THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THE INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
We are required by law to:
- Make sure that medical information that identifies you is kept confidential;
- Give you this notice of our legal duties and privacy practices regarding your medical information;
- Follow the terms of the notice currently in effect.
This notice describes the information practices of:
- Cascade Valley Hospital
- Cascade Valley Hospital Wound Care and Hyperbaric Medicine Center
- Cascade Valley Arlington Surgical Center
- Cascade Valley Arlington Orthopaedics
- Cascade Valley Arlington Women’s Health
- Cascade Valley Granite Falls Clinic
- Cascade Valley Darrington Clinic
- Cascade Valley Arlington Pediatrics
This notice also describes the information practices of:
- Any health care professional authorized to enter information into your chart at one of our facilities;
- All personnel in all departments and clinics of Cascade Valley Hospital and Clinics;
- Any member of a volunteer group we allow to help you while you are being treated;
- Any contractors and agency personnel working on site.
We understand that medical information about you and your health is personal. We are committed to protecting your medical information. We create a record of the care and services that you receive. We need this record to provide quality care and to comply with certain legal requirements. This notice applies to all of the records created at the sites listed above, whether made by hospital or clinic personnel, or by your personal care provider.
You have the right to:
• Get a copy of your paper or electronic medical record and request amendments to your paper or electronic record
• Request confidential communication or ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
You have some choices in the way that we use and share information as we:
• Tell family and friends about your condition, or include you in a hospital directory
• Provide disaster relief
• Provide mental health care
• Market our services and sell your information, or raise funds
Our Uses and Disclosures
We may use and share your information as we:
• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law or for the protection of national security and intelligence activities
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will email your personal health information to you only upon specific request and your acknowledgement of the risks of unencrypted transmissions.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. There may also be fees associated with creating an affidavit of completeness as set by Washington State laws, if such a certification is requested.
Ask us to correct your medical record
• You can ask us to correct health information about you that you think is incorrect or incomplete. You must request this amendment in writing and identify which information you want changed and why it should be changed.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
• You can complain if you feel we have violated your rights by contacting us using the information on at the end of this notice.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.
In the event of a breach of privacy, you will be notified in accordance with Federal and State laws
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospital directory
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes
In the case of fundraising:
• We may contact you for fundraising efforts, but you can tell us not to contact you again.
• You may also”opt-out” of future communication through the registration process when you receive services at Cascade Valley Hospital, Cascade Valley Arlington Surgery Center, or Cascade Valley Clinics.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary. This may include quality initiatives, medical and legal reviews, working with auditors and examiners, compliance reviews and providing information to other regulatory bodies as required by law or health care contract.
Example: We use health information about you to manage your treatment and services.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities. We may also use your information to determine your eligibility for benefits and services by phone or electronic means.
Example: We give information about you to your health insurance plan so it will pay for your services. We may also give your information to another provider involved in your care and treatment at one of our facilities so that they may bill for their services or contact you directly.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain situations such as:
• Preventing or controlling disease
• Reporting births and deaths
• Reporting reactions to medications or problems with products to the Food and Drug Administration (FDA)
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Give notice of exposure to disease or condition that is a health risk
• Preventing or reducing a serious threat to anyone’s health or safety
We can use or share your information for health research.
Comply with the law or efforts to protect national security and intelligence activities
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
We may disclose medical information about you to authorized federal officials for intelligence and all security activities authorized by law, or so that you may provide protection to the President, other authorized persons, including foreign heads of state, or to conduct special investigations.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena. We may also release medical information if asked to do so by a law enforcement official:
• To identify or locate a suspect, fugitive, material witness, or missing person;
• About the victim of a crime, if, under certain limited circumstances, we are unable to obtain the person’s agreement;
• About a death we believe may be the result of criminal conduct;
• About criminal conduct at the hospital; and
• In emergency circumstances to report a crime, the location of the crime or victims, of the identity,
description or location of the person who allegedly committed the crime.
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office and on our website at www.cascadevalley.org.
For concerns or questions regarding this notice, please contact our Privacy Officer, Jola Barnett at
(360)618-7812 or firstname.lastname@example.org.
This notice is effective September 23, 2013.
How We May Use and Disclose Information About You
The following categories describe different ways that we use and disclose medical information. For each category, we will explain our meaning and give examples. Not every use or disclosure will be listed, but all of the ways that we are permitted to use and disclose medical information will fall within one of the categories.
- For Treatment: We may use medical information about you to provide you with medical treatment and/or services. We may disclose information about you to doctors, nurses, technicians, medical students, or other hospital, surgery center or clinic personnel who are involved in your care. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. The doctor may tell the dietician so appropriate meals can be arranged for you. Different departments of the hospital may also share information about you to coordinate the various things you need, like x-rays, lab work, and prescriptions. We may also disclose information about you to people outside our health system who may be involved in your medical care after you leave our system.
- For Payment: We may use and disclose medical information about you so that your medical treatment and services may be billed to, and payment collected from, your insurance company or other third party (like your auto insurance company, if applicable). This includes Workers Compensation. We may also tell your health plan about treatment you may receive to obtain prior approval or to determine whether your plan will cover the treatment.
- For Health Care Operations: We may use and disclose medical information about you for hospital, surgery center and clinic functions. These uses and disclosures are necessary to run our facilities and to make sure that our patients receive quality care. For example, we may use your medical information to review your treatment and services, and to evaluate the performance of our staff in caring for you. We may also combine medical information about many of our patients to decide what additional services we should offer, or whether certain new treatments are effective. We may also disclose medical information to care personnel for review and learning purposes. We may also combine medical information we have with medical information from other hospitals to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and its delivery without learning who the specific patients are.
