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Privacy Statement
 

Notice Of Privacy Practices

As required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

This notice describes how health information about you (as a patient of this practice) may be used and disclosed and how you can get access to your individually identifiable health information.

Please review this notice carefully.

A. Our commitment to your privacy:
Our practice is dedicated to maintaining the privacy of your individually identifiable health information (also called protected health information, or PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI. By federal and state law, we must follow the terms of the Notice of Privacy Practices that we have in effect at the time.

We realize that these laws are complicated, but we must provide you with the following important information:

  • How we may use and disclose your PHI,
  • Your privacy rights in your PHI,
  • Our obligations concerning the use and disclosure of your PHI.

The terms of this notice apply to all records containing your PHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

B. If you have questions about this Notice, please contact:
Sound Family Medicine Privacy Officer
3908 10th St SE
Puyallup, WA 98374 

C. We may use and disclose your PHI in the following ways:

The following categories describe the different ways in which we may use and disclose your PHI.

1. Treatment.

  • We may ask you to have laboratory tests (such as blood or urine tests).
  • To others who may assist in your care.
  • To other health care providers for purposes related to your treatment.
  • We may disclose your PHI to others who may assist in your care, such as your spouse, children or parents in the event we deem necessary.

2. Payment.

  • In order to bill and collect payment for the services and items you may receive from us. 
  • We may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits).

3. Health care operations.

  • To evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice. 
  • To other health care providers and entities to assist in their health care operations.

4. Appointment reminders.

  • To contact you and remind you of an appointment.

5. Disclosures required by law.

  • When we are required to do so by federal, state or local law.

D. Use and disclosure of your PHI in certain special circumstances:
The following categories describe unique scenarios in which we may use or disclose your identifiable health information:

1. Public health risks. Our practice may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:

  • Maintaining vital records, such as births and deaths,
  • Reporting child abuse or neglect,
  • Reporting reactions to drugs or problems with products or devices,
  • Notifying appropriate government agency (ies) and authority (ies) regarding the potential abuse or neglect of an adult patient.
  • Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

2. Health oversight activities. Oversight activities can include:

  • Investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative and criminal procedures or actions.
  • Oversight agencies seeking this information include government agencies that oversee the health care system required by law.

3. Lawsuits and similar proceedings.

  • In response to a court or administrative order.
  • In response to a discovery request, subpoena or other lawful process by another party involved in the dispute.

4. Law enforcement. We may disclose PHI, so long as legal requirements are met, for law enforcement. These law enforcement purposes include:

  • Medical emergency and it is likely that a crime has occurred.
  • Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement.
  • Concerning a death we believe has resulted from criminal conduct,
  • In response to a warrant, summons, court order, subpoena or similar legal process.

5. Serious threats to health or safety.

  • When necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. 

6. Military.

  • If you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

7. National security.

  • To federal officials for intelligence and national security activities required by law.

8. Inmates.

  • To correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.
  • For the institution to provide health care services to you.
  • For the safety and security of the institution.

9. Workers’ compensation.

  • For workers’ compensation and similar programs.

E. Your rights regarding your PHI:
You have the following rights regarding the PHI that we maintain about you:

1. Confidential communications.

  • You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location.
  • You may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to Sound Family Medicine Privacy Officer specifying the requested method of contact, or the location where you wish to be contacted.

2. Requesting restrictions.

  • For treatment, payment or health care operations.
  • To only certain individuals involved in your care or the payment for your care. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies or when the information is necessary to treat you.
  • In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to Sound Family Medicine Privacy Officer.  Your request must describe in a clear and concise fashion:
  • The information you wish restricted
  • Whether you are requesting to limit our practice’s use, disclosure or both,
  • To whom you want the limits to apply.

3. Inspection and copies.

  • You have the right to inspect and obtain a copy of the PHI that
  • may be used to make decisions about you, including patient medical     records and billing records, but not including psychotherapy notes.
  • You must submit your request in writing to Sound Family Medicine Privacy Officer.
  • Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request.

4. Amendment.

  • You may ask us to amend your health information if you believe it is incorrect or incomplete. To request an amendment, your request must be made in writing and submitted to Sound Family Medicine Privacy Officer.
  • You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion:
  • Accurate and complete;
  • Not part of the PHI kept by or for the practice;
  • Not part of the PHI which you would be permitted to inspect.
  • Not created by our practice, unless the individual or entity that created the information is not available to amend the information.

5. Accounting of disclosures.

  • All of our patients have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your PHI for purposes not related to treatment, payment or operations.
  • Use of your PHI as part of the routine patient care in our practice is not required to be documented – for example,
  • The doctor sharing information with the nurse; or the billing department using your information to file your insurance claim.
  • In order to obtain an accounting of disclosures, you must submit your request in writing to Sound Family Medicine Privacy Officer.
  • All requests for an “accounting of disclosures” must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003.

6. Right to a paper copy of this notice.

  • You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact Sound Family Medicine Privacy Officer.

7. Right to file a complaint.

  • If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services.
  • To file a complaint with our practice, contact Sound Family Medicine Privacy Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

8. Right to provide an authorization for other uses and disclosures.

  • Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.
  • Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing.
  • After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note: we are required to retain records of your care.

Again, if you have any questions regarding this notice or our health information privacy policies, please contact Sound Family Medicine Privacy Officer.

 


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©2007 SOUND FAMILY MEDICINE  |  LAST UPDATED: 03/24/2007