Wheatridge Family Clinic
THIS NOTICE DESCRIBES HOW PRIVATE HEALTH (PHI) INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Wheatridge Family Clinic is required by law to maintain the privacy of your PHI and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice, or if you want more information about the privacy practices at Wheatridge Family Clinic, please contact our Privacy Officer.
Terms of this notice are subject to change.
I. How Wheatridge Family Clinic collects health information from you and stores it in a chart and on a computer. This is your medical record. The medical record is the property of Wheatridge Family Clinic, but the information is the medical record belongs to you. Wheatridge Family Clinic protects the privacy of your health information. The law permits Wheatridge Family Clinic to use or disclose your health information for the following purposes:
- Treatment: The provision, coordination, or management of health care and related services by one or more health care providers, including the coordination or management of health care by a health care provider with a third party; consultation between health care providers relating to a patient; or the referral of a patient for health care from one health care provider to another.
- Payment: A covered health care provider or health plan to obtain or provide reimbursement for the provision of health care; and to the individual to whom health care is provided and include, but are not limited to:
- Determinations of eligibility or coverage (including coordination of benefits or the determination of cost sharing amounts), and adjudication or subrogation of health benefit claims.
- Risk adjusting amounts due based on the enrollee health status and demographic characteristics.
- Billing claims management, collections activities, obtaining payment under a contract for reinsurance (including stop-loss insurance and excess loss insurance) and related health care data processing.
- Review of health care services with respect to medical necessity coverage under a health plan, appropriateness of care or justification of charges
- Utilization review activities, including pre-certification and preauthorization of services concurrent and retrospective review of services.
- Disclosure to consumer reporting agencies of any of the following protected health information relating to collection of premiums or reimbursement
Name and address, date of birth, social security number, payment history, account number, name and address of health care provider and/or health plan
- Regular Health Care Operations: The activities related to covered functions, and any of the following activities of an organized health care arrangement in which the covered entity participates:
- Conducting quality assessment and improvement activities, including outcomes evaluation and development of clinical guidelines, provided that the obtaining of generalizable knowledge is not the primary purpose of and studies resulting from such activities, population-based activities relating to improving health or reducing health care costs, protocol development case management and care coordination, contacting of health care providers and patients with information about treatment alternatives; and related functions that do not include treatment.
- Reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance, health plan performance, conducting training programs in which students, trainees, or practitioners in areas of health care learn under supervision to practice or improve their skills as health care providers, training of non-health care professionals, accreditation, certification, licensing, or credentialing activities.
- Underwriting, premium rating, and other activities relating to the creation, renewal or replacement of a contract of health insurance or health benefits, and ceding, securing, or placing a contract of reinsurance of risk relating to claims for health care (including stop loss insurance and excess of loss insurance).
- Conducting or arranging for medical review legal services, and auditing functions, including fraud and abuse detections and compliance programs.
- Business planning and development, such as conducting cost management and planning-related analyses related to managing and operating the entity, including formulary development of methods of payment or coverage policies.
- Management activities relating to implementation of and compliance.
- Customer service, including the provision of data analyses for policy holders, plan sponsors, or other customers, provided that protected health information is not disclosed to such policy holder, plan sponsor or customer.
- Resolution of internal grievances.
- Due diligence in connection with the sale or transfer of assets to a potential successor in interest, if the potential successor in interest is a covered entity or, following completion of the sale or transfer.
- Business associates who agree to safeguard your information may be contracted by us to perform certain functions or activities on our behalf, such as payment and health care operations.
- Appointment reminders. We may use your private health information to contact you about appointments for treatment or other health care you may need.
- Identity verification. We may photograph you for identification purposes, storing the photo in your medical record. This is for you protection and safety, but you may opt out.
- Health Information Exchange. We may share your health information electronically or on using a fax. These organizations may include hospitals, laboratories, other health care providers, public health departments and/or health plans.
- Disclosure in case of disaster relief: We may disclose your name, city of residence, age, gender and general condition to a public or pirate disaster relief organization to assist disaster relief efforts, unless you object at the time.
- Disclosures to parents as personal representatives of minors: In most cases, we may disclose your minor child’s private health information to you. The law denies your access to your minor’s information as it pertains to drug use or addiction, certain mental health services and venereal disease.
