Birth & Family Clinic Privacy Notice

This notice describes how information about you may be used and disclosed by Birth & Family Clinic and how you can get access to this information.  Please review it carefully.

Understanding Your Health Information
Each time you visit our hospital, physicians, or other healthcare providers, a record of your visit is made.  This record may contain personal identifying information about you and your health.  It will also contain information related to your care.  This may include your medical history, results of physical examinations, test results, diagnoses, treatments, instructions provided to you by your healthcare provider and plans for future health care services.  This information is often referred to as your health or medical record.  Your medical record serves as a:

  • Record for planning your care and treatment.
  • Way to communicate among the many health professionals who provide your care.
  • Legal document describing the care you received.
  • Resource you or your healthcare insurance company can use to check the accuracy of your bill.
  • Tool for educating health professionals.
  • Source of information for medical research.
  • Source of information for public health officials responsible for improving the health of our nation.
  • Source of information for Birth & Family Clinic operations including the development of future plans, marketing our services, assessing the quality of your care and identifying ways to improve our services to your and the community.

Understanding what is in your record and how it is used helps you to:

  • Make sure it is accurate.
  • Better understand who, what, when and why others may use your health information.
  • Make decisions about allowing the information to be used or shared by others.

Designated Record Set
In addition to your health record Birth & Family Clinic also maintains financial records and specialized documents such as x-ray films that are maintained separate from your health record.  The combination of these documents is referred to as your designated record set.

Your Health Information Rights
The paper and electronic medical record we keep on you is the property of Birth & Family Clinic.  However, the information in the record belongs to you and you have the right to:

  • Receive a copy, read and ask questions about this notice.
  • Request that we limit uses and releases of your information.  You must make the request in writing.  We are not required to agree to the request, but we will cooperate with any requests we agree to.
  • Request and receive from us a paper copy of the most current Notice of Privacy Practices for Protected Health Information.
  • Request that you be allowed to see and get a copy of your medical record.  You must give us the request in writing.  Forms for this purpose are available at our reception desk and on our web page.
  • Request to have us review a denial of access to your medical record.  The request may be denied for certain reasons.
  • Request corrections to your health records; the request must be given to us in writing.  If the request is denied, you may submit a written statement of disagreement that will become part of your medical record and included when the related information is used or disclosed.
  • Obtain a report of certain disclosures of your health information.
  • Request that any or all communications of your health information be made by different means or to a different location.  The request must be in writing.
  • Revoke any authorizations to use or disclose your health information except when the information has already been disclosed.

Our Responsibilities
Birth & Family Clinic is required to:

  • Protect the privacy of your health information.
  • Provide you with a notice about our legal duties and privacy practices.
  • Uphold the terms of this notice.
  • Inform you if we do not agree to a requested restriction.
  • Respect reasonable requests to communicate health information by different means or to different locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain.

For More Information or to Report a Problem
If you have any questions, you may contact our Clinic Administrator or Medical Records Department.

If you believe your privacy rights have been violated, you can file a complaint with the privacy officer or office of civil rights:
Privacy Officer, Birth & Family Clinic Administrator: (425) 640-4950
Region X, Office of Civil Rights, Department of Health and Human Services: (206) 615-2290

There will be no action taken against you for filing a complaint.

Examples of Disclosures for Treatment, Payment and Health Operations
We will use your health information for treatment:
For example:Information received or recorded by a nurse, medical assistant, physician, mid-level practitioner or other member of your healthcare team will be in your record and used to plan the course of treatment best for you.  Your provider will enter in your record any instructions to your healthcare team.  Members of your team will review the instructions and record any actions they took and their observations.

We will use your health information for payment purposes:
For example:A bill will be sent to you, or your insurance company (or organizations acting on their behalf) if you have provided written authorization for us to do so.  The information we provide to them will identify you, your diagnosis, procedures you may have had and supplies used.  A copy of your medical record may be provided to an external review agency working with your insurance company to review services provided and to ensure correct reporting of those services.

We will use your health information for Birth & Family Clinic operations:
For example: Members of our quality improvement team(s) may use information in your health record to evaluate the care we provide and the results of your case and others like it.  This information is used to improve the quality and effectiveness  of the health care services we provide.

Other Uses or Disclosures
Business Associates:  An example would be, but not limited to, contracting with a copy service to make copies of your health records.  When these services are used, we may disclose your health information to our business associate so they can perform the job we’ve asked them to do.  To make sure your health information is protected, we require our business associates to keep your information confidential.

Notification:  We may use or provide information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location and general condition.

Communication with Family:  Health professionals, using their best judgment, may talk to a family member, other relative, close personal friend or any other person you identify, about health information that is important to the person’s involvement in your care or payment related to your care.

Research:  We may provide information to researchers when their research has been approved by an Institutional Review Board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Organ Procurement Organizations:  We may provide health information to companies engaged in procuring, banking, or transplanting organs for the purpose of tissue donation and transplant.

Marketing:  We may contact you to provide appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you.

Food and Drug Administration (FDA):  We may provide to the FDA health information related to adverse events regarding food, supplements, product and produce defects to enable product recalls, repairs or replacement.

Workers Compensation:  We may provide health information as authorized by law to workers compensation or other similar programs.

Public Health:  We may provide your health information to public health or legal representatives responsible for preventing or controlling disease, injury or disability.

Effective: 04/01/2003 | Revised: 08/2010