Notice of Privacy Practices
This notice describes how medical information
about you may be used, disclosed and Safeguarded, and how you can get access to
this information. Please review it carefully.
Who is Subject to This Notice:
H Berryman Edwards, MD, FAPA
Our Responsibility
The confidentiality of your personal health information is
very important to us. Your health information includes records that we create
and obtain when we provide you care, such as a record of your symptoms,
examination and test results, diagnoses, treatments and referrals for further
care. It also includes bills, insurance claims, or other payment information
that we maintain related to your care.
This Notice describes how we handle your health
information and your rights regarding this information. Generally speaking, we
are required to:
Maintain the privacy of your health information as
required by law;
Provide you with this Notice of our duties and privacy
practices regarding the health information about you that we collect and
maintain;
Follow the terms of our Notice currently in effect.
Contact Information
After reviewing this Notice, if you need further
information or want to contact us for any reason regarding the handling of your
health information, please direct any communications to the following contact
person:
H Berryman Edwards, MD
14535 Bel-Red Road, Suite B200
Bellevue, WA 98007
Uses and Disclosures of Information
Under federal law, we are permitted to use and disclose
personal health information without authorization for treatment, payment, and
health care operations.
Example of using or disclosing health information for
treatment:
A nurse takes your pulse and blood pressure, records
it in the medical record, and informs your doctor of the results.
We provide your name to a pharmacy when ordering
prescriptions.
We may be required to provide your diagnosis to a
laboratory when we order laboratory analysis of blood or urine samples.
Example of using or disclosing health information for
payment:
We submit a bill to your health insurer to receive
payment for your care; the insurer asks for health information (for example,
your diagnosis and what care we provided) in order to pay us. In such
situations, we will disclose only the minimum amount of information
necessary for this purpose.
Other Uses and Disclosures
In addition to uses and disclosures related to treatment,
payment, and health care operations, we may also use and disclose your personal
information without authorization for the following additional purposes:
Abuse, Neglect, or Domestic Violence
As required or permitted by law, we may disclose
health information about you to a state or federal agency to report
suspected abuse, neglect, or domestic violence. If such a report is
optional, we will use our professional judgment in deciding whether or not
to make such a report. If feasible, we will inform you promptly that we have
made such a disclosure.
Appointment Reminders and Other Health Services
We may use or disclose your health information to
remind you about appointments or to inform you about treatment alternatives
or other health-related benefits and services that may be of interest to
you, such as case management or care coordination.
Business Associates
We may share health information about you with
business associates who are performing services on our behalf. For example,
we may contract with a company to service and maintain our computer systems,
or to do our billing. Our business associates are obligated to safeguard
your health information. We will share with our business associates only the
minimum amount of personal health information necessary for them to assist
us.
Communicable Diseases
To the extent authorized by law, we may
disclose information to a person who may have been exposed to a communicable
disease or who is otherwise at risk of spreading a disease or condition.
Communications with Family and Friends
We may disclose information about you to persons who
are involved in your care or payment for your care, such as family members,
relatives, or close personal friends. Any such disclosure will be limited to
information directly related to the person’s involvement in your care.
If you are available, we will provide you an
opportunity to object before disclosing any such information. If you are
unavailable because, for example, you are incapacitated or because of some
other emergency circumstance, we will use our professional judgment to
determine what is in your best interest regarding any such disclosure.
We may require authorization before disclosing
information to family and friends.
Coroners, Medical Examiners, and Funeral Directors
We may disclose health information about you to a
coroner or medical examiner, for example, to assist in the identification of
a decedent or determining cause of death. We may also disclose health
information to funeral directors to enable them to carry out their duties.
Disaster Relief
We may disclose health information about you to
government entities or private organizations (such as the Red Cross) to
assist in disaster relief efforts.
If you are available, we will provide you an
opportunity to object before disclosing any such information. If you are
unavailable because, for example, you are incapacitated, we will use our
professional judgment to determine what is in your best interest and whether a
disclosure may be necessary to ensure an adequate response to the emergency
circumstances.
Food and Drug Administration (FDA)
We may disclose health information about you to the
FDA, or to an entity regulated by the FDA, in order, for example, to report
an adverse event or a defect related to a drug or medical device.
Health Oversight
We may disclose health information about you for
oversight activities authorized by law or to an authorized health oversight
agency to facilitate auditing, inspection, or investigation related to our
provision of health care, or to the health care system.
Judicial or Administrative Proceedings
We may disclose health information about you in the
course of a judicial or administrative proceeding, in accordance with our
legal obligations.
Law Enforcement
We may disclose health information about you to a
law enforcement official for certain law enforcement purposes. For example,
we may report certain types of injuries as required by law.
