THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT
YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATON. PLEASE REVIEW IT
CAREFULLY.
Puget Sound Vein
Center is required by law to maintain the
privacy of your health information, to provide
you with a notice of its legal duties and
privacy practices, and to follow the information
practices that are described in this notice.
This notice applies to all health information
and health records generated by the health care
professionals, employees, contract staff,
students and volunteers at Puget Sound Vein
Center. This notice explains how your health
information may be used and/or disclosed and
also describes the rights you have concerning
your own medical information. Your health
information will not be used or disclosed except
as indicated in this notice. You have a right to
request and receive a paper copy of this notice.
Please review it carefully and let us know if
you have questions.
Medical
Information
Each time you
visit a hospital, physician or other health care
provider, a record of your visit is made.
Typically, this record contains your symptoms,
examination and test results, diagnoses,
treatment and a plan for future care or
treatment. This information is often referred to
as your health or medical record. We understand
that medical information about you and health is
personal, and we are committed to protecting
your medical information.
How Will We Use
and Disclose Your Medical Information?
Treatment:
We may use your medical information to provide
you with medical services and supplies. We may
also disclose your medical information to others
who need that information to treat you, such as
doctors, physician assistants, nurses, medical
and nursing students, technicians, therapists,
emergency service and medical transportation
providers, medical equipment providers, and
others involved in your care. We also may use
and disclose your medical information to contact
you to remind you of an upcoming appointment, to
inform you about possible treatment options or
alternatives, or to tell you about
health-related services available to you.
Family
Members and Others Involved in Your Care:
We may disclose your medical information to
immediate family members or another person with
whom you have a close personal relationship.
Payment:
We may use and disclose your medical information
to get paid for the medical services and
supplies we provide to you. For example, your
health plan or health insurance company may ask
to see parts of your medical record before they
will pay us for your treatment. We may provide
this information to them according to the term
set in your prior authorization.
Office
Operations:
We may use and disclose your medical information
if it is necessary to improve the quality of
care we provide to patients. We may use
your medical information to conduct
quality-improvement activities, to obtain audit,
accounting or legal services, or to conduct
business management and planning. This helps
evaluate the performance of our staff in caring
for you.
Required
by Law:
Federal, state or local laws sometimes require
us to disclose patients’ medical information.
For instance, we are required to report the
abuse or neglect of children or vulnerable
adults. We also are required to give information
to the State Workers’ Compensation Program for
work-related injuries.
Public
Health:
We also may report certain medical information
for public health purposes. For instance, we
report communicable diseases to the State. We
also may need to report patient problems with
medications or medical products to the FDA, or
may notify patients of recalls of products they
are using.
Public
Safety:
We may disclose medical information for public
safety purposes in limited circumstances. We may
disclose medical information to law enforcement
officials in response to a search warrant or a
grand jury subpoena. We also may disclose your
medical information to law enforcement officials
and others to prevent an imminent threat to
health or safety.
Health
Oversight Activities:
We may disclose medical information to a
government agency that oversees the hospital or
its personnel, such as the Department of Health,
the federal agencies that oversee Medicare, the
Medical Quality Assurance Commission or the
Nursing Quality Assurance Commission. These
agencies need medical information to monitor the
hospital’s compliance with state and federal
laws.
Judicial
Proceedings:
The hospital may disclose medical information if
it is ordered to do so by a court, or if the
office receives a subpoena or a search warrant.
You will receive advance notice about this
disclosure in most situations so that you will
have a chance to object to sharing your medical
information.
Information with Additional Protection:
Certain types of medical information have
additional protection under state and federal
law. For instance, medical information about HIV
and sexually transmitted diseases, mental health
and alcohol and drug abuse treatment receive
special protection. For those types of
information, the office is required to get your
permission before disclosing that information to
others in many circumstances.
Other
Uses and Disclosures:
If the office wishes to use or disclose your
medical information for a purpose that is not
discussed in this notice, the office will seek
your permission. If you give your permission to
the office, you may take back that permission
any time, unless we or others have already taken
substantial action in reliance on your
permission to use or disclose the information.
If you ever would like to revoke your
permission, please notify the Privacy Officer in
writing.
What Are Your
Rights?
Right to
Request Your Medical Information:
You have the right to look at your own medical
information and to get a copy of that
information (the law requires us to keep the
original record). This includes your medical
record, your billing record and other records we
use to make decisions about your care. To
request your medical information, please contact
the Health Information Department. Your request
may be denied in certain limited circumstances.
If your request is denied you may request that
the denial is reviewed. If you request a copy of
your information, we will charge you for our
costs to copy the information. We will tell you
in advance what this copying will cost. You can
look at your record at no cost.
Right to
Request Amendment of Medical Information You
Believe Is Erroneous or Incomplete:
If you examine your medical information and
believe that some of the information is wrong or
incomplete, you may ask us to amend your record.
Your request must be made in writing and
submitted to the Privacy Officer and a reason
must be provided to support your request.
Right to
Get a List of Certain Disclosures of Your
Medical Information:
You have the right to request a list of many of
the disclosures we make of your medical
information. If you would like to receive such a
list, write to the Health Information
Department. We will provide the first list to
you free, but we may charge you for any
additional lists you request during the same
year. We will tell you in advance what this list
will cost.
Right to
Request Restrictions on How the office Will Use
or Disclose Your Medical Information for
Treatment, Payment or Health Care Operations:
You have the right to ask that we limit the way
we use or disclose your health information for
treatment, payment or health care operations. 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
emergency treatment. If you want to request a
restriction, submit your request in writing to
the Privacy Officer and describe your request in
detail.
Right to
Request Confidential Communications:
You have the right to ask us to communicate with
you in a way that you feel is more confidential.
For example, you can ask us not to call your
home, but to communicate only by mail. To do
this, write to the Privacy Officer. You can also
ask to speak with your health care providers in
private, outside the presence of other patients
— just ask them!
Questions/Complaints
If you have general questions about this notice
or would like additional information please
contact the Privacy Officer at 360-794-1415.
If you are
concerned that we have violated your privacy, or
you disagree with a decision we made about
access to your record, you may contact our
Patient Action Line at 360-794-1415. All reports
related to potential privacy violations will be
forwarded to the Privacy Officer for
investigation and follow-up.
You may also send
a written complaint to:
Washington State Department of Health
510 4 Avenue West, Suite 404
Seattle, WA 98119
You may also
contact the Secretary of Health & Human Services
if you feel your privacy rights have been
violated.
We will
not penalize you or retaliate against you in any
way for filing a complaint.
Changes to This
Notice
This notice is
effective April 14, 2003.
From time to
time, we may change our practices concerning how
we use or disclose patient medical information,
or how we will implement patient rights
concerning their information. We reserve the
right to change this notice and to make the
provisions in our new notice effective for all
medical information we maintain. If we change
these practices, we will publish a revised
Notice of Privacy Practices. The revised notice
will be posted at our places of service and on
our Web site at www.pugetsoundveincenter.com. |