- Emergency treatment: We are not required to get your consent before emergency care as long as we try to get your consent after treatment, or if we try to get your consent but you are unconscious or in severe pain, and we think you would consent if you were able to do so.
- For Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or care at one of our facilities.
- For 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.
- For Research: Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another medication for the same condition. All research projects are evaluated for balance between research needs and patients’ needs for privacy.
- As Required By Law: We will disclose medical information about you when required to do so by federal or state law.
- To Avert a Serious Threat to Health or Safety: We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety, or the health and safety of the public. Any disclosure, however, would only be to someone able to help prevent the threat.
- Organ and Tissue Donation: If you are a donor, we may release medical information to organizations that handle organ procurement or transplantation, as necessary to facilitate organ or tissue donation and transplantation.
- Military and Veterans: If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release information about foreign military personnel to the appropriate foreign military authority.
- Public Health Risks: We may disclose medical information about you for public health purposes. These purposes generally include the following:
- To prevent or control, disease, injury or disability;
- To report births and deaths;
- To report suspected child abuse or neglect;
- To report reactions to medications or problems with products;
- To notify people of recalls of product they may be using;
- To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
- To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree OR when required by law.
- Health-Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law (for example, Department of Health, Medicare, and DSHS). These activities may include, for example, audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
- Lawsuits and Disputes: If you are involved in a lawsuit or dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute.
- Law Enforcement: We may release medical information if asked to do so by a law enforcement official:
- In response to a court order, subpoena, warrant, summons, or similar process;
- To identify or locate a suspect, fugitive, material witness or missing person;
- About the victim of a crime, if, under certain limited circumstances, we are unable to obtain the person’s agreement;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct at the hospital; and
- In emergency circumstances to report a crime, the location of the crime or victims, of the identity, description or location of the person who allegedly committed the crime.
- Coroners, Medical Examiners and Funeral Directors: We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release information about patients to funeral directors as necessary to carry out their duties.
- Fundraising: To contact you for Cascade Valley Hospital and Clinics Foundation fundraising purposes. We would only release information such as your name, address, phone number and the dates that you received treatment or service from us. You will be given the opportunity to instruct us not to contact you for this purpose.
- National Security and Intelligence Activities: We may disclose medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
- Protective Services for the President and Others: We may disclose medical information about you to authorized federal officials so that you may provide protection to the President, other authorized persons, or foreign heads of state, or to conduct special investigations.
- Inmates: 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 would be necessary for the institution to provide you with health care, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.
Two Uses and Disclosures that You Have the Opportunity to Object To:
- For Hospital, Surgery Center and Clinic Directories: We may include certain limited information about you in these directories while you are at the facility. This information may include your name, location, general condition (for example, fair, stable, etc.) and your religious affiliation. The directory information, except for religious affiliation, may be released to people who ask for you by name. Your religious affiliation may be given to clergy, even if they do not ask for you by name. This is so your family, friends and clergy can visit you and generally know how you are doing.
- Disclosures to Family, Friends and Others: We may provide your medical information to a family member, friend or other person that you indicate is involved in your care, or in the payment for your care, unless you object in whole or in part.
Your Rights Concerning Medical Information About You
You have the following rights regarding medical information we maintain about you:
- Right to Inspect and Copy: You have the right to inspect and get a copy of medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.To inspect and get a copy of medical information that may be used to make decisions about you, you must submit your request in writing to the Medical Records Department of Cascade Valley Hospital (for the hospital and surgery center) or to the Clinic Process Coordinator of any of our clinics.We may deny your request to inspect and copy your record in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the organization will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
- Right to Amend: If you think the 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 us. To request an amendment, your request must be made in writing and submitted to our Privacy Officer. In addition, you must supply 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 your request. In addition, we may also 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 our facilities;
- is not part of the information which you would be permitted to inspect and copy; or
- is accurate and complete.
- Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures”. This is a list of the disclosures we made of medical information about you.To request this list, or accounting of disclosures, you must submit your request in writing to the Medical Records Department of the hospital (and for the srugery center), or to the Clinic Process Coordinator of any of our clinics. Your request must state a time period which may not be longer than six years, and may not include dates before April 14, 2003. The first list you request in any twelve-month period will be free of charge. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request before any costs are incurred.
- Right to Request Restrictions: You have the right to request a restriction or limitation on the medical information that we use or disclose about you for treatment, payment of 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 the payment of your care. For example, you could ask that we not use or disclose information about a surgery that you had.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 submit your request in writing to our Privacy Officer. In your request, you must tell us what information you want to limit, whether you want to limit our use, our disclosure, or both, and to whom you want the limits to apply.
- Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or in a certain location. For example, you can ask that we only contact you at work, or by mail.To request confidential communications, you must notify the Admitting Representative or Patient Service Representative when you register. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
- Right to a Paper Copy of this Notice: You have a right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our website, at www.cascadevalley.org. To obtain a paper copy of this notice, contact the Admitting Department at Cascade Valley Hospital or any receptionist at any of our clinics or surgery center.
Changes to this Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you, and for information we receive in the future. We will post a copy of the current notice in the hospital, each clinic and the surgery center. The notice will contain the effective date on the top of each page.
The first time you register at the hospital, surgery center or a clinic, we will offer you a copy of the notice currently in effect.
If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer or with the Secretary of the Department of Health and Human Services. To file a complaint with the Privacy Officer, contact:
Cascade Valley Hospital and Clinics
330 So. Stillaguamish Avenue
Arlington, WA 98223
360-435-2133, extension 4900.
All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
Other uses of medical information
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided you.
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