Women’s Health Center of West Virginia, Inc.
Notice of Privacy Practices
THIS NOTICE IS EFFECTIVE APRIL 14, 2003.
AMENDED SEPTEMBER 23, 2013
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.
We are required by law to protect medical information about you that identifies you.
This may be information about health care services that we provide to you or payment for health care provided to you. It may also be information about your past, present, or future health care condition.
We are also required by law to provide you with this Notice of Privacy Practices explaining our legal duties and privacy practices with respect to health care information. We are legally bound to follow the terms of this Notice. In other words, we are only allowed to use and disclose health care information in the manner that we have described in this Notice.
We may change the terms of this Notice in the future. We reserve the right to make changes and to make the new Notice effective for all health care information that we maintain. If we make changes to the Notice, we will:
Post the new Notice in our waiting area
Have copies of the new Notice available upon request (you may also contact our Privacy Officer at 304-344-9841 to obtain a copy of the current Notice).
The rest of this notice will: discuss how we may use and disclose medical information about you; explain your rights with respect to medical information about you; describe how and where you may file a privacy related complaint
UNDERSTANDING YOUR HEALTH RECORD AND INFORMATION
Each time you visit a hospital, physician or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment. This information often referred to as your health or medical record, serves as a basis for planning your care as well as a legal document describing the care you received. This also helps verify to a third-party payer that the services billed were actually provided. Understanding what is in your record and how health information is used helps you to ensure its accuracy, to better understand who, what, when, where and why others may access your health information, and to make more informed decisions when authorizing disclosures to others.
WE MAY USE AND DISCLOSE HEALTH CARE INFORMATION ABOUT YOU IN SEVERAL CIRCUMSTANCES
We use a guardian or other person responsible for the minor, except in limited circumstances. However, we will not release to a parent or guardian patient records of diagnosis, treatment or provision of health care services to minors for birth control, prenatal care, drug rehabilitation or related and disclose health care information about consumers every day. This section of our Notice explains in some detail how we may use and disclose health care information about you in order to provide health care, obtain payment for that health care, and operate our business efficiently. This section then briefly mentions several other circumstances in which we may use or disclose health care information about you. For more information about any of these uses or disclosures, or about any of our privacy policies, procedures or practices, you may contact our Privacy Officer at 304-344-9841.
We will use your health information for treatment. For example, information obtained about you by a physician, case manager, nurse or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Members of your healthcare team will also record treatments and the tests and interventions ordered for you. Your physician will also record information about medications they have prescribed for you as well as your response to these medications.
We will use your health information for payment. For example, a bill may be sent to you and/or a third-party payor. Information on or accompanying the bill may include information that identifies you, as well as your diagnosis, your physician and the type of services you have received.
We will use your health information for health care operations. For example, members of the healthcare team(s) and quality improvement staff may use information in your health record to assess the care and outcomes in your case. This information will then be used in an effort to continually improve the quality and effectiveness of the services we provide. We will use your health information to enter data for billing and documentation purposes. We may also contact you via telephone or letter to provide appointment reminders.
We will use your health information with persons involved in your care.We may disclose health care information about you to a relative, close personal friend or any other person you identify if that person is involved in your care and the information is relevant to your care. If the consumer is a minor, we may disclose health care information about the minor to a parent, guardian or other person responsible for the minor, except in limited circumstances. However, we will not release to a parent or guardian patient records of diagnosis, treatment or provision of health care services to minors for birth control, prenatal care, drug rehabilitation or related services or venereal disease, without prior written consent thereof from the patient.
You may ask us at any time not to disclose health care information about you to persons involved in your care. We will agree to your request and not disclose the information except in certain limited circumstances. For example, Jane's husband regularly comes to the health center with Jane for her appointments and he helps her with her medication. When the nurse is discussing a new medication with Jane, Jane invites her husband to come into the private room. The nurse discusses the medication with Jane and Jane's husband.
We may use and/or disclose certain protected health information (PHI) without written authorization in limited circumstances such as: those required by law; public health activities, health oversight activities, disclosures about abuse, neglect or domestic violence; judicial and administrative proceedings; law enforcement purposes; and certain government functions. *Please note: this is NOT an exhaustive list and is not limited to the examples listed below.
Examples of uses and disclosures required by law: A responsible clinician can disclose PHI when, in his/her opinion, there is an imminent danger to the health or safety of the consumer or another individual. In these circumstances, we are required by law to take action to ensure that no harm occurs to the consumer or someone else.
Examples of uses and disclosures for public health activities: We may disclose PHI about you for public health activities. For example, activities related to investigating exposure to communicable diseases or reporting child abuse, neglect and violence.
Examples of uses and disclosures for health oversight activities: We may disclose medical information about you to a health oversight agency. For example, a government agency may request information from us while they are investigating possible insurance fraud.
Examples of uses and disclosures for research activities: on rare occasions the Center's Privacy Committee may determine that information may be released for research studies without authorization. Stringent guidelines would be met prior to such a release.
Examples of uses and disclosures about abuse, neglect or domestic violence: We may disclose PHI to a government authority that is authorized by law to conduct an investigation regarding abuse and/or neglect. For example, if you are an adult and we reasonably believe that you may be a victim of abuse, neglect or domestic violence.
Examples of uses and disclosures for law enforcement purposes: We can disclose PHI without an authorization for specific law enforcement purposes. For example, we may disclose limited PHI without individual authorization in response to law enforcement official's request for such information for the purpose of identifying or locating a suspect, fugitive, material witness, or missing person.