- Military and national security: We may disclose your PHI to authorized federal officials as necessary for national security and intelligence activities.
- Lawsuits and legal disputes: We may disclose your PHI in responding to a court order, subpoena or discovery request. We may disclose your information without your authorization, for example, to defend a lawsuit or arbitration.
- Serious threat to health or safety: We may use and disclose your private health information if we belied it is necessary to avoid a serious threat to your health or safety to someone else.
- Abuse or neglect: By law, we may disclose your PHI to authorities to report suspected child abuse or neglect or to identify suspected victims of abuse, neglect, or domestic violence.
- Inmates: Federal law requires us to give you this notice; inmates do not have the same rights to control their PHI as other individuals. If you are an image of a correctional institution or in the custody of law enforcement, we may disclose your information to the institution or official for certain purposes to protect your health or safety or someone else’s.
4. Notification and communication with family: We may disclose your PHI to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. If you are able and available to agree or abject, we will give you the opportunity to object prior to making this notification. If you are unable or unable to agree or object, our health professionals will use their best judgment in communication with your family and others
5. Required by Law: As required by law, we may use and disclose your PHI.
6. Public Health: As required by law, we may disclose your health information to public health authorities for purposes related to : preventing or controlling disease injury or disability; reporting child abuse or neglect; reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure
7. Health oversight activities: We may disclose your PHI to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.
8. Judicial and administrative proceedings: We may disclose your PHI in the course of any administrative or judicial proceeding.
9. Law enforcement: We may disclose your PHI to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.
10. Deceased person information: We may disclose your PHI to coroners, medical examiners and funeral directors.
11. Organ donations: We may disclose your PHI to organizations involved in procuring, banking or transplanting organs or tissues.
12. Research: We may disclose your PHI to researchers conducting research that has been approved by an Institutional Review Board or Wheatridge Family Clinic’s review board.
13. Public safety: We may disclose your PHI to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or general public.
14. Specialized government functions: We may disclose your PHI for military, national security, prisoner and government benefits purposes.
15. Worker’s compensation: We may disclose your PHI as necessary to comply with worker’s compensation laws.
16.Electronic prescriptions to your pharmacy: using a secure, encrypted software program
17.State and Federal Monitoring Programs: We currently disclose your PHI to two State database systems.
- Colorado Immunization Information System (CIIS), operated by the Colorado Department of Public Health which consolidates immunization records from multiple providers, allowing us to generate recall notices for those who are not up-to-date, minimizing over-immunization, and identifying missed opportunities for immunization.
- Colorado Prescription Monitoring Program (PDMP), which provides a secure database of controlled substance prescriptions that have been dispensed by, registered Colorado pharmacies. The purpose of the database is to provide objective information to assist prescribers and pharmacists in providing appropriate treatment for their patients.
II. When Wheatridge Family Clinic May Not Use Your Health Information
Except as described in the Notice of Privacy Practices, Wheatridge Family Practice will not use or disclose your PHI without your written authorization. If you authorize Wheatridge Family Clinic to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
III. Your Health Information Rights
The following rights are not absolute and are subject to some limitations and conditions.
- You have a right to request restrictions on certain uses and disclosures of your health information.
- Wheatridge Family Clinic is not required to agree to the restrictions you requested.
- You have a right to inspect and obtain a copy your PHI.
- You have a right to request that Wheatridge Family Clinic amend your health information that is incorrect or incomplete. Wheatridge Family Clinic is not required to change your health information and will provide you with information about Wheatridge Family Clinic’s denial and how you can disagree with the denial.
- You have a right to receive an accounting or disclosures of your health information made by Wheatridge Family Clinic except that Wheatridge Family Clinic does not have to account for the disclosures described in parts 1-18 of section 1 of this Notice of Privacy Practices.Requests must be made in writing. Once we receive your request, we will let you know when and how you can see or obtain a copy of your record. In certain circumstances, if you agree, we will give you a summary or explanation of your PHI instead of providing copies. We are permitted to charge you a fee for the copies, summary, or explanation. If we do not have the record you asked for but we know who does, we will tell you who to contact to request it. In limited situations, we may deny some or your entire request to see or receive copies of your records, but if we do, we will tell you why in writing and explain your right, if any, to have our denial reviewed. Submit all requests to Wheatridge Family Clinic, 6301 W. 38th Ave, Wheatridge, CO 80033.
