Notice of Privacy Practices

The Pain Center of Western Washington

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.

The Pain Center of Western Washington respects your privacy. We understand that your personal health information is very sensitive. 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 the 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, diagnoses, treatments, 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.

Examples of Use and Disclosures of Protected Health Information for Treatment, Payment, and Health Operations

               For treatment:

·         Information obtained by a nurse, physician, or other member of our health care team will be recorded in your medical record and used to help decide what care may be right for you.

·        We may also provide information to others providing you care. This will help them stay informed about your care.

For payment:

·        We request payment from your health insurance plan. Health plans need information from us about your medical care. Information provided to health plans may include your diagnoses, procedures performed, or recommended care.

For health care operations:

·        We use your medical records to assess quality and improve services.

·         We may use and disclose medical records to review the qualifications and performance of our health care providers and 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 to raise funds.

·        We may use and disclose your information to conduct or arrange for services, including:

·         medical quality review by your health plan;

·          accounting, legal, risk management, and insurance services;

·          audit functions, including fraud and abuse detection and compliance programs.

Your Health Information Rights

                The health and billing records we create and store are the property of the practice/health care facility. The protected health information in it, however, 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 the request. But we will comply with any request granted;

·        Request and receive from us a paper copy of the most current Notice of Privacy Practices for Protected Health Information (“Notice”);

·        Request that you be allowed to see and get a copy of your protected health information. You may make this request in writing. We have a form available for this type of request.

·         Have us review a denial of access to your 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. It will be stored in your medical record, and included with any release of your records.

We may use and disclose your protected health information without your authorization as follows:

·        To Organ Procurement Organizations (tissue donation and transplant) or persons who obtain, store, or transplant organs.

·        To the Food and Drug Administration (FDA) relating to problems with food, supplements, and products.

·        To Comply with Workers’ Compensation Laws—if you make a workers’ compensation claim.

·        For Public Health and Safety Purposes as Allowed or Required by Law:

·          to prevent or reduce a serious, immediate threat to the health or safety of a person

·          or the public.

·         To Report Suspected Abuse or Neglect to public authorities.

·        For Law Enforcement Purposes such as when we receive a subpoena, court order, or other legal process, or you are the victim of a crime.

·        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 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 further details please feel free to contact our office.

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