The Vancouver Clinic
NOTICE OF PRIVACY PRACTICES
Effective Date: February 17th, 2011
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.
This Notice of Privacy Practices explains how The Vancouver Clinic (TVC), and its clinical staff and employees, may use and share your Protected Health Information (PHI) with others for treatment, payment, health care operations, and other purposes allowed or required by law.
- TVC RESPONSIBILITIES:
We are required, by law, to keep your health information private and provide you with this Notice of Privacy Practices. We will act according to the terms of this notice. We may, at any time, change this Notice of Privacy Practices and make any new practices effective for all PHI we maintain. This Notice of Privacy Practices is posted on our Web Site (www.TVC.org) and is also available at check-in stations in all locations.
- WHAT IS PHI?
Protected Health Information (PHI) is information about a patient’s age, race, sex, and other personal health information that may identify the patient. The information relates to the patient’s physical or mental health in the past, present, or future, and to the care, treatment, and services needed by a patient because of his or her health.
- WHAT DOES HEALTHCARE OPERATIONS INCLUDE?
Health care operations include activities such as discussions between TVC staff and other health care providers, training clinic staff, interacting with insurance companies, carrying out medical reviews to measure quality, and managing business functions.
- HOW IS MEDICAL INFORMATION USED?
TVC uses medical records to record health information, to plan care and treatment, and to carry out routine health care functions.
- EXAMPLES OF HOW MEDICAL INFORMATION MAY BE USED FOR TREATMENT, PAYMENT, OR HEALTH CARE OPERATIONS:
· TVC may provide PHI to referring providers to create and carry out a plan for your treatment.
· TVC may provide PHI to your insurance company to file claims for payment.
· TVC may use PHI to review the quality of services you receive.
· TVC may send you reminders for medical care checkups.
· TVC may share PHI with public health agencies as permitted by law to track, for example, childhood immunizations.
· TVC will use and disclose PHI when required by federal or state law, or by court order. For example, to investigate reports of abuse.
· TVC may use and disclose PHI for public benefits under other government programs.
· TVC may disclose PHI to law enforcement in order to avoid a serious threat to the health and safety of a person or the public.
· TVC may disclose PHI to your family or other persons who are officially involved in your medical care. You have the right to object to the sharing of this information.
- WHY I MIGHT BE ASKED TO SIGN A RELEASE OF INFORMATION AUTHORIZATION FORM?
To release patient PHI to other people for any reason other than treatment, payment, and health care operations (described above) or as required or permitted by law, we must have a permission form known as an Authorization Form signed by the patient or the patient’s parent or legal guardian. This form clearly authorizes how you (the patient) wish the information to be used and disclosed.
- SHARING INFORMATION WITH TVC BUSINESS ASSOCIATES:
Some services at TVC are provided through contracts with business associates or business partners. Examples include medical transcription and claims processing. When these services are contracted, we may disclose the minimum PHI necessary they need to perform the job we have hired them to do. To protect your health information, we contractually require our business associates to follow the same privacy laws that TVC must follow. In addition, our business associates are obligated by law to protect your privacy to the same degree we are.
- YOUR PRIVACY RIGHTS
The following explains your rights with respect to your PHI and a short description of how you may use these rights:
· Right to See and Get Copies of Your Records. In most cases, you have the right to review or get copies of your records. You must make the request in writing. You may be charged a fee for the cost of copying your records.
· Right to Request a Correction or Update of Your Records. You may ask TVC to change (amend) or add missing information to your records if you think there is a mistake. In certain cases, we may deny your request for a change. If we deny your request, you have the right to file a statement with the TVC Privacy Officer, stating that you disagree. We may prepare a response to your statement and will provide you with a copy of this response. If you wish to change your PHI, please contact the TVC Privacy Officer. Requests for changes must be in writing.
· Right to Get a List of Disclosures. You have the right to ask TVC for a list of disclosures made after April 14, 2003. This right applies to any time TVC has disclosed your PHI for purposes other than treatment, payment, or health care operations as described in this Privacy Notice. We are not required to account for information releases: that you requested, that you agreed to by signing an Authorization Form, that are given to family or friends involved in your care, or certain other releases we are allowed to make without your permission. The request for a record must be made in writing to the TVC Privacy Officer. The request should state the time period for the list. Requests for records about TVC’s disclosures of your PHI are limited to time frames of six years or less as required by law.
· Right to Request Limits on Uses or Disclosures of PHI. You have the right to ask that TVC limit how your information is used or disclosed for the purposes of treatment, payment, and healthcare operations.. You must make the request in writing and tell TVC what information you want to limit and to whom you want the limits to apply. TVC is not required to agree to the restriction. If a restriction is granted you can request that the restriction be terminated in writing or verbally.
· Right to Revoke Permission. If you are asked to sign an authorization to use or disclose information, you can cancel that authorization at any time. You must make the request in writing. This will not affect information that has already been shared.
· Right to Choose How We Communicate with You. We will agree to reasonable requests. To carry out the request, we may also ask you for another address or another way to contact you, for example, mailing to a post office box. We will not ask you to explain why you are making the request. Requests must be made in writing to the TVC Privacy Officer.
· Right to Get a Paper Copy of this Notice. You have the right to ask for a paper copy of this notice at any time.
· Right to File a Complaint. You have the right to file a complaint if you do not agree with how TVC has used or disclosed information about you.
- WHAT IF I HAVE A QUESTION OR COMPLAINT?
You may contact TVC at the address, phone number or email listed below. You may also contact The U.S. Department of Health and Human Services, Office for Civil Rights at (206) 615-2290 or at 800-368-1019 if you want to file a complaint or to report a problem with how TVC has used or disclosed information about you. Your benefits will not be affected by any complaints you make. TVC cannot retaliate against you for filing a complaint, cooperating in an investigation, or refusing to agree to something that you believe to be unlawful.
If you have any questions about this notice or need more information, please contact the TVC Privacy Officer:
The Vancouver Clinic Privacy Officer
700 NE 87th Ave.
Vancouver, WA 98684
Phone: (360) 397-3355
Fax: (360) 604-1678
Email: PrivacyOfficer@tvc.org