Highline Therapy
Services
Notice of Privacy Practices
Effective Date: 4-14-03
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. If you have any questions, please contact Colleen
Dillingham (253) 874-2998 or Claudine Gibbs (206) 242-5186.
Who Will Follow This Notice
This notice describes Highline Therapy Services and that of:
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• Any health care professional
authorized to enter information into your chart |
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• All departments of the
practice |
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• Any volunteer or student
we allow to help you while you are at our practice |
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• All employees, staff and
other practice personnel |
Our Pledge Regarding Medical Information
We understand that medical information about you and your health is
personal. We are committed to protecting medical information about
you. We create a record of the care and services you receive at the
practice. We need this record to provide you with quality care and
to comply with certain legal requirements. This notice applies to all
of the records of your care generated by our practitioners.
This notice will tell you about the ways in which we may use and disclose
medical 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:
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• Make sure that medical information that identifies
you is kept private. |
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• Give you this notice of
our legal duties and privacy practices with respect to |
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medical information
about you. |
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• Follow the terms of the
notice that is currently in effect. |
How We May Use and Disclose Medical Information about You
The following categories describe different ways that we use and disclose
medical information. For each category of uses or disclosures 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 of the ways we
are permitted to use and disclose information will fall within one
of the categories.
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For treatment: We may use medical
information about you to provide you with medical treatment or
services. We may disclose medical information about you to other
therapists, technicians, or therapy students who are involved in
taking care of you in our practice. Different members of the practice
may share medical information about you in order to coordinate
the different things you need, such as modality set-up and exercises. |
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For payment: We may use and disclose medical
information about you so that the treatment and services you receive
at our practice may be billed to and payment may be collected from
you, an insurance company, or a third party. For example, we may
need to give your health plan information about your care received
so your health plan will pay us or reimburse you for the procedure.
We may also tell your health plan about a treatment you are going
to receive to obtain prior approval or to determine whether your
plan will cover the treatment. |
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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. |
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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. |
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Individuals involved in
your care or payment for your care: We may 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. |
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As required by law: We will disclose
medical information about you when required to do so by federal,
state or local law. |
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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 or another person. Any disclosure,
however, would only be to someone able to help prevent the threat. |
Special Situations
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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 medical information about foreign military personnel to
the appropriate foreign military authority. |
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Workers’ compensation: We
may release medical information about you for workers’ compensation
or similar programs. These programs provide benefits for work-related
injuries or illness. |
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Public health risks: We may disclose
medical information about you for public health activities. These
activities generally include the following: |
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To prevent or control disease, injury or disability |
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To report child abuse or neglect |
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To report reactions to medications or
problems with products. |
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To notify people of recalls of products
they may be using. |
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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. |
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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
or authorized by law. |
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Health oversight activities: We may disclose medical information to a health oversight agency for activities
authorized by law. These oversight activities 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. |
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Lawsuits and disputes: If you are involved
in a lawsuit or a 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, but only
if efforts have been made to tell you about the request or to obtain an
order protecting the information requested. |
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Law enforcement: We may release medical
information if asked to do so by a law enforcement official: |
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In response to a court order,
subpoena, warrant, summons, or similar process. |
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To identify or locate a suspect, fugitive,
material witness, or missing person. |
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About the victim of a crime if, under
certain limited circumstances, we are unable to obtain the person’s
agreement. |
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About criminal conduct at the practice. |
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In emergency circumstances to report a
crime; the location of the crime or victims; or the identity, description
or location of the person who committed the crime. |
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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 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. |
Your Rights Regarding Medical Information about You
You have the following rights regarding medical information we maintain
about you:
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Right to
inspect and copy: You have the right to inspect and copy medical information
that may be used to make decisions about your care. Usually,
this includes medical and billing records.
To inspect and copy medical information that may be used to
make decision about your care, you must submit your request and
consent to release this information in writing to Highline Therapy
Services.
The Consent to Release form must be filled out completely and
all authorizations must be up-to-date. Highline Therapy Services
reserves the right to deny your request to inspect and copy in
certain very limited circumstances. You have the right to request
that the denial be reviewed. |
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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
the practice.
To request an amendment, your request must be made in writing
and submitted to Highline Therapy Services. 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: |
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Was not created by us, unless
the person or entity that created the information is no longer available
to make the amendment. |
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Is not part of the medical information
kept by this practice. |
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Is not part of the information, which
you would be permitted to inspect and copy. |
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Is accurate and complete. |
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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 Highline Therapy Services. Your request must state
a time period, which may not be longer than six years and may not include
dates before April 14, 2003. Your request should indicate in what form
you want the list (for example, on paper, electronically). The first
list you request within a 12-month period will be free. 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 at that time before any costs are incurred. Disclosures
made for treatment or for payment purposes (healthcare operations) are
not included in this list. |
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Right to request restrictions: 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 the payment for your care, like a family member or friend. For
example, you could ask that we not use or disclose information about
treatment 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 emergency treatment.
To request restrictions, you must make your request in writing to Highline
Therapy Services. In your request, you must tell us (1) what information
you want to limit; (2) whether you want to limit our use, disclosure,
or both; and (3) to whom you want the limits to apply, for example, disclosures
to your spouse. |
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Right to request confidential
communications: You have the right to request that we communicate with you about medical
matters in a certain way or at 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 Highline Therapy Services. 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. |
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Right to an additional copy of
this notice: You have the right to request an additional copy of this notice at any
time. To obtain a paper copy of this notice contact Highline Therapy Services. |
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 as well as any information we receive in
the future. We will post a copy of the current notice in the practice.
The notice will contain the effective date on the first page in the
top right-hand corner.
Complaints
If you believe your privacy rights have been violated, you may file
a complaint with the practice or with the Secretary of the Department
of Health and Human Services. To file a complaint with the practice,
contact Colleen Dillingham, Privacy Officer- 253-874-2998 or Claudine
Gibbs, Privacy Officer- 206-242-5186. 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 use 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
to you.
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