- You have a right to choose how we send PHI to you or someone else. You can elect to have your PHI sent to a different address (for example, your work address) or by different means (for example fax instead of regular mail). Your PHI is stored electronically, you may request a copy of your record in an electronic format or make a specific written request to WFC to transmit the electronic copy to a designated third party. If the cost of meeting your request involves more than a reasonable additional amount, we are permitted to charge you our costs that exceed that amount.
- You have a right to a paper copy of this Notice of Privacy Practices.You may ask us for a list of our disclosures of your PHI by writing to us at Wheatridge Family Clinic, Attn.: Release of Information Department, 6301 w. 38th Ave, Wheatridge, CO 80033. You are entitled to one disclosure accounting in any 12-month period at no charge. If you request any additional accountings less than 12 months later, we may charge a fee.If you would like to have a more detailed explanation of these rights or if you would like to exercise on any of your rights, contact Wheatridge Family Clinic’s Privacy Officer.
IV. Authorization is Required
The following cases require your authorization for use and disclosure of your private health information.
Marketing purposes and any disclosure that constitute a sale of health information
- Marketing purposes and any disclosure that constitute a sale of health information
- Records of psychotherapy notes
- Any other uses not described in our Privacy PracticeV. Opt Out It is your right to opt out of sharing your private health information in these situations.
1. You have the right to refuse receiving communications to raise funds on behalf of Wheatridge Family Clinic
2. You have the right to restrict disclosures of your private health information to your health plan if you pay out-of-pocket in full for your health services. You must notify our staff at the time of visit to exercise this opt out optionVI. Changes to this Notice of Privacy Practices
Wheatridge Family Clinic reserves the right to amend this Notice of Privacy Practices at any time in the future as long as the change is consistent with state and federal law. Any revised notice will apply both to the PHI we already have about you at the time of the change, and any PHI created or received after the change takes effect. If we make an important change to our privacy practices, we will promptly change this notice and make the new notice available on our website at www.wfclinic.com. Until such amendment is made, Wheatridge Family Clinic is required by law to comply with this notice and will post all changes to this notice.
V. Opt Out:It is your right to opt out of sharing your private health information in these situations.
- You have the right to restrict disclosures of your private health information to your health plan if you pay out-of-pocket in full for your health services. You must notify our staff at the time of visit to exercise this opt out option.
VI. How We Handle A Security Breach of Your PHI: We take our responsibility of protecting your PHI seriously and have put in place administrative safeguards (such as policies and procedures and employee training), technical safeguards (Such as encryption and passwords), and physical safeguards (such as locked areas and alarm systems) to protect your PHI. It is a reality, because we are human, that an accidental release of your PHI may exist. (Such as a record faxed to the wrong recipient or a building theft). If a breach of your PHI occurs, we will notify you after we have conducted a thorough review of the incident. You will be notified as soon as possible but no more than 60 calendar days.
VII. Changes to This Notice of Privacy Practices: Wheatridge Family Clinic reserves the right to amend this Notice of Privacy Practices at any time in the future as long as the change is consistent with state and federal law. Any revised notice will apply both to the PHI we already have about you at the time of the change, and any PHI created or received after the change takes effect. If we make an important change to our privacy practices, we will promptly change this notice and make the new notice available on our website at www.wfclinic.com. Until such amendment is made, Wheatridge Family Clinic is required by law to comply with this notice and will post all changes to this notice.
VIII. Complaints: Complaints about this Notice of Privacy Practices or how Wheatridge Family Clinic handles your PHI should be directed to the Wheatridge Family Clinic’s Office Manager and Privacy Officer between the hours of 8am and 5 pm at Wheatridge Family Clinic, 6301 W. 38th Ave, Wheatridge, CO 80033.
IX. Effective Date of This Notice: September 23, 2013
X. Formal Complaints If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Ave., S.W.
Room 509f HHH Building
Washington, DC 20201
You may also address your complaint to one of the regional Office for Civil Rights. A list of these offices can be found online at www.hhs.gov/ocr/regmail.html.