealing with gunshot and other wounds; or when ordered in judicial or
administrative proceedings. We may disclose your health information to
a law enforcement official for purposes such as identifying or locating
a suspect, fugitive, material witness or missing person, complying with
a court order or subpoena and other law enforcement purposes.
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7. Public health: As required by law, we may disclose your health
information to public health authorities for purposes related to:
Preventing or controlling disease, injury or disability; reporting child
abuse or neglect; reporting domestic violence; reporting to the Food and
Drug Administration problems with products and reactions to medications;
and reporting disease or infection exposure.
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8. Health oversight activities: We may disclose your health information
to health agencies during the course of audits, investigations,
inspections, licensure and other proceedings.
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9. Deceased person information: We may disclose your health information
to coroners, medical examiners and funeral directors.
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10. Public safety: We may disclose your health information to
appropriate persons in order to prevent or lessen a serious and imminent
threat to the health or safety of a particular person or the general
public.
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11. Worker’s compensation: We may disclose your health information as
necessary to comply with worker’s compensation laws.
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12. Appointment
reminders: We may contact you to provide appointment
reminders stating the date of the appointment and the provider with whom
you are scheduled.
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13. Change of ownership: In the event that Family Health Centers is sold
or merged with another organization, your health information/record will
become the property of the new owner.
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II. When Family Health Centers May Not Use or Disclose Your
Health Information
14. Except as described in this Notice of Privacy Practices, Family Health
Centers will not use or disclose your health information without your
written authorization. If you do authorize Family Health Centers to use
or disclose your health information for another purpose, you may revoke
your authorization in writing at any time.
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III. Your Health Information Rights
1. You
have the right to request restrictions on certain uses and
disclosures of your health information. We are not
required to agree to the restriction that you requested.
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2. You have the right to receive your health information through a
reasonable alternative means or at an alternative location (for example,
e-mail instead of regular mail). We must agree to your request so long
as we can easily provide it in the format you requested.
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3. You have the right to see and get copies of your health information.
In most cases, you have the right to look at or get copies of your PHI
that we have, but you must make this request in writing. In certain
situations, we may deny your request. If we do, we will tell you, in
writing, our reasons for the denial and explain your right to have the
denial reviewed. There may be charges for copies made.
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4. You have a right to request that we amend your health information
that is incorrect or incomplete. We are not required to change your
health information. We will provide you with information about any
denial and how you can disagree with the denial.
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5. You have a right to receive an accounting of disclosures of your
health information made by us, except that we do not have to account for
the disclosures described in parts 1 (treatment), 2 (payment), 3 (health
care operations), and 4 (information provided to you) of section I of
this Notice of Privacy Practices.
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6. You have a right to a paper copy of this Notice of Privacy Practices.
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If
you would like to have a more detailed explanation of these
rights contact
Family Health Centers
Privacy Officer
P.O. Box 1340
Okanogan, WA 98840
1-800-660-2129
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IV.
Changes to this Notice of Privacy Practices: Family Health Centers
reserves the right to amend this Notice of Privacy Practices at any time
in the future, and to make the new provisions effective for all
information that it maintains, including information that was created or
received prior to the date of such amendment. Until such amendment is
made, we are required by law to comply with this Notice. We will advise
all current patients when a revision to this Notice has occurred and
offer patients the opportunity to obtain an updated copy, if desired. A
copy will be posted in a public area of the clinic for review.
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V. Complaints: Complaints about this Notice of Privacy Practices or how
Family Health Centers handles your health information should be directed
to:
Family Health Centers
Privacy Officer
P.O. Box 1340
Okanogan, WA 98840
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If you are not satisfied with the manner in which this office handles a
complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
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You may also address your complaint to one of the regional Offices for
Civil Rights. A list of these offices can be found online at
http://www.hhs.gov/ocr/regmail.html.
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If you
would like to exercise your Health Information Rights contact
the department indicated below:
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To exercise your right to: |
Contact |
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Request restrictions on certain uses and
disclosures of your health information |
Privacy Officer |
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Receive your health information through a
reasonable alternative means or at an alternative location (for
example, e-mail instead of regular mail) |
Privacy Officer |
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See and get copies of your health information |
Medical Records Department |
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Request that we amend your health information
that is incorrect or incomplete |
Medical Records Department |
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Receive an accounting of disclosures of your
health information made by us |
Privacy Officer |
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A paper copy of this Notice of Privacy Practices |
Patient Registration Department |
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PRIVACY