NOTICE OF PRIVACY PRACTICES
Mill Creek Family Services, LLC, (referred to here as “MCFS”)
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.
As part of this professional practice, MCFS maintains personal information about you and your health. State and federal law protects your privacy by limiting MCFS in how we may use and disclose such information. Protected health information (“PHI”) is information about you, including demographic information, that may identify you or be used to identify you, and that relates to your past, present or future physical or mental health or condition, the provision of health care services, or the past, present or future payment for the provision of health care.
Your Rights Regarding Your PHI maintained by MCFS are as follows:
Right of Access to Inspect and Copy. You have the right, which may be restricted only in certain limited circumstances, to inspect and receive a copy of the PHI that MCFS maintains. MCFS may charge a reasonable, cost-based fee for the copying process. Your copy request may also include transmittal directions to a third party.
Right to Amend. If you feel the PHI MCFS has about you is incorrect or incomplete, you may ask MCFS in writing to amend the information although MCFS is not required to agree to the amendment. You may write a statement of disagreement if your request is denied. The statement will be maintained as part of your PHI and will be included with any disclosure.
Right to an Accounting of Disclosures. MCFS maintains a record of disclosures we have made of your PHI. You have the right to request a copy of such an accounting.
Right to Request Restrictions. You have the right to request in writing a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. MCFS is generally not required to agree to such a request. If MCFS has been paid in full for all of the services covered by such a request, then MCFS will honor a request to restrict disclosure to your insurance.
Right to Request Confidential Communication. You have the right to request that MCFS communicates with you in a certain way or at a certain location. MCFS will accommodate reasonable requests and will not ask why you making the request.
Right to a Copy of this Notice. You have the right to obtain a paper copy of this notice upon request.
Right of Complaint. You have the right to file a complaint in writing with MCFS or with the Secretary of Health and Human Services if you believe MCFS has violated your privacy rights. MCFS will not retaliate against you for filing a complaint.
MCFS Uses and Disclosures of PHI for Treatment, Payment and Health Care Operations
Treatment. MCFS may use your PHI, with your written authorization, for the purpose of providing you with health care treatment, including management, coordination and continuity of your care with other of your current providers.
Payment. MCFS may use your PHI in connection with billing statements sent to you. MCFS may use your PHI for the purpose of tracking charges and credits to your account. Unless you have requested and MCFS has specifically agreed to restrict disclosure of your PHI to your health plan, MCFS may disclose your PHI to third party payers to obtain information concerning benefit eligibility, coverage, and remaining availability as well as to submit claims for payment.
Health Care Operations. MCFS may use and disclose your PHI for the health care operations of professional practice in support of the functions of treatment and payment. Such disclosures would be to Business Associates for health care education, or to provide planning, quality assurance, peer review, administrative, legal, or financial services to assist MCFS in the delivery of your health care.
Appointment Reminders. With your agreement, MCFS may use your PHI to contact you regarding MCFS appointments.
Uses and Disclosures That Do Not Require Your Authorization or Opportunity to Object
Required by Law. MCFS may use or disclose your PHI to the extent that the use or disclosure is required by law, made in compliance with the law, and limited to the relevant requirements of the law. Examples are public health reports, abuse and neglect reports, law enforcement reports, and reports to coroners and medical examiners in connection with investigation of deaths. MCFS also must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining MCFS compliance with the requirements of the Privacy Rule.
Health Oversight. MCFS may disclose your PHI to a health oversight agency for activities authorized by law, such as for professional licensure. Oversight agencies also include government agencies and organizations that audit their provision of financial assistance to MCFS, such as third-party payers.
Threat to Health or Safety. MCFS may disclose your PHI when necessary to minimize an imminent danger to the health or safety of you or any other individual.
Disaster or Emergency Relief Purposes. In situations of your absence, incapacity or emergency and in accordance with good professional practice, MCFS may disclose your PHI minimally necessary to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, which are directly relevant to your identification and care.
Business Associates. MCFS may disclose your PHI to the extent minimally necessary to Business Associates that are contracted by MCFS to perform health care operations or payment activities on behalf of MCFS, which may involve their collection, use, or disclosure of your PHI. To safeguard the privacy of your PHI, such contracts are regulated by the Department of Health and Human Services and must contain provisions designed to limit the use and re-disclosure of your PHI, to require compliance by the Business Associate with your individual rights, to subject the Business Associate to specified security obligations, and to require the Business Associate to require such obligations of a subcontractor.
Compulsory Process. MCFS will disclose your PHI if a court issues an appropriate order. MCFS will also disclose your PHI if (1) you and MCFS have each been notified in writing at least fourteen days in advance of a subpoena or other legal demand, identifying the PHI sought, and the date by which a protective order must be obtained to avoid compliance, (2) no qualified judicial or administrative protective order has been obtained, (3) MCFS has received satisfactory assurances that you received notice of your right to seek a protective order, and (4) the time for your doing so has elapsed.
Uses and Disclosures of PHI With Your Written Authorization
MCFS will make other uses and disclosures of your PHI only with your written authorization. You may revoke this authorization in writing at any time, unless MCFS has taken a substantial action in reliance on the authorization such as providing you with health care services for which MCFS must submit subsequent claim(s) for payment.
This Notice of Privacy Practices informs you how MCFS may use and disclose your PHI and your rights regarding your PHI. MCFS is required by law to maintain the privacy of your PHI and to provide you with notice of our legal duties and privacy practices with respect to your PHI, and to notify you following a breach of unsecured PHI related to you. MCFS is required to abide by the terms of this Notice of Privacy Practices. MCFS reserves the right to change the terms of this Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that MCFS maintains at that time. MCFS will make available a revised Notice of Privacy Practices by providing you a copy upon your request and it will be made available on the MCFS website.
Contact Information and Complaints
Courtney Greene is the MCFS designated Privacy Officer, so, if you have any questions about this Notice of Privacy Practices, or complaints about how your PHI has been utilized, please contact:
Mill Creek Family Services
16000 Bothell-Everett Hwy, Ste. 360, Mill Creek, WA 98012
phone: 425.357.9111 ext. 601