This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review this notice carefully.
As part of our services, we maintain personal information about you and your health. State and federal law protect such information by limiting its uses and disclosures. Protected health information is information about you, including demographic information, that may identify you or be used to identify you. The protected health information may relate 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. The confidentiality of alcohol and drug abuse patient records is also specifically subject to additional restrictions under other state and federal law. We are required to comply with these additional restrictions.
The following are your rights regarding health information 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 your health information that we maintain. We will provide a copy or a summary of your health and claims records, usually within 30 days of your written request. Please ask us for the proper form for this purpose. We may charge a reasonable, cost-based fee for copies. As to your health information that we maintain in electronic form and format, you may request a copy to which you are otherwise entitled in electronic form and format if it is readily producible, but if not, then in any readable form and format as we may agree, for example in PDF. Your copy request may also include transmittal directions to a third party.
Right to Amend. You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this. We are not required to make the changes you request on. If we do not make the requested changes, you have the right to include a statement of disagreement in your record.
Right to Request Confidential Communications. You can ask us to contact you in a specific way (for example, at your home or office) or to send mail to a different address. We will consider all reasonable requests, and we are required to say “yes” if you tell us you would be in danger if we do not.
Right to an Accounting of Disclosures. You have the right to ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with and why We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures, such as any you asked us to make. We’ll provide one accounting a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Right to Request Restrictions. You have the right to ask us not to use or share certain health information for treatment, payment, or other operations We are not required to agree to your request. We would say “no” if it would affect your care.
Right to a Copy of this Notice. You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Right of Complaint. 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.
Right to Choose Someone to Act for You. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
Treatment: We can use your health information and share it with professionals who are treating you. For example, we may receive information about your diagnosis and treatment plan from a physician so we can arrange additional services.
Payment: We can use and disclose your health information to receive payment for your health services. For example, we might share information about you with your insurance company to receive reimbursement for your care.
Health Care Operations: We may use and disclose your health information for the health care operations of our program in support of the functions of treatment and payment. Such disclosures would be to a qualified organization only or to a business associate or Qualified Service Organization to provide services to the program and its patients for data processing, bill collecting, dosage preparation, laboratory analyses, or legal, medical, accounting, or other professional services, or services to prevent or treat child abuse or neglect.
Required by Law: We will share information about you if state or federal laws require it, including the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Audit and Evaluation: We may disclosure your health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and organizations performing utilization and quality control. If we disclose health information to a health oversight agency, we will have an agreement in place that requires the agency to safeguard the privacy of your health information.
Medical Emergencies: We may use or disclose your health information in a medical emergency situation to medical personnel only. We can share health information with organ procurement organizations, a corner, or a medical examiner when someone dies.
Research: We may disclose your health information for use in a research project that has met certain privacy conditions stated in the law. For more information see: https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html
Criminal Activity on Program Premises/Against Program Personnel: We may disclose your health information to law enforcement officials if you have committed a crime on program premises or against program personnel or you have made a threat to commit such crimes. Such disclosure is limited to circumstances of the incident, including name, address, status as a patient, and last know whereabouts.
Qualified Service Organization: We may disclose your health information to a Qualified Service Organization (QSO) to provide certain services to the program and its patients, such as data processing, bill collecting, dosage preparation, laboratory analyses, or legal, medical, accounting, or other professional services, or services to prevent or treat child abuse or neglect, including training on nutrition and child care and individual and group therapy. If a QSO has more than incidental access to health information, and/or the functions or services relate to payment, than a Business Associate Agreement will be utilized, otherwise only a Qualified Service Organization Agreement will be used. In the case the service is from a health care provider performing services to treat you, a Business Associate Agreement will not be utilized because you will have a direct patient-provider relationship.
For the Public Good: We may disclose your health information in certain specific situation, such as the following: Preventing disease; helping with product recalls; reporting adverse reactions to medications; reporting suspected child or elder abuse, neglect, or domestic violence; and preventing or reducing a serious threat to anyone’s health or safety.
Address Workers’ Compensation, Law Enforcement, and other Government Requests: We can use or share health information about you in the following situations: For addressing worker’s compensation claims; for law enforcement purposes or with a law enforcement official; for addressing health oversight agencies for activities authorized by law; and for special government functions such as military, national security, and presidential protective services.
Court Order: We can share health information about you in response to a court or administrative order, or in response to a subpoena.
We will make other uses and disclosures of your health information only with your written authorization. You may revoke this authorization in writing at any time, 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 subsequent claim(s) for payment.
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described here, talk to us. Tell us what you want us to do, and we will follow your instructions related to sharing information with your family, close friends, or other involved in payment for your care; and sharing information in a disaster relief situation.
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In situations of your absence, incapacity or emergency and in accordance with good professional practice, we may disclose your health information 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.
We will never share any substance abuse treatment records without your written permission.
We never market or sell personal information.
We are required by law to maintain the privacy and security of your protected health information and maintain all the elements within this notice. We will let you know promptly if a breach occurs that may have compromise the privacy or security of your information. We must follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
We can change the terms of this notice, and the changes will apply to all information we have about you period the new notice will be available upon request, on our website, and we will mail a copy to you. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all health information we maintain at that time. We will make available a revised Notice of Privacy Practices by providing you a copy.
If you have questions about this Notice of Privacy Practices, please contact: Ann McMurray, Privacy Official, at: The Center • A Place of HOPE, Inc., 547 Dayton Street, Edmonds WA 98020. Phone (425) 771-5166. Fax (425) 670-2807. Our website is www.aplaceof hope.com. You can complain if you feel we have violated your rights by contacting us using the information in the previous paragraph. You can file a complaint with the U.S. Department of Health and Human Services Office of Civil Rights by sending a letter to 200 Independence Avenue SW, Washington, DC, calling (877) 696-6775 or visiting https://www.hhs.gov/hipaa/filing-a-complaint/what-to-expect/index.html. We will not retaliate if you file a complaint.
This Notice of Privacy Practices became effective on June 11, 2015.