Information regarding your health care, including payment for health care, is protected by two federal laws: the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), 42 U.S.C. § 1320d et seq., 45 C.F.R. Parts 160 & 164, and the Confidentiality Law, 42 U.S.C § 290dd-2, 42 C.F.R. Part 2. Under these laws, Affinity Counseling and Treatment (Affinity) may not say to a person outside Affinity that you attend the program, nor may Affinity disclose any information identifying you as an alcohol or drug abuser, or disclose any other protected information except as permitted by federal law.
Affinity Counseling and Treatment must obtain your written consent before it can disclose information about you for payment purposes. For example, Affinity Counseling and Treatment must obtain your written consent before it can disclose information to your health insurer in order to be paid for services. Generally, you must also sign a written consent before Affinity Counseling and Treatment can share information for treatment purposes or for health care operations. However, federal law permits Affinity Counseling and Treatment to disclose information without your written permission:
(1) Pursuant to an agreement with a qualified service organization/business associate;
(2) For research, audit or evaluations;
(3) To report a crime committed on Affinity Counseling and Treatment’s premises or against Affinity Counseling and Treatment personnel;
(4) To medical personnel in a medical emergency;
(5) To appropriate authorities to report suspected child abuse or neglect;
(6) As allowed by court order.
For example, Affinity Counseling and Treatment can disclose information without your consent to obtain legal or financial services, or to another medical facility to provide health care to you, as long as there is a qualified service organization / business associate agreement in place.
Before Affinity Counseling and
Treatment can use or disclose any information about your health in a manner
which is not described above, it must first obtain your specific written
consent allowing it to make the disclosure. Any such written consent may be
revoked by you in writing.
Under HIPAA you have the right to request restrictions on certain uses and disclosures of your health information. Affinity Counseling and Treatment is not required to agree to any restrictions you request, but if it does agree than it is bound by that agreement and may not use or disclose any information which you have restricted except as necessary in a medical emergency.
You have the right to request that we communicate with you by alternative means or at an alternative location. Affinity Counseling and Treatment will accommodate such requests that are reasonable and will not request an explanation from you. Under HIPAA you also have the right to inspect and copy you own health information maintained in Affinity Counseling and Treatment, except to the extent that the information contains psychotherapy notes or information compiled for use in a civil, or administrative proceeding or in other limited circumstances.
Under HIPAA you also have the right, with some exceptions, to amend health care information maintained in Affinity Counseling and Treatment’s records, and to request and receive an accounting of disclosures of your health-related information made by Affinity Counseling and Treatment during the six years prior to your request. You also have the right to receive a paper copy of this notice.
Affinity Counseling and Treatment’s Duties
Affinity Counseling and Treatment is required by law to maintain the privacy of your health care information and to provide you with a notice of its legal duties and privacy practices with respect to your health information. Affinity Counseling and Treatment is required by law to abide by the terms of this notice. Affinity Counseling and Treatment reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information it maintains.
Complaints and Reporting Violations
You may complain to Affinity Counseling and Treatment and the Secretary of the United States Department of Health and Human Services if you believe that your privacy rights have been violated under HIPAA. To send a complaint to Affinity Counseling and Treatment directly, you may send them to email@example.com, or send a letter to the Affinity HR Department at 12503 SE Mill Plain Blvd., STE 119A, Vancouver, WA 98684. To file a complaint with the Department of Health, you can send an email to HSQAComplaintIntake@doh.wa.gov, call (360) 236-4700; or send written correspondence to Health Systems Quality Assurance Complaint Intake, P.O. Box 47857, Olympia, WA 98504. You will not be retaliated against for filing such a complaint.
Violation of the Confidentiality Law by a program is a crime. Suspected violations of the Confidentiality Law may be reported to the United States Attorney in the district where the violation occurs.
For further information regarding confidentiality, contact the Washington State Department of Health through their website www.doh.wa.gov, or by phone at (800) 525-0127.
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 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.
Ask us to correct your medical record
• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• 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 page 1.
• 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
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
•Contact you for fundraising efforts
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:
•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.
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.
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.
Example: We give information about you to your health insurance plan so it will pay for your services.
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:
•Helping with product recalls
•Reporting adverse reactions to medications
•Reporting suspected abuse, neglect, or domestic violence
•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
•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.
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 are required by law to maintain the privacy and security of your protected health information.
•We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
•We must follow the duties and privacy practices described in this notice and give you a copy of it.
•We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of This Notice
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 web site.