I. THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
PLEASE REVIEW IT CAREFULLY
II. WE HAVE A LEGAL DUTY TO SAFE-GUARD YOUR PROTECTED HEALTH INFORMATION (PHI)
We are required by law to protect the privacy of your health information. We call this information “protected health information,” or “PHI” for short. PHI includes information that can be used to identify you. We may have created or received this information about your past, present, or future health or condition, the provision of health care to you, or payment for this health care. We must provide you with notice about our privacy practices explaining how, when and why we use and disclose your PHI.
With some exceptions, we may not use or disclose any more of your PHI than is necessary to accomplish the purpose of the use or disclosure. Additional disclosures of records outside of these uses requires authorization from you, the patient. Any given authorization may be revoked at a future date. We are legally required to follow the privacy practices that are described in this notice.
We reserve the right to change the terms of this notice and our privacy policies at any time. Any changes will apply to the PHI we already have. Before we make an important change to our policies, we will promptly change this notice and post a new notice in the hospital’s main reception area. We are bound by the notice in effect at the time of your service. You may also request a copy of this notice from our Patient Access dept. at any time and can view a copy of the notice on our website at www.whidbeygen.org.
III. HOW WE MAY USE AND DISCLOSE YOUR PHI
The following categories describe different ways we use and disclose health information. For each category we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories.
1. For Treatment. We may disclose your PHI to physicians, nurses, medical students, and other health care personnel who provide you with health care services or are involved in your care, with the exception of psychotherapy records. For example, if you’re being treated for a knee injury, we may disclose your PHI to the physical rehabilitation department in order to coordinate your care.
2. For Payment. We may use and disclose your PHI in order to bill and collect payment for the treatment and services provided to you. For example, we may disclose your PHI to our business associates, such as: billing companies, claims processing companies, and others that process our health care claims. This notice serves as full disclosure of our right to use PHI for billing pursuant to the Graham-Leach Bliley Act and the Health Insurance Portability and Accountability Act (HIPAA). See Section IV to limit disclosure.
3. For Health Care Operation. We may disclose your PHI in order to operate this hospital. For example, we may use your PHI in order to evaluate the quality of health care services that you received or to evaluate the performance of the health care professions who provided health care services to you. We may also provide your PHI to our accountants, attorneys, consultants, and others to make sure we’re complying with the laws that affect us. We will take appropriate steps to protect the PHI including but not limited to removal of personal identifiers, limited disclosures, and other available means.
4. Appointment Reminders. We may use and disclose health information to contact you as a reminder that you have an appointment for treatment or care.
5. Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
6. Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
7. Fund Raising Activities. We may contact you as part of a fund raising effort. If you do not wish to be contacted as part of a fund raising effort, you must opt out at the time of registration.
8. Hospital Directory. We may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don’t ask for you by name. This is so your family, friends and clergy can visit you in the hospital and generally know how you are doing. If you do not wish for this information to be disclosed, please inform your provider while in the hospital.
9. Research. Under certain circumstances, we may provide PHI to participate in approved medical research.
10. Individuals Involved in Your Care or Payment for Your Care. We may orally release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in the hospital. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location. If you do not wish for this information to be disclosed, please inform your provider while in the hospital.
11. As Required By Law. We make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence, when dealing with gunshot and other wounds; or when ordered in a judicial or administrative proceeding. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
12. To Avoid Harm. We may use and disclose medical information about you when necessary to prevent a serious imminent threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
13. Organ and Tissue Donation. We may notify organ procurement organizations to assist them in organ, eye, or tissue donation and transplants in the event of death.
14. Workers’ Compensation. If you are seeking Workers’ Compensation, we may disclose your PHI to the extent necessary in order to comply with Workers Compensation laws.
15. Public Health Activities. We report information about births, deaths, and various diseases, to government officials in charge of collecting that information, and we provide coroners, medical examiners, and funeral directors necessary information relating to an individual’s death.
16. Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. The oversight activities include, for example, audits, investigation, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
17. Specialized governmental functions. We make disclosures when required for armed forces personnel, national security and intelligence activities, protecting the President, Medical suitability determinations for the Department of State, and public benefits programs.
IV. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI
You have the following rights with respect to your PHI:
1. The Right to Request Limits on Uses and Disclosures of Your PHI.
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had. If you restrict or limit information to those responsible for payment, you may be billed directly for services provided. If elements of your PHI are legally required to be reported, you may not restrict or limit the disclosure of that information. We are not required to agree to your request.
If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
To request restrictions, you must make your request in writing to the Health Information Management dept. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosures, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
2. Right to Choose How We Send PHI to You.
You have the right to request that we communicate with you about medical matters in a certain way or a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to the Health Information Management dept. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
3. The Right to See and Get Copies of Your PHI.
In most cases, you have the right to read and receive copies of your PHI that we have, but must make the request in writing. If we don’t have your PHI but we know who does, we will tell you how to get it. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed. Instead of providing the PHI you requested, we may provide a summary or explanation of the PHI as long as you agree to that.
4. The Right to Get a List of the Disclosures We Have Made.
You have the right to get a list of instances in which we have disclosed your PHI. The list will not include uses or disclosures to third party payors. The list also won’t include uses and disclosures made for national security purposes, to corrections or law enforcement personnel, or before April 14th 2003. We will respond within 60 days of receiving your request. The list we give you will include disclosures made in the last six years unless you request a shorter time. The list will include the date of disclosure, to whom the PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge the fees allowed by the WAC 246-08-400 and the RCW 70.02.010 for each additional request.
5. The Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the hospital. To request an amendment, your request must be made in writing and submitted to the Health Information Management dept. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the medical information kept by or for the hospital;
- Is not part of the information which you would be permitted to inspect and copy.
6. The Right to Get This Notice by E-Mail.
You have the right to get a copy of this notice by e-mail at email@example.com. Even if you agreed to receive this notice electronically, you also have the right to request a paper copy at any time. You may obtain a copy of this notice at our website, www.whidbeygen.org.
7. Complaints. Complaints may be made to Whidbey General Hospital or directly to the Secretary of the Department of Health and Human Services if you feel your rights have been violated. Please contact the Quality & Patient Safety dept. or Administration for assistance in filing your complaint. No retaliatory actions will be taken at any time against a patient who files a complaint.
8. Effective Date. This notice went into effect on April 14, 2003. Revised on May 1, 2013.
9. For further information please contact:
Quality and Patient Safety
360-678-7656 ext. 3151
360-321-7656 ext. 3151
This notice describes the privacy practices of:
Whidbey General Hospital
South Whidbey Community Clinic
North Whidbey Community Clinic
Home Health Care and Hospice
Hospital-managed Primary Care and Specialty Clinics
If you need a document with larger print, please contact WGH Public Relations at
360-678-7656 ext 3350 or
360-321-7656 ext 3350