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Summary of Notice of Privacy Practices
of
UW Speech and Hearing Sciences and its Clinics
Effective April 14, 2003

This is a summary of the attached Notice of Privacy Practices - It does not replace the Notice of Privacy Practices for UW Speech and Hearing Sciences and its Clinics.

Summary
UW Speech and Hearing Sciences and its Clinics have a responsibility to protect the privacy of your health information.

You have certain rights: 
    1. You may request restricted use of your health information. (Note: Your request will be considered but we may not be able to agree to your request.)
    2. You may ask us to contact you in an alternative way
    3. You may view and receive copies of your health record. 
    4. You may ask for an amendment to your record.
    5. You may ask for a list of disclosures of your health information.
    6. You may make complaints related to the privacy of your health information.
Additionally,
  • You may tell us not to share information with your family members.

We follow certain rules for using and disclosing your health information. 

  • Your personal health information is used and disclosed to perform treatment, obtain payment, or carry out operational activities. 
  • We may also use and disclose your information to teach and train staff and students. 
  • We may use and disclose your information to conduct research.  An Institutional Review Board must approve research projects.
  • We may use and disclose your health information when otherwise required or allowed by law or when you give us written authorization.

The law provides extra protection for certain health information:

  • Sexually transmitted diseases information
  • Drug and alcohol abuse treatment records
  • Mental health records
  • HIV/AIDS
For more detail, please read the Notice of Privacy Practices.  You will find it posted in the UW Speech and Hearing Clinic, and may request a printed copy from the Speech and Hearing Clinic office.

Notice of Privacy Practices of
UW Speech and Hearing Sciences and its Clinics

Effective April 14, 2003

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.

Overview

We recognize our responsibility for safeguarding the privacy of your health information.  This Notice provides information regarding use and disclosure of protected health information by UW Speech and Hearing Sciences and its Clinics when services are provided within UW Speech and Hearing Sciences and its Clinics and/or when the Providers are acting as part of one or more of the joint arrangements described below.  This Notice also describes your rights and our obligations for using your health information and informs you about laws that provide special protections for your health information.  It also explains how your protected health information is used and how, under certain circumstances, it may be disclosed.  It tells you how any changes in this Notice will be made available to you.

The Providers

UW Speech and Hearing Sciences and its Clinics.  UW Speech and Hearing Sciences and its Clinics are a health care component that provides health care services and performs payment and health care operations.  UW Speech and Hearing Sciences and its Clinics may use and disclose information for treatment, payment, and health care operations.  Certain individuals or offices within the University of Washington provide support functions to UW Speech and Hearing Sciences and its Clinics that might include the use of health information.  For example, the University provides risk management and information system support services to UW Speech and Hearing Sciences and its Clinics.  When providing these support services, University staff maintain and protect the confidentiality of your health information.

Protected Health Information

This Notice applies to health information - created or received by the Providers at UW Speech and Hearing Sciences and its Clinics - that identifies you and that relates to your past, present or future physical or mental condition, the care provided or the past, present or future payment for your health care. This information, often contained in your health or medical record, among other purposes, serves as:

  • A means of communication among the many health professionals who contribute to your care;
  • The legal record describing the care you received;
  • A means by which you or a third-party payer can verify that services billed were actually provided;
  • A tool in educating health professionals;
  • A source of data for medical research;
  • A source of information for public health officials;
  • A source of data for facility planning and marketing; and
  • A tool we use to monitor, evaluate and continually work to improve the care we render and the outcomes we achieve.

Understanding what is in your record and how your health information is used and disclosed helps you to:

  • Ensure accuracy in the record;
  • Better understand who, what, when, where, and why others may access your health information; and
  • Make a more informed decision when authorizing disclosures to others.

Use and Disclosure of Your Protected Health
Information Without Your Authorization

Here are some examples of how we may use and disclose protected health information without your authorization. 

