N.E. WASHINGTON HEALTH PROGRAMS Notice of Privacy Practices Revised date: September 2013

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1 N.E. WASHINGTON HEALTH PROGRAMS Notice of Privacy Practices Revised date: September 2013.This notice describes how protected health information about you may be used and disclosed and how you can get access to this information. Please review this carefully. If you have questions about this notice, please contact the Privacy Officer at Northeast Washington Health Programs at 509 E. Main, Chewelah, WA 99109, (509) OUR PLEDGE: N.E. Washington Health Programs (NEWHP) understands that medical/dental information about you and your health is personal. We are committed to protecting medical/dental information about you. We create a record of care and services you receive at NEWHP. We need this record to provide you with quality care and to comply with certain legal requirements. We will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to do so. The law protects the privacy of health information we create and obtain in providing our care and services to you. For example, your protected health information includes your symptoms, test results, diagnosis, treatment, health information from other providers, and billing and payment information relating to these services. Federal and state law allows us to use and disclose your protected health information for purposes of treatment and health care operations. State law requires us to get your authorization to disclose this information for payment purposes. This notice will tell you about the ways in which we may use and disclose medical/dental information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. We are required by law to: Make sure that medical/dental information that identifies you is kept private; Give you this notice of our legal duties and privacy practices concerning medical/dental information about you; and Follow the terms of the notice that is currently in effect. HOW WE MAY USE AND DISCLOSE MEDICAL/DENTAL INFORMATION ABOUT YOU For Treatment: Information received from a nurse, physician, dentist or other health care team member will be recorded in your NEWHP record and used to help decide what care may be right for you. We may also provide information to doctors, nurses, technicians, nursing and medical students or hospital personnel who are involved in your care. We may also share medical/dental information about you in order to coordinate the different things you need, such as prescriptions, lab work and diagnostic testing. We may also disclose medical/dental information about you to people who may be involved in your medical/dental care such as family members, clergy, and rehabilitation centers, etc. s:\employee policy manual\org-notice of privacy practices Page 1 of 5 (9/13)

2 For Payment: We may request payment from your health insurance plan. Health plans need information from us about your medical/dental care. Information provided to health plans may include your diagnosis, procedures performed, tests, pending treatments for prior approval, or recommended care. For Health Care Operations: We use your medical records to assess NEWHP quality and to improve services. We may use and disclose medical records to review the qualifications and performance of our health care providers and/or to train our staff. We may contact you to remind you about appointments and give you information about treatment alternatives or other health-related benefits and services. We may contact you for any fundraising activities. NEWHP will provide a straightforward method allowing you to opt out of current and future fundraising and will not condition treatment or payment of the decision to opt out and will also allow you to opt back in at any time. We may disclose medical/dental information about you when required to do so by federal, state or local law. We may, under certain circumstances, disclose medical/dental information about you for research purposes. We will ask your specific permission if the researcher will have access to your name, address or other information that reveals your identity. NEWHP does not initiate or participate in any type of marketing related to consumer PHI. An individual s authorization is required for the use and disclosure of PHI for consumer marketing purposes. NEWHP does not participate in the sale of any PHI. The sale of PHI without an individual s authorization is not permitted. Genetic Information is defined as any genetic tests, genetic counseling and genetic education of an individual and his/her family members and the health history of those family members and is Protected Health Information. We may use and disclose your information to conduct or arrange services, including: o Medical quality review by your health plan; o Accounting, legal, risk management and insurance services; o Audit functions, including fraud and abuse detection and compliance programs. YOUR RIGHTS REGARDING MEDICAL/DENTAL INFORMATION ABOUT YOU The health and billing records we create are stored at the property of N.E. Washington Health Programs. The protected health information in it generally belongs to you. You have a right to: Receive, read and ask questions about this Notice; Ask us to restrict certain uses and disclosures. You must deliver this request in writing to us. We are not required to grant this request. We will comply with any reasonable request granted; Request and receive from us a paper copy of the most current Notice of Privacy Practices for Protected Health Information; s:\employee policy manual\org-notice of privacy practices Page 2 of 5 (9/13)