Examples of uses and disclosures for governmental functions: We may use or disclose PHI for certain governmental functions. For example, we may disclose information about you for national security and intelligence activities
Other than the uses and disclosures described above, we will not use or disclose health care information about you without an "authorization" – or signed permission from you or your personal representative. In some instances, we may wish to use or disclose health care information about you and we may contact you to ask you to sign an authorization form. In other instances you may contact us to ask us to disclose health care information and we will ask you to sign an authorization form.
If you sign a written authorization allowing us to disclose health care information about you, you may later revoke (or cancel) your authorization in writing (except in very limited circumstances related to obtaining insurance coverage). If you would like to revoke your authorization, you may write us a letter revoking your authorization or fill out an Authorization Revocation Form. Authorization Revocation Forms are available from our Privacy Officer. If you revoke your authorization, we will follow your instructions except to the extent that we have already relied upon your authorization and taken some action.
YOU HAVE RIGHTS WITH RESPECT TO HEALTH CARE INFORMATION ABOUT YOU
This section of the Notice will briefly mention each of these rights. If you would like to know more about your rights, please contact our Privacy Officer at 304-344-9841.
1. Right to a copy of this Notice
You have a right to have a paper copy of our Notice of Privacy Practices at any time. In addition, a copy of this Notice will always be posted in our waiting area. If you would like to have a copy of our Notice, ask the receptionist for a copy or contact our Privacy Officer. If you access our web site the Notice of Privacy Practices will be posted at the site.
2. Right of access to inspect and copy
You have the right to inspect (which means see or review) and to receive a copy of health care information about you that we maintain in certain groups of records. If you would like to inspect or receive a copy of health care information about you, you must provide us with a request in writing. You may write us a letter requesting access or fill out an Access Request Form. Access Request Forms are available from our Privacy Officer. Our agency must act on this request no later than 30 days after receipt of the request.
We may deny your request in certain circumstances. If we deny your request, we will explain our reason for doing so in writing. We will also inform you in writing if you have the right to have our decision reviewed by a licensed professional.
If you would like a copy of the information, we may charge you a fee to cover the costs of the copy. We may be able to provide you with a summary or explanation of the information. Contact our Privacy Officer for more information on these services and any possible additional fees.
3. Right to have health care information amended
You have the right to have us amend (which means correct or add) health care information about you that we maintain in certain groups of records. If you believe that we have information that is either inaccurate or incomplete, we may amend the information to indicate the problem and notify others who have copies of the inaccurate or incomplete information. If you would like us to amend information, you must provide us with a request in writing. You may write us a letter requesting an amendment or fill out an Amendment Request form. Amendment request forms are available from our Privacy Officer. Our agency must act on this request no later than 60 days after receipt of the request.
We may deny your request in certain circumstances. If we deny your request, we will explain our reason for doing so in writing. You will have the opportunity to send us a statement explaining why you disagree with our decision to deny your amendment request and we will share your statement whenever we disclose the information in the future.
4. Right to an accounting of disclosures we have made
You have the right to receive an accounting (which means a detailed listing) of disclosures that we have made for the previous six (6) years (beginning April 14, 2003). If you would like to receive an accounting, you may send us a letter requesting an accounting, fill out an Accounting Request Form, or contact our Privacy Officer. Accounting Request Forms are available from our Privacy Officer. Our agency must act on this request no later than 60 days after receipt of the request.
The accounting will not include several types of disclosures, including disclosures for treatment, payment, or health care operations. It will also not include disclosures made prior to April 14, 2003.
If you request an accounting more than once every twelve (12) months, we may charge you a fee to cover the costs of preparing the accounting.
5. Right to request restrictions on uses and disclosures
You have the right to request that we limit the use and disclosures of health care information about you for treatment, payment, and health operations. We are not required to agree to your request.
If we do not agree to your request, we must follow your restrictions (except if the information is necessary for emergency treatment). You may cancel the restrictions at any time. In addition, we may cancel a restriction at any time as long as we notify you of the cancellation and continue to apply the restriction to information collected before the cancellation.
You have the right to direct us not to tell your health insurance carrier about services that you have elected to pay for out of pocket.
6. Right to request an alternative method of contact
You have the right to be contacted at a different location or by a different method. For example, you may prefer to have all written information mailed to your work address rather than your home address.
We will agree to any reasonable request for alternative methods of contact. If you would like to request an alternative method of contact, you must provide us with a request in writing. You may write us a letter or fill out a form to request an alternative method of contact. Forms are available from our Privacy Officer.
7. Right to notification of breach
If your unsecured protected health information (PHI) is breached, we will notify you and provide you with resources and information.
YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES
If you believe that your privacy rights have been violated or if you are dissatisfied with our privacy policies or procedures, you may file a complaint either with us or with the federal government. We will not take any action against you or change our treatment of you in any way if you file a complaint.
To file a written complaint with Women's Health Center of West Virginia, Inc., you may bring your complaint to your health care worker, his/her supervisor, the Privacy Officer or you may mail it to the following address:
Women's Health Center of West Virginia, Inc.
P.O. Box 20580
Charleston, WV 25362
ATTENTION: Privacy Officer
To file a complaint with the federal government, you may contact the Office of Civil Rights for assistance:
Office for Civil Rights
US Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, DC 20201