Washington State

GENERAL INFORMATION

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.

Your Rights

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 support@affinitycounseling.net, 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.

Contact

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.