3 Request that you be allowed to see and get a copy of your protected health information (PHI). You may make this request in writing. We have a form available to make this request. We maintain your record in an electronic format. You have the right to request an electronic copy of your PHI or have it transmitted to another individual or entity in an electronic format such as CD, USB, etc. We will make every effort to provide access to your PHI in the form or format you request, if it is readily producible in such form or format. Otherwise your record will be provided in either our standard copy form or our standard electronic format. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical/dental record or for a readable hard copy. Be notified upon a breach of any of your unsecured Protected Health Information. Restrict the disclosure of information on out-of pocket payments. If you paid out-ofpocket in full for a specific item or services (meaning you have requested that we not bill your health plan), you have the right to ask that your Protected Health Information with respect to that item or service not be disclosed to a health plan for the purposes of payment or health care operation, and we will honor that request. Receive a copy of a clinical summary upon completion of our services for you. The clinical summary, which contains PHI, once handed to you, becomes your responsibility to safeguard against theft or unwanted disclosure of information to others. Have us review a denial of access to you health information- except in certain circumstances. Ask us to change your health information. You may give us this request in writing. You may write a statement of disagreement if your request is denied. That statement will be stored in your medical record, and included with any release of your records. When requested, we will give you a list of disclosures of your health information. The list will not include disclosures to third-party payors. You may receive this information free of charge once every 12 months. We will notify you of the cost involved if you request this information more than once in 12 months. Ask that your health information be given to you by another means or at a different location. Please sign, date, and give us your request in writing. Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released. It also does not affect any action taken before we have it. Sometimes, you cannot cancel an authorization if its purpose was to obtain insurance. Your Written Authorization Is Required for Other Uses and Disclosures: The following uses and disclosures of your Protected Health Information will be made only with written authorization from you: Uses and disclosures of Protected Health Information for marketing purposes. Disclosures that constitute a sale of your Protected Health Information Psychotherapy note maintained by NEWHP will only be used and disclosed with your authorization. s:\employee policy manual\org-notice of privacy practices Page 3 of 5 (9/13)

4 CHANGES TO THIS NOTICE NEWHP has the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice. You may receive the most recent copy of this notice by calling and asking for it, by visiting any NEWHP office to pick one up or by logging on to our website at www. newhp.org To Ask for Help or Report Problems If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact: N.E. Washington Health Programs Attn: Privacy Officer 509 E. Main / PO Box 808 Chewelah, WA or If you believe your privacy rights have been violated, you may discuss your concerns with any staff member or deliver a written complaint to the Privacy Officer at the address noted above. You may also file a complaint with the U.S. Secretary of Health and Human Services. We respect your right to file a complaint with us or with the U.S. Secretary of Health and Human Services. If you complain, NEWHP will not take any action against you or change our treatment of you in any way. Other Disclosures and Uses of Protected Health Information Notification of Family and Others We may release health information about you to a friend or family member who is involved in your medical/dental care. We may also give information to someone who helps pay for your care. We may tell family and friends your condition and that you are in a hospital. In addition, we may disclose health information about you to assist in disaster relief efforts or in an emergency. We may use your protected health information without your authorization as follows: With Medical Researchers - if the research has been approved and has policies and procedures to protect your privacy. We may also share information with medical researchers preparing to conduct a research project. To Funeral Directors/Coroners/Organ Procurement Organizations (Tissue Donation and Transplant) - consistent with applicable laws and regulations. To the Food and Drug Administration (FDA )- relating to problems with food, medications, or other products causing an adverse reaction. We may also share information in reporting any incident involving medical equipment that causes injury, for the purpose of assessing for manufacturing errors. To Comply with Workers Compensation Laws - if you make a workers compensation claim. s:\employee policy manual\org-notice of privacy practices Page 4 of 5 (9/13)

5 For Public Health and Safety Purposes as Allowed or Required by Law - o To prevent or reduce serious, immediate threat to the health or safety of a person or the public. o To public health or legal authorities To protect public health and safety To prevent or control disease, injury, or disability To report vital statistics such as birth or deaths. To Report Suspected Abuse or Neglect - to public authorities. To Correctional Institutions - if you are in jail or prison, as necessary for your health and the health and safety of others. For Law Enforcement Purposes - such as when we receive a subpoena, court order, or other legal processes, or if you are the victim of a crime. For Health and Safety Oversight Activities - For example, we may share health information with the Department of Health. For Disaster Relief Purposes - For example, we may share health information with disaster relief agencies to assist in notification of your condition to family and others, or for identification purposes. For Work-Related Conditions that Could Affect Employee Health - For example, an employer may ask us to assess health risks on a job site. To the Military Authorities of the U.S. and Foreign Military Personnel - For example, the law may require us to provide information necessary to a military mission. In the Course of Judicial/Administrative Proceedings - at your request, or as directed by a subpoena or court order. For Specialized Government Functions - For example, we may share information for National Security purposes. For Government or Private Use for the purpose of obtaining a grant or funding. Other Uses and Disclosures of Protected Health Information Uses and disclosures not in this Notice will be made only as allowed by law or with your written authorization. Web Site We have a website that provides information about us. For your benefit, this Notice is on the Web site at this address: Effective Date: September 2013 s:\employee policy manual\org-notice of privacy practices Page 5 of 5 (9/13)