Treatment.  We use and disclose your health information to provide treatment.  For example:

  • Your Clinician uses your information to determine whether specific diagnostic tests and therapies should be ordered. 
  • Clinicians, Nurses, technicians, students, or other personnel may need to know and/or discuss your health problems to carry out treatment and to understand how to evaluate your response to treatment. 
  • We may disclose your health information to another one of your treatment providers in the community, unless the provider is not currently providing treatment to you and you direct us in writing not to make the disclosure.

Payment.  We may use your health information for payment purposes.  For example:

  • We may use your information to prepare claims for payment for services.
  • If you have health insurance and we bill your insurance directly, we will have to include information that identifies you, as well as your diagnosis, procedures, and supplies used so that we can be compensated for the treatment provided.  However, we will not disclose your health information to a third-party payor without your authorization except when allowed by law.


Health Care Operations.  We may use and disclose your health information to carry out health care operations.  For example, we use and disclose health information from patients to monitor and improve our health services.  Also, authorized staff may look at portions of your record to perform administrative activities. 

Train Staff and Students.  We may use and disclose your information to teach and train staff and students.  One example of this is when teaching clinical faculty review patient health information with clinical graduate students.

Conduct Research.  We may use and disclose your information for research. An Institutional Review Board will review each request to use or disclose your information for research.  This is a Board that reviews research at the University of Washington to make sure that projects are as safe as possible.  In some cases, your health care information might be used or disclosed for research without your consent.  For example, a researcher might: review medical charts to determine if enough patients exist to conduct a specific study; or to include your information in a research data base.  In these cases, the Institutional Review Board makes sure that using your information without your consent is justified and that steps are taken to limit the use of your information.  In all other cases, we must obtain your authorization to use or disclose your information for a research project.  We may share information about you used for research with researchers at other institutions.

Contact You for Information.  Your health information may also be used to contact you (for example, by calling you or sending you a letter) to remind you about appointments, to provide diagnostic results, to inform you about important treatment alternatives, or to advise you about other health-related benefits and services.

Conduct Fundraising.  The Providers may use information such as your name, address, phone number, and the dates you received services at UW Speech and Hearing Sciences and its Clinic to contact you for UW Speech and Hearing Sciences and its Clinic fundraising activities or fundraising activities related to the Providers' operations.  We raise funds to expand and support health care services, educational programs, and research activities related to our discipline of speech and hearing sciences.  We will not sell, trade, or loan your information to any third parties but the Providers may share your protected health information with third parties working directly for one of the Providers.  If you do not wish to be contacted as part of our fundraising efforts, please notify us in writing at

UW Speech and Hearing Clinic
Privacy Office
4131 15th Avenue NE
Seattle, WA 98105

Joint Activities.  Your health information may be used and shared by the Providers in furtherance of their joint activities and with other individuals or organizations that engage in joint treatment, payment or health care operational activities with the Providers.

Business Associates.  Your health information may be used by the Providers and disclosed to individuals or organizations that assist the Providers with their treatment, payment and health care operations or with complying with their legal obligations to use and disclose your information as described in this Notice. For example, we may disclose information to consultants or attorneys who assist us in our business activities.  These business associates must agree to protect the confidentiality of your information.

Other Uses and Disclosures.  We also use and disclose your information to enhance health care services, to protect patient safety, to safeguard public health, to ensure that our facilities and practitioners comply with government and accreditation standards and when otherwise allowed by law.  For example:

  • We provide government oversight agencies with data for health oversight activities such as auditing or licensure;
  • We provide information to Workers' Compensation agencies and self-insured employers for work-related illness or injuries;
  • We provide information to appropriate government agencies when we suspect abuse or neglect;
  • We provide notice to appropriate individuals when we believe it necessary to avoid a serious threat to health or safety or to prevent serious harm to an individual;
  • We provide information to law enforcement when required or allowed by law;
  • We disclose information pursuant to court order or lawful subpoena;
  • We provide information to coroners, medical examiners and funeral directors;
  • We provide information to government officials when required for specifically identified government functions such as national security; and
  • We disclose information when otherwise required by law, such as to the Secretary of the United States Department of Health and Human Services for purposes of determining our compliance with our obligations to protect the privacy of your health information.

