Notice of Privacy Practices of UW Autism Center

Effective September 27th, 2004

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.

Summary

UW Autism Center has a responsibility to protect the privacy of your health information.

You have certain rights:

• 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.)
• You may ask us to contact you in an alternative way.
• You may view and receive copies of your health record.
• You may ask for an amendment to your record.
• You may ask for a list of disclosures of your health information.
• 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.

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 Autism Center when services are provided within the Autism Center. 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 Autism Center . UW Autism Center is composed of a single entity.

Certain individuals or offices within the University of Washington provide support functions to UW Autism Center that might include the use of health information. For example, the University provides risk management and information system support services to the UW Autism Center. When providing these support services, University staff maintain and protect the confidentiality of your health information.

Non-UW Physicians. Occasionally, non-UW clinicians participate in and provide services to patients within the UW Autism Center described in this Notice. When this occurs, protected health information is shared between the entities or providers as necessary for treatment, payment, and certain health care operations.

Protected Health Information

This Notice applies to health information – created or received by the UW Autism Center – 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 physician uses your information to determine whether specific diagnostic tests, therapies, and medications should be ordered.

• 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 carryout 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 clinicians review patient health information with trainees or practicum students.

 Conduct Research . We may use and disclose your information for research. If the information is individually identifiable an Institutional Review Board will review each request to use or disclose your information for research. If it is not identifiable information, it may also go through this process. This is a Board that reviews research at UW Autism Center 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 see if wearing a bicycle helmet was a factor in how serious bicycle injuries are; or to determine if we have enough patients to conduct a

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.

Heightened Confidentiality of Your Patient Health Information

Special state and federal protections apply to certain classes of patient health information. For example, additional protections may apply to sexually transmitted diseases information, drug and alcohol abuse treatment records, mental health records, and HIV/AIDS. When required by law, the UW Autism Center will obtain your authorization before releasing this type of 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 UW Autism Center to exercise your rights, you may contact:

UW Autism Center
Center on Human Development and Disability
Box 357920 ,
Seattle , WA 98195-7920
206-221-6806

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 Autism Center, we 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 Autism Center. The UW Autism Center will not retaliate against any individual for filing a complaint.

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 at the UW Autism Center. In addition, each time you register at or are admitted to the UW Autism Center for treatment or health care services you may request a copy of the current Notice in effect from your care provider or you may request a copy of this Notice from the UW Autism Center Privacy Office. An electronic version of the notice is also posted at http://depts.washington.edu/uwautism/.