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Notice of Privacy Practices
Effective April 14, 2003
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"THIS NOTICE DESCRIBES HOW MEDICAL AND OTHER
CONFIDENTIAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW
YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY."
45CFR164.520(b)(1)(i)
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OUR PRIVACY RESPONSIBILITIES UNDER HIPAA
Washington law requires the Department of Health (DOH) to protect
health records in our possession. If you receive services
through our Metabolic Treatment Product Program (MTPP), federal law,
the Health Insurance Portability and Accountability Act of 1996
(HIPAA), also protects your health information. In addition, HIPAA
requires that we provide you this Notice of Privacy Rights. It lets you
know how we may use and disclose your health information and your
rights regarding the health information we have in our possession. If it is necessary to change the information in this notice the
revised notice will be available at the:
Washington State Department of Health
Public Health Laboratories
Newborn Screening Metabolic Treatment Product Program
1610 NE 150th Street
Shoreline, WA 98155-9701
HEALTH INFORMATION THAT WE MAINTAIN ABOUT YOU
We maintain records of:
- Your name and (if different) the name and relationship of the person
receiving Metabolic Treatment Product
- Your billing and shipping address
- Your telephone number
- Your (or the patient's, if different) condition that requires
Metabolic Treatment Product
- The date the doctor diagnosed the condition
- Clinical findings related to the condition such as results of blood
tests, developmental and educational evaluations done by the PKU and
Biochemical Genetics Clinic
- The date, type and amounts of product shipped
- Your insurance and other coverage information such as billing
records and copies of applications you may have submitted through us for
financial assistance programs e.g. Children with Special Health Care
Needs (CSHCN).
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the right to:
- request restrictions on certain
uses and disclosures (DOH is not required to agree to the
restriction)
- receive communications
of protected health information by alternative means or at
alternative locations
- inspect, copy and amend your
protected health information held at the DOH Metabolic Treatment
Product Program
- receive an accounting of certain
disclosures (of your protected health information)
- receive a paper copy of this
notice even if you have received it electronically
HOW WE USE AND DISCLOSE YOUR HEALTH INFORMATION
We only use or disclose your health information as state and
federal laws require or permit. In some cases, the law requires that
you authorize the disclosure. In other cases, the law allows us to
disclose your health information without your authorization.
Use and Disclosure Not Requiring Your Authorization
Treatment: We may use your health information for our
treatment activities, such as disclosing it to other healthcare providers as helpful to treat
you.
Payment: We may use and disclose your health information for
our payment and collection activities, such as sending claims to
insurance companies for the payment of metabolic treatment products.
Healthcare Operations: We may use and disclose your health
information to manage our program operations, such as reviewing the
quality of services you receive.
Business Associates: We may disclose your health information
to organizations that help us with our work, such as the billing
service we use to process claims to your health insurance
company. We have a written agreement that requires these
organizations to use your health information for only the reasons
necessary to do the work, and protect it from other uses or
disclosures, just like we do.
To Contact You
We may use the information in your health records to contact you
if we have information about treatment or other health-related
benefits and services that may be of interest to you.
Other Permitted Uses and Disclosures
HIPAA specifically permits us to use or disclose your health
information for other purposes without your consent or
authorization. In our experience such disclosures are rare, and the
limited information we maintain is generally not applicable.
However, when
authorized by law, and to the extent we may have the information,
HIPAA permits us to disclose it to:
-
comply with the requirements of
federal, state, or local laws, court orders or other lawful
process and for administrative or court proceedings
- report a public health authority
for the purpose of preventing or controlling disease, injury, or
disability
- report to the FDA for the
quality, safety or effectiveness of FDA-regulated products or
activities
- notify a person who may have been
exposed to a communicable disease or may otherwise be at risk of
contracting or spreading a disease or condition
- report abuse, neglect or domestic
violence to a government authority
- provide necessary information to
a health oversight agency for activities such as audits,
investigations, inspections, licensure of the healthcare system,
government benefit programs and regulated entities
- a law enforcement official for
specified law enforcement purposes
- coroners or medical examiners for
identification or determining cause of death
- funeral directors to carry out
their duties with respect to the decedent
- organ procurement organizations
for facilitating donation and transplantation
- researchers conducting studies
approved by an Institutional Review Board
- prevent or lessen a serious and
imminent threat to the health of safety of a person or the
public
- authorized federal officials for
specialized government functions such as military and veterans
activities; national security and intelligence activities;
protective services for the president; medical suitability
determinations; correctional institutions; government entities
providing public benefits and
- comply with workers’ compensation
laws
Uses and Disclosures with Your Authorization
Other uses and disclosures or your personal information
require your written authorization. You may revoke your
authorization at any time by doing so in writing.
HOW YOU CAN REACH US
If you want additional information about our privacy practices or
if you believe the DOH Metabolic Treatment Product Program has violated your privacy rights, you may file a
complaint by contacting the Department of Health Privacy Official,
PO BOX 47890, Olympia, WA 98504-7890 or by email at
dohprivacyofficial@doh.wa.gov.
You may also file a complaint with the Federal Office for Civil
Rights. Contact information available on our
Helpful HIPAA Links page. DOH does not
retaliated against people who file a complaint.
Additional Protections for Certain Information
- Confidential HIV related Information for which additional
protections are provided by state law
- Alcohol or Substance Abuse Treatment Information for which
additional protections are provided by state law
- Mental Health Treatment information for which additional
protections are provided by state law.
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