Effective January 1, 2005
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 letter is available in alternate formats that meet the guidelines for the Americans with Disabilities Act (ADA). If you require this Notice in an alternate format, please contact our ADA Liaison at: Phone 206-296-4600 or TTY Relay: 711. The most recent copy of this document will be posted in all Seattle - King County Department of Public Health care centers and on our Web site at www.kingcounty.gov/health. |
Seattle - King County Department of Public Health is committed to protecting your personal health information. Protected health information (PHI) includes information that we have created or received regarding your health, your health care, and payment for your health care.
THIS NOTICE COVERS THE FOLLOWING ENTITIES PROVIDING YOUR CARE:
All employees, physicians, physician residents, dentists, nurses, administrative staff, social workers, nutritionists, contract staff, medical students, community health providers, affiliated physicians and other health care professionals providing you care through Seattle - King County Department of Public Health care centers and/or programs must abide by this Notice of Privacy Practices. Public Health may share your information with these covered entities to help them provide medical care to you.
Washington State and federal laws require us to provide a higher level of protection for some types of PHI. Washington State law provides a higher level of protection for health care information and specifically limits the disclosure of certain types of PHI, including records regarding mental health, confirmed sexually transmitted disease, HIV/AIDS, and drug and alcohol treatment. Information about this type of care can only be released in accordance with those stricter laws. Minors may consent to their own treatment for family planning services, sexually transmitted disease testing/treatment, outpatient mental health treatment or outpatient alcohol and drug abuse treatment.
PART 1 -- YOUR RIGHTS WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION
Here is a listing of your rights with respect to your protected health information, along with a description of how you may exercise these rights:
To exercise your rights under the law, call the numbers listed in this document; write our Privacy Office or visit one of the Public Health care centers. Our staff will assist you with your request.
PART 2 - PUBLIC HEALTH'S RESPONSIBILITIES UNDER THE LAW
Public Health is required by law to provide you with our Notice of Privacy Practices. This law is the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Under this law, we must protect the privacy of your "protected health information" or PHI. PHI is information that we have created or received regarding your health or payment for your health care. It includes both your medical records and personal information such as your name, social security number, address, and phone number.
We are required to:
We reserve the right to change our practices regarding the protected health information we maintain. If we make changes, we will update our Notice and make it available to you. The most recent copy of the Notice will be posted in all Public Health care centers, and on our web site at www.kingcounty.gov/health
PART 3 - HOW WE MAY USE OR DISCLOSE MEDICAL INFORMATION ABOUT YOU
Public Health uses and discloses PHI in a number of ways connected to your treatment, payment for your care, and health care operations. Your PHI may be transmitted by FAX for the purpose of treatment, payment or operations. You have the right to ask that we do not transmit your information by FAX. Here are some examples of how we may use or disclose your personal health information without your authorization.
To provide treatment; for example:
To receive payment for services we provide or to obtain insurance authorization for services we recommend; for example:
To carry out healthcare operations; for example:
For Research: We may use and disclose medical information about you for research purposes.
For Joint Activities: Your health information may be used and shared by the Providers in furtherance of their joint activities and with other individuals or organizations that engage in joint treatment, payment or healthcare operational activities with the Providers.
As required by Law: We may use and disclose protected health information when required by federal or state law.
For judicial and administrative proceedings: We may disclose protected health information in response to an order of a court or administrative tribunal; in response to a subpoena, discovery request, or other lawful process.
For law enforcement purposes: We may disclose protected health information to a law enforcement official.
For Abuse Reports and Investigations: Public Health may use and disclose information regarding suspected cases of abuse, neglect, or domestic violence, when the law so requires.
To Medical Examiners/Coroners or Funeral Directors: We may use and disclose protected health information consistent with applicable laws to allow them to carry out their duties.
To Comply with Workers' Compensation Laws: We may disclose protected health information as authorized by laws relating to workers compensation or other programs that provide benefits for work-related injuries or illness without regard to fault.
For organ, eye, or tissue donation purposes: We may disclose protected health care information to organ procurement organizations or entities.
For Specialized Government Functions: We may use and disclose information to agencies administering programs that provide public benefits. For example, Public Health may disclose information for the determination of Supplemental Security Income (SSI) benefits. We also may provide information to government officials for specifically identified government functions such as national security or military activities; or law enforcement custodial situations, such as correctional institutions.
To Avoid Serious threat to health or safety: Public Health may use and disclose protected health information when we believe it necessary to avoid a serious threat to the health or safety of a person or the general public.
For Public Health and Safety Purposes as Allowed or Required by Law: We may disclose protected health information to health care oversight agencies for oversight activities authorized by law.
Disaster Relief: We may use and disclose information about you to assist in disaster relief efforts.
Other Uses and Disclosures Require Your Written Authorization:
Uses and disclosures not described in this Notice will be made only as allowed by law or with your written authorization. You may revoke your authorization to use or disclose protected health information at any time; the revocation must be in writing. The revocation will not affect uses or disclosures that have already been made.
PART 4 - HOW YOU MAY ASK FOR HELP OR COMPLAIN
For more Information, please contact:
Privacy Office
Seattle - King County Department of Public Health
401 5th Avenue, Suite 900
Seattle, WA 98104
Phone: 206-205-5975
TTY Relay: 711
If you believe your privacy rights have been violated, you may file a complaint with the Privacy Office of the Health Department, at the address above. You may also complain to the Secretary of the U.S. Department of Health and Human Services, at the address below. You will not be retaliated against for filing a complaint.
Office for Civil Rights
Medical Privacy, Complaint Division
U.S. Department of Health and Human Services
200 Independence Avenue, SW, HHH Building, Room 509H
Washington, D.C. 20201
Phone: 866-627-7748
TTY: 886-788-4989
Online: www.hhs.gov/ocr