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. The Notice of Privacy Practices contains a detailed description of how our office will protect your health information, your rights as a patient and our common practices in dealing with patient health information. Please refer to this Notice for further information. State law requires us to get your authorization to disclose this information for payment purposes.
Examples of Uses and Disclosures of Protected Health Information for Treatment, Payment, and Health Care Operations:
- Information obtained by a nurse, provider, or other member of our health care team will be recorded in your medical records and used to help decide what care may be right for you.
- We may also provide information to others providing your care. This will help them stay informed about your care.
We request payment from your health insurance plan. Health plans need information from us about your medical care. Information provided to health plans may include your diagnoses, procedures performed, or recommended care.
Health Care Operations:
- We use your medical records to assess quality and improve services.
- We may use and disclose medical records to review the qualifications and performance of our health care providers and to train our staff.
- We may contact you to remind you about appointments and give you treatment alternatives or other health-related benefits and services.
- We may contact you to raise funds.
- We may use and disclose your information to conduct or arrange for services, including:
- medical quality review by your health plan;
- accounting, legal, risk management, and insurance services; and
- audit functions, including fraud and abuse detection and compliance programs.
You have a right to:
- Have access to and/or a copy of your health information. You must deliver this request in writing;
- Receive an accounting of some disclosures we have made of your health information;
- Request restrictions as to how your health information is used or disclosed. You must deliver this request in writing.
- Request that we communicate with you in confidence.
- Request amendment to your health information. You must deliver this request in writing.
- Receive, read, and ask questions about this Notice.
- Request and receive from us a paper copy of the most current Notice of Privacy Practices for Protected Health Information.
- Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released. It also does not affect any action taken before we have it. Sometimes, you cannot cancel an authorization if its purpose was to obtain insurance.
- Keep your protected health information private.
- Give you this notice and follow the terms of this Notice.
Other Disclosures and Uses of Protected Health Information:
- Unless you object, we may release health information about you to a friend or family member who is involved in your medical care. In addition, we may disclose health information about you to assist in disaster relief efforts.
- We may use and disclose your protected information without your authorization as follows:
- With Medical Researches—if the research has been approved and has policies to protect the privacy of your health information. We may also share information with medical researchers preparing to conduct a research project.
- To funeral directors/coroners consistent with applicable law to allow them to carry out their duties.
- To organ procurement organizations (tissue donation and transplant) or persons who obtain, store, or transplant organs.
- To the Food and Drug Administration (FDA) relating to problems with food, supplements, and products.
- To comply with Workers’ Compensation Laws—if you make a workers’ compensation claim.
- For public health and safety purposes as allowed or required by law:
- To prevent or reduce a serious, immediate threat to the health and safety of a person or the public.
- To public health or legal authorities.
- To report suspected abuse or neglect to public authorities.
- To correctional institutions, if you are in jail or prison, as necessary for your health and the health and safety of others.
- For law enforcement purposes such as when we receive a subpoena, court order, or other legal process, or you are the victim of a crime.
- For health and safety oversight activities. For example, we may share health information with the Department of Health.
- For disaster relief purposes. For example, we may share health information with the disaster relief agencies to assist in notification of your condition to family or others.
- For work-related conditions that could affect employee health. For example, an employer may ask us to assess health risks on a job site.
- To the military authorities of U.S. and foreign military personnel. For example, the law may require us to provide information necessary to a military mission.
- In the course of judicial/administrative proceedings at your request, or as directed by a subpoena or court order.
- For specialized government functions. For example, we may share information for national security purposes.
Other Uses and Disclosures of Protected Health Information
- Uses and disclosures not in this Notice will be made only as allowed/required by law or with your written authorization.
For questions or complaints:
If you believe that your privacy rights have been violated you may file a complaint to CVCH Privacy Officer and/or the Office for Civil Rights at (206) 615-2287. The complaint must be in writing on paper or electronically. CVCH as matter of law, professional ethics, and guidelines shall not retaliate in any manner against you for fi ling a complaint.
For additional information or clarification of our agency’s privacy policies and procedures, or about filing a complaint, please contact the Privacy Officer at 509-662-6000 or by email at email@example.com
Effective date of this notice is June 1, 2002, the date of its original publication, distribution, and use.
Revised Date: June 20, 2016