This notice describes how medical information about you may be used and disclosed, and how you may access to this information. Please review it carefully.

In the process of providing medical care, Northwest Women’s Health Care collects and retains personal information about each of our patients. Federal and State confidentiality and privacy laws protect the confidentiality of this protected health information. We respect your privacy and appreciate the importance of protecting this sensitive information.

The law allows Northwest Women’s Healthcare to use or disclose your protected health information without your consent in order to provide treatment or to bill and collect payments for the services provided. We may use or disclose your protected information to facilitate referrals or transmit information to other medical facilities that are involved in your care. Some communicable diseases, work related health issues and domestic violence must be reported to the appropriate public health agencies and do not require your consent. Responses to court orders, subpoenas, police and cases of national security are other examples of disclosures that do not require consent. In the absence of an objection on your part, your physician may use or disclose protected health information to family members or other third parties without your consent, if in his or her professional judgment, disclosure is in your best interest. This may also happen in the case of a medical emergency.

Federal and state laws that provide special protections for certain kinds of personal health information (such as information about sexually transmitted and other communicable diseases, drug and alcohol abuse, certain mental health services) call for specific authorizations from you to disclose information to third parties. When your personal health information falls under these special protections, we will secure the required written authorization.

The health and billing records we create and store are the property of the practice. However, you have the right to request restrictions on certain uses and disclosures of your personal health information.

You have the right to inspect and receive copies of your medical records. If you wish to do so, you must complete our Authorization to Release of Medical Information form. There may be an administrative fee for copying these records.

You have the right to request that we correct information in your record that you believe is incorrect or add information that you believe is missing. All requests that are agreed to will be made a permanent part of your chart.

You have the right to request and receive an accounting of all disclosures of personal information that are not directly related to your treatment, payment for your treatment, or our health care operations.

You may request restrictions on the use of your protected health information by Northwest Women’s Health Care. Upon receipt, we will review the request and notify you of our decision to either accept or reject the request.

You have the right to request that your protected health information be provided to you in a confidential manner by alternative means or locations. This includes alternative mailing addresses, voice mails or emails.

If you are concerned that we have violated your privacy, or you disagree with a decision we made about access to your record, you may contact our Privacy Officer at (206) 832-0424. You may also send a written complaint to the Washington State Department of Health 510 Fourth Avenue West, Suite 404, Seattle, WA. 98119 or the Secretary of Health and Human Services.

Our original Notice of Privacy Practices was effective April 1, 2003. You have a right to request a copy. We reserve the right to change the terms of this notice and to make the new notice provisions effective for all personal health information that we maintain.