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 CAREFULLY.
The Health Insurance Portability and Accountability
Act of 1996 (HIPAA) is a federal program that requires all medical
records and other individually identifiable health information used
or disclosed by us in any form, whether electronically, on paper, or
orally, to be kept properly confidential. This Act gives you, the
patient, significant new rights to understand and control how your
health information is used. HIPAA provides penalties for covered
entities that misuse personal health information.
The Wellman Clinic, p.s. is required by law
to maintain the privacy of protected health information and to
provide individuals with notice of its legal duties and privacy
practices with respect to protected health information. The Wellman
Clinic reserves the right to revise its privacy practices and any
changes will be posted in a 'notice of revised privacy practices'
available for review upon request..
We may use and disclose your medical records only
for each of the following purposes: treatment, payment and health
care operations.
Treatment means providing,
coordinating, or managing health care and related services by one or
more health care providers. An example of this would be in the event
another practitioner joined the practice here to treat patients in
our absence.
Payment means such activities as
obtaining reimbursement for services, confirming coverage, billing
or collection activities, and utilization review. An example of this
would be sending a bill for your visit to your insurance company for
payment.
Health care operations include
the business aspects of running our practice, such as conduction
quality assessment and improvement activities, auditing functions,
cost-management analysis, and customer service. An example of this
would be an internal quality assessment review. W may contact you to
provide appointment reminders or information about treatment
alternatives or other health-related benefits and services that may
be of interest to you.
Any other uses and disclosures will be made only
with your written authorization. You may revoke such authorization
in writing and we are required to honor and abide by that written
request, except to the extent that we have already taken actions
relying on your authorization
Your private health information will be kept on site
at The Wellman Clinic, 403 Myrtle Street, Mount Vernon, WA,
in a locked file. The only person with access to the locked file at
any time, either before or after clinic hours is Susan Wellman, the
designated privacy officer. Your rights are listed below. You may
exercise these rights by presenting your request in writing to the
privacy officer:
a. The right to confidential communications. You
have the right to choose how this office communicates with you
regarding your health care. For example, you can choose how and
where you prefer to be contacted, such as by phone at work, or never
by phone at work.
b. The right to request restrictions on certain uses
and disclosures of protected health information, including those
related to disclosures to family members, other relatives, close
personal friends, or any other person identified by you. Although we
are not required to agree to a requested restriction, if we do
agree, we must abide by it unless you stipulate in writing to remove
said restriction.
c. The right to access, inspect and copy your
protected health information. This office has 30 days to respond to
a written request for records, and will provide them in hard copy
format. Alternately, you may request and receive a summary of your
medical information. However, HIPPA provides certain exceptions to
the rights afforded to access, inspect or copy patient records,
including:
a. information developed for legal activity
including civil and criminal actions
b. information obtained from another source
that is viewed as confidential where release would compromise the
confidence
d. The right to amend your protected health
information. A request to amend must be in writing, and must include
a reason for the amendment. This office has 60 days to act on the
request. e. The right to receive an accounting of disclosures of
protected health information.
Use and disclosure of protected health information:
The patient's health care information can be
released to a third party only with written authorization. This
authorization may be initiated by either The Wellman Clinic or the
patient. Third parties include insurance companies, attorneys, etc.
A valid authorization must contain specific identification of the
persons or class of persons to whom The Wellman Clinic may make the
requested use or disclosure. It must also provide a description of
each purpose of the requested use or disclosure. It must have an
expiration date or an expiration event that relates to the
individual or the purpose of the use or disclosure. This
authorization must be signed and dated. In the event that The
Wellman Clinic seeks to gain an authorization for use of information
and the patient refuses such authorization, The Wellman Clinic will
not retaliate, punish, deny services or in any other way penalize
the patient for this behavior. Some disclosures do not require
authorization:
a. Fulfilling the request of adult
protective services or other governmental social services
agencies
b. Responding to state and federal agencies
with respect to HIPAA privacy compliance
c. Bona fide law enforcement related
requests
d. Subpoenas
Use and disclosure situations that require an
opportunity for the patient to agree or object:
a. Disaster relief purposes
b. Provision of the private health
information to the persons assisting in the patients care.
The Wellman Clinic will release the private health
information to their contracted billing service for use in billing
third parties for reimbursement. Other persons who may have access
to the patients private information may be those individuals who
perform legal, actuarial, accounting, consulting, data aggregation,
management, administrative, accreditation or financial services. For
example, these persons could be private attorneys, risk management
consultants, transcription vendors, QA consultants, record copying
services, collection agencies, auditing firms, or billing services.
You have recourse if you feel that your privacy
protections have been violated. You have the right to file a written
complaint with our office, or with the Department of Health and
Human Services, Office of Civil Rights, about violations of the
provisions of this notice or the policies and procedures of our
office.
Please contact us if you need more
information:
Susan Wellman, Privacy Officer
The Wellman
Clinic
1600 Roosevelt Suite A
Mount Vernon, WA 98273
For more information about HIPAA or to file a
complaint:
U.S. Department of Health and Human
Services
Office of Civil Rights
200 Independence Ave. SW
Washington, DC 20201
1.877.696.6755
