This notice describes how medical information about you may be used and disclosed and how you can get access to this information. PLEASE REVIEW IT CAREFULLY.

Whole Family Health Center (WFHC) is required by law to maintain the privacy of your protected health information. This Notice of Privacy Practices tells you how your protected health information may be used and how the clinic keeps your information private and confidential. This notice explains the legal duties and practices relating to your protected health information. As part of the clinic’s legal duties this Notice of Privacy Practices must be given to you. The clinic is required to follow the terms of the Notice of Privacy Practices currently in effect. WFHC may change the terms of its notice. The change, if made, will be effective for all protected health information that it maintains. New or revised notices of privacy practices will be available by email and at all WFHC buildings.

Uses and Disclosures of your protected health information

Protected health information includes demographic and medical information that concerns the past, present, or future physical or mental health of an individual. Demographic information could include your name, address, telephone number, social security number and any other means of identifying you as a specific person. Protected health information contains specific information that identifies a person or can be used to identify a person. It is health information created or received by a health care provider, health plan, employer, or health care clearinghouse. WFHC can act as each of the above business types. This medical information is used by WFHC in many ways while performing normal business activities.

Your protected health information may be used or disclosed by WFHC for purposes of:

Treatment: Health care professionals use medical information in the clinics or hospital to take care of you. Your protected health information may be shared, with or without your consent, with another health care provider for purposes of your treatment. WFHC may use or disclose your health information for case management and services.

Payment: We may use and disclose health information about your treatment and services to bill and collect payment from you, your insurance company or a third party payer to pay for the services provided to you.

Health Care Operations: Members of the medical staff and/or quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it.Your information may be used by certain clinic personnel to improve the clinic’s health care operations. The clinic also may send you appointment reminders, information about treatment options or other health-related benefits and services.

Fundraising: We may contact you to raise funds for the facility; however, you have the right to elect not to receive such communications.

Business Associates: There are some services provided in our organization through contracts with business associates. When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, business associates are required by federal law to appropriately safeguard your information.
Research: We may use or disclose health information for research studies but only when they meet all federal and state requirements to protect your privacy (such as using only de-identified data whenever possible). You may also be contacted to participate in a research study.

Some protected health information can be disclosed without your written authorization as allowed by law. Those circumstances include:

• Reporting abuse of children, adults, or disabled persons.
• Investigations related to a missing child.
• Internal investigations and audits by the clinic’s divisions, bureaus, and offices.
• Investigations and audits by the state’s Inspector General and Auditor General and the legislature’s Office of Program Policy Analysis and Government Accountability.
• Public health purposes including vital statistics, disease reporting, public health surveillance, investigations, interventions and regulation of health professionals.
• District medical examiner investigations.
• Research approved by the clinic.
• Court orders, warrants, or subpoenas.
• Law enforcement purposes, administrative investigations, and judicial and administrative proceedings.

Other uses and disclosures of your protected health information by the center will require your written authorization. This authorization will have an expiration date that can be revoked by you in writing. These uses and disclosures may be for marketing and for research purposes. Certain uses and disclosure of psychotherapist notes will also require your written authorization.

Individual Rights

You have the right to request WFHC to restrict the use and disclosure of your protected health information to carry out treatment, payment, or health care operations. You may also limit disclosures to individuals involved with your care. The clinic is not required to agree to any restriction. You may also restrict certain protected health information from disclosure to health plans where the individual pays out of pocket, in full for the care and requests such a restriction.

You have the right to be assured that your information will be kept confidential. WFHC may mail or call you with health care appointment reminders. We will make contact with you in the manner and at the address or phone number you select. You may be asked to put your request in writing. If you are responsible to pay for services, you may provide an address other than your residence where you can receive mail and where we may contact you.

You have the right to inspect and receive a copy of your protected health information. Your inspection of information will be supervised at an appointed time and place. You may be denied access as specified by law. If access is denied, you have the right to request a review by a licensed health care professional who was not involved in the decision to deny access. This licensed health care professional will be designated by the center.

You have the right to correct your protected health information. Your request to correct your protected health information must be in writing and provide a reason to support your requested correction. WFHC may deny your request, in whole or part, if it finds the protected health information:

• Was not created by the center,
• Is not protected health information,
• Is by law not available for your inspection, or
• Is accurate and complete.

If your correction is accepted, WFHC will make the correction and tell you and others who need to know about the correction. If your request is denied, you may send a letter detailing the reason you disagree with the decision. The center will respond to your letter in writing. You also may file a complaint, as described below in the section titled Complaints.

You have the right to receive notifications whenever a breach of your unsecured protected health information occurs.

You have the right to receive a summary of certain disclosures the clinic may have made of your protected health information. The summary may not be for more than a 6-year period from the date of your request and will not include the following:

• Disclosures made to you.
• Disclosures to individuals involved with your care.
• Disclosures authorized by you.
• Disclosures made to carry out treatment, payment, and health care operations.
  Disclosures for public health.
• Disclosures for health professional regulatory purposes.
• Disclosures to report abuse of children, adults, or disabled.
• Disclosures prior to April 14, 2003.

This summary does include disclosures made for:

• Purposes of research, other than those you authorized in writing.
• Responses to court orders, subpoenas, or warrants.

If you received this Notice of Privacy Practices electronically, you have the right to a paper copy upon request.

For Further Information

Requests for further information about the matters covered by this notice may be directed to the Chief Executive Officer or the administrator of the WFHC facility where you received the notice.

For Complaints

If you believe your privacy rights have been violated, you may file a complaint with:
The Secretary of the U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Telephone 202-619-0257 or toll free 877-696-6775.

The complaint must be in writing, describe the acts or omissions that you believe violate your privacy rights, and be filed within 180 days of when you knew or should have known that the act or omission occurred. WFHC will not retaliate against you for filing a complaint.

This Notice of Privacy Practices is effective April 14, 2003 and revised September 23, 2013. The notice shall be in effect until a new Notice of Privacy Practices is approved and posted.