(Condensed Version – Complete Notice Available Upon Request)
Effective Date: January 1, 2009 / Version 1.0
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.
Uses and Disclosures
We will use and disclose elements of your protected health information (PHI) in the following ways without your signed authorization:
- Treatment – to assist us and those treating you.
- Payment – to bill you for our services and to collect payment from you.
- Health Care Operations – to evaluate and improve the quality of the health services we provide.
- To Business Associates – to allow them to carry out the tasks we have hired them to do. Our contracts with Business Associates include provisions requiring their protection of your PHI.
- Public Policy Purposes
- As required by applicable federal, state and local laws.
- For purposes or in support of: Public health reporting; healthcare oversight activities; law enforcement activities; reporting abuse, neglect, or domestic violence; judicial and administrative proceedings that involve you; worker’s compensation; prevention of serious threat to health or safety; records-based research under specific conditions; and military and national security.
- To the following persons/organizations: Coroners, medical examiners and funeral directors as necessary for them to carry out their duties; organ procurement organizations; correctional institutions if you are an inmate; or people assisting in your care or payment of your care.
All other uses and disclosures by us will require us to obtain from you a written authorization in addition to any other permission you will provide us.
Your Rights
You have the following rights concerning your PHI:
- Restrictions: To request restricted access to all or part of your PHI. Request must be made in writing.We are not required to grant your request.
- Confidential Communications: To receive correspondence of confidential information by alternate means or location. Request must be made in writing.
- Access: To inspect or receive copies of your PHI. Request appropriate form.
- Amendment: To request changes be made to your PHI. Request appropriate form.
- Accounting: To receive an accounting of the disclosures by us of your PHI in the six years prior to yourrequest. Request appropriate form. If you request this information more than every 12 months we may charge you a fee. Our fee is currently set at $3.00.
- This notice: To get updates or reissue of this notice, at your request. Contact FHS’ Privacy Officer.
- Complaints: To complain to us or the U.S. Department of Health & Human Services if you feel your privacy rights have been violated. Contact FHS’ Privacy Officer. The law forbids us from taking retaliatory action against you if you complain.
Our Duties
We are required by law to maintain the privacy of your PHI. We must abide by the terms of this notice or any update of this notice.
Privacy Contact Information
Contact information for any correspondence, request for forms, or complaints: Futura Health Screening / Attn: Privacy Officer / 11714 N Creek Parkway N, Suite 100/ Bothell, WA 98011-8250 / (425) 486-8868.