Minors
If you are an unemancipated minor under Washington law, there may be circumstances in which we disclose
health information about you to a parent, guardian, or other person acting
in loco parentis, in accordance with our legal and ethical
responsibilities.
Notification
We may notify a family member, your personal
representative, or other person responsible for your care, of your location,
general condition, or death.
If you are available, we will provide you an
opportunity to object before disclosing any such information. If you are
unavailable because, for example, you are incapacitated or because of some
other emergency circumstance, we will use our professional judgment to
determine what is in your best interest regarding any such disclosure.
Parents
If you are a parent of an unemancipated minor, and
are acting as the minor’s personal representative, we may disclose health
information about your child to you under certain circumstances. For
example, if we are legally required to obtain your consent as your child’s
personal representative in order for your child to receive care from us, we
may disclose health information about your child to you.
In some circumstances, we may not disclose health
information about an unemancipated minor to you. For example, if your child
is legally authorized to consent to treatment (without separate consent from
you), consents to such treatment, and does not request that you be treated
as his or her personal representative, we may not disclose health
information about your child to you without your child’s written
authorization.
Personal Representative
If you are an adult or emancipated minor, we may
disclose health information about you to a personal representative
authorized to act on your behalf in making decisions about your health care.
Public Health Activities
As required or permitted by law, we may disclose
health information about you to a public health authority, for example, to
report disease, injury, or vital events such as death.
Public Safety
Consistent with our legal and ethical obligations,
we may disclose health information about you based on a good faith
determination that such disclosure is necessary to prevent a serious and
imminent threat to the public or to identify or apprehend an individual
sought by law enforcement.
Required By Law
We may disclose health information about you as
required by federal, state, or other applicable law.
Specialized Government Functions
We may disclose health information about you for
certain specialized government functions, as authorized by law. Among these
functions are the following: military command; determination of veterans
benefits; national security and intelligence activities; protection of the
President and other officials; and the health, safety, and security of
correctional institutions.
Workers’ Compensation
We may disclose health information about you for
purposes related to workers’ compensation, as required and authorized by
law.
Your Health Information Rights
Under the law, you have certain rights regarding the
health information that we collect and maintain about you. This includes the
right to:
Request that we restrict certain uses and
disclosures of your health information; we are not, however, required to
agree to a requested restriction.
Request that we communicate with you by alternative
means, such as making records available for pick-up, or mailing them to you
at an alternative address, such as a P.O. box. We will accommodate
reasonable requests for such confidential communications.
Request to review, or to receive a copy of, the
health information about you that is maintained in our files and the files
of our business associates (if applicable). If we are unable to satisfy your
request, we will tell you in writing the reason for the denial and your
right, if any, to request a review of the decision.
Request that we amend the health information about
you that is maintained in our files and the files of our business associates
(if applicable). Your request must explain why you believe our records about
you are incorrect, or otherwise require amendment. If we are unable to
satisfy your request, we will tell you in writing the reason for the denial
and tell you how you may contest the decision, including your right to
submit a statement (of reasonable length) disagreeing with the decision.
This statement will be added to your records.
Request a list of our disclosures of your health
information. This list, known as an “accounting” of disclosures, will not
include certain disclosures, such as those made for treatment, payment, or
health care operations. We will provide you the accounting free of charge,
however if you request more than one accounting in any 12 month period, we
may impose a reasonable, cost-based fee for any subsequent request. Your
request should indicate the period of time in which you are interested (for
example, “from May 1, 2003 to June 1, 2003”). We will be unable to provide
you an accounting for any disclosures made before April 14, 2003, or for a
period of longer than six years.
Request a paper copy of this Notice.
In order to exercise any of your rights described above,
you must submit your request in writing to our contact person (see section III
above for information). If you have questions about your rights, please speak
with our contact person, available in person or by phone,
during normal office hours.
To Request Information or File a Complaint
If you believe your privacy rights have been violated, you
may file a written complaint by mailing it or delivering it to Dr. Edwards. You may complain to the Secretary of Health and
Human Services (HHS) by writing to Office for Civil Rights, U.S. Department of
Health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH
Building, Washington, D.C. 20201; by calling 1-800-368-1019; or by sending an
email to OCRprivacy@hhs.gov. We cannot, and will not, make you waive your right
to file a complaint with HHS as a condition of receiving care from us, or
penalize you for filing a complaint with HHS.
Revisions to this Notice
We reserve the right to amend the terms of this Notice. If
this Notice is revised, the amended terms shall apply to all health information
that we maintain, including information about you collected or obtained before
the effective date of the revised Notice. If the revisions reflect a material
change to the use and disclosure of your information, your rights regarding such
information, our legal duties, or other privacy practices described in the
Notice, we will promptly distribute the revised Notice, post it in the waiting
area(s) of our office, make copies available to our
patients and others, and post it on our website.
Effective Date:
4.14.2003
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