Use and Disclosure When You Have the Opportunity to Object

Disclosure to and Notification of Family, Friends, or Others.  Unless you object, your health care provider will use his or her professional judgment to provide relevant protected health information to your family member, friend, or another person that you indicate has an active interest in your care or the payment for your health care or for notifying these individuals of your location, general condition or death.

Use and Disclosure that Requires Your Authorization

Other than the uses and disclosures described above, we will not use or disclose your protected health information without your written authorization.  If you provide us with written authorization, you may revoke that authorization at any time unless disclosure is required for us to obtain payment for services already provided, we have otherwise relied on the authorization or the law prohibits revocation.  Also, in some situations, federal and state laws may provide special protections for certain kinds of protected health information, such as drug or alcohol treatment records.  When required by those laws, we may contact you to receive written authorization to use or disclose that information. 

Your Individual Rights Regarding Patient Health Information

You have specific individual rights as to the use and disclosure of your protected health information.  To contact the Providers to exercise your rights, you may contact:

UW Speech and Hearing Clinic
Privacy Office
4131 15th Avenue NE
Seattle, WA 98105
206-543-5440

Your specific rights are listed below: 

  • The right to request restricted use:  You may request in writing that we not use or disclose your information for treatment, payment, and/or operational activities except when specifically authorized by you, when required by law, or in emergency circumstances.  We are not legally required to agree to your request.  If you make your request to UW Speech and Hearing Sciences, UW Speech and Hearing Sciences will provide you with written notice of its decision regarding your request.
  • The right to receive confidential communications:  You have the right to request that we communicate with you about medical matters in a particular way or at a certain location.  For example, you can ask that we only contact you at work or by mail.  To request confidential communications, you must make your request in writing to the address above.  We will accommodate all reasonable requests.  Your request must specify how or where you wish to be contacted.   
  • The right to inspect and receive copies:  In most cases, you have the right to look at or order a copy of your health information.
  • The right to request an amendment to your record:  If you believe that information in your record is incorrect or that important information is missing, you have the right to request in writing that we correct the existing information or add the missing information.  In your request for the amendment, you must give a reason for the amendment.  We are not required to amend your record, but a copy of your request will be added to your record if you direct us to file it.
  • The right to know about disclosures:  You have the right to receive a list of instances when we have disclosed your health information except in certain instances, such as disclosures for treatment, payment, or health care operations or when you have authorized the use or disclosure.  Your first accounting of disclosures in a calendar year is free of charge.  Each additional request within the same calendar year will require a processing fee.
  • The right to make complaints:  If you are concerned that we have violated your privacy, or you disagree with a decision we made about access to your records, you may file a complaint with the UW Speech and Hearing Clinic Privacy Office. The Providers will not retaliate against any individual for filing a complaint.

You may also send a written complaint to the Washington State Department of Health:

Washington State Department Of Health
510 4th Avenue West, Suite 404
Seattle, Washington 98119
Toll-Free: 1-800-633-6828

If you believe that your privacy rights have been violated, you may also contact the U.S. Secretary of Health and Human Services:

U. S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
202-619-0257
Toll-Free: 1-877-696-6775

Privacy Notice Changes

Our Legal Duty:  We are required by law to protect the privacy of your information, to provide this Notice about our privacy practices, and to follow the privacy practices that are described in this Notice. 

We reserve the right to change the privacy practices described in this Notice.   We reserve the right to make the revised or changed Notice effective for protected health information we already have as well as any information we may receive in the future.  We will post a copy of the current Notice in UW Speech and Hearing Clinic.  In addition, each time you register at the UW Speech and Hearing Clinic for treatment or health care services as an outpatient, you may request a copy of the current Notice in effect.  An electronic version of the notice is also posted at http://depts.washington.edu/sphsc.

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