Skagit Valley Medical Center respects your privacy. We understand that your personal health information is sensitive and that we are privileged to have access to this information. We will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to do so.

Participating Organizations
This notice applies to the employees and providers of Skagit Valley Medical Center and all its affiliated organizations:

• Stanwood Camano - Skagit Valley Medical Center
• Skagit Valley Medical Center Occupational Medicine
• Sedro-Woolley - Skagit Valley Medical Center
• Skagit Valley Medical Center Urgent Care

Your Health Care Information
This notice applies to the information and records we have about your health and the health care and services we provide to you. This includes information we create and receive from outside sources. It may be in written, electronic, or spoken form. It may include information about your health history, health status, symptoms, examinations, test results and images, diagnoses, treatments, procedures, prescriptions, related billing activity and demographic information such as address, phone numbers, social security numbers and similar information.

How We May Use and Disclose
Information About You
For the purposes of this notice, Federal law allows or requires us to use and disclose health information in several different situations. The following describes these situations and provides examples for each.

For Treatment:
We may use and disclose your health information to provide treatment and other services. We may disclose this information to providers, nurses, technicians, office staff and other personnel who are involved in your health care.

For example, your provider may order lab tests and will send the laboratory the information they need to perform the testing. Or your provider may refer you to a physical therapist and will disclose information to the therapist so they can provide the necessary treatment.

Skagit Valley Medical Center also participates as a partner in the following organizations and may use and disclose your health information as a part of providing treatment through these services:
• Ultrasound Associates (ultrasound / fluoroscopy)
• Advanced Imaging Northwest (MRI / CT imaging)
• Skagit Valley Hospital (hospitalist program)

For Payment:
We may use and disclose your health information in order to bill and receive payment from either you, a health plan or a third party. Skagit Valley Medical Center is required by State law to obtain your permission to release health information to a health plan.

For example, information sent to a health plan for a bill may include your diagnoses, procedures performed, or recommended care. Or we may contact your health plan before scheduling a service in order to receive approval, or to determine whether or not your plan will pay for the treatment. We may also use or disclose your information to receive payment for services provided through the partnerships listed above.

For Operations:
We may use and disclose your health information as part of our daily operations. These uses are necessary to run our facilities and to provide quality care to our patients.

For example:
• We may use your medical records to assess quality and improve services.
• We may use and disclose medical records to review the qualifications and performance of our health care providers and to train our staff.
• We may contact you to remind you about appointments.
• We may contact you to provide information about treatment alternatives or other health-related benefits and services.
• We may use and disclose your information to conduct or arrange for services, including:
• medical quality review by your health plan;
• accounting, legal, risk management, and insurance services;
• audit functions, including fraud and abuse detection and compliance programs.

Special Situations
We may use or disclose health information for the following purposes, subject to State and Federal legal requirements and limitations:

• As Required by Law. We will disclose your health information when required to do so by State, Federal or Local law.

• To Avert A Serious Threat To Health Or Safety. We may use and disclose your health care information when necessary to prevent a serious threat to the health and safety of you, the public or another person.

• For Research Purposes. We may use and disclose your health information for research projects that are subject to a special approval process. We will ask you for your permission if the researcher will have access to your name, address, or other information that reveals your identity.

• For Organ and Tissue Donation. If you are an organ donor, we may disclose your health information to organizations that handle organ procurement or organ, eye or tissue transplantation, or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

• For Military or National Security. If you are a member of the armed forces, we may disclose health information about you as required by law.

• To Workers Compensation. We may disclose health information about you for workers compensation claims or similar programs.

• Public Health Risks. We may disclose your health information for public health reasons in order to:

- prevent or control disease, injury or disability
- to report births, deaths
- to report suspected abuse, neglect or domestic violence or non-accidental physical injuries
- to notify you of recalls of products you may be using
- to report reactions to medications or problems with products or procedures

• To Funeral Directors & Coroners. We may disclose your health information to these professionals as necessary for them to carry out their duties, consistent with applicable law.

• For Health Oversight Activities. We may disclose your health information to a health oversight agency for audits, investigations, inspections, or licensing purposes.

• Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your health information in response to a court order, subpoena, warrant or other lawful process.

• To Correctional Institutions. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your health information to an official of the institute or enforcement agency.

• For Law Enforcement Purposes. We may disclose your health information in situations which include the following:

- in response to a subpoena, court order, or other legal process,
- if you are the victim of a crime,
- during investigation of criminal conduct at this facility,
- in emergency circumstances to report a crime.

• For Disaster Relief Purposes. We may disclose your health information with disaster relief agencies to assist in notification of your condition to family or others.

• Family, Relatives and Friends. We may disclose your health information to your family members, relatives and friends if we obtain your verbal agreement or if, based on our professional judgment, we believe you would not object.

For example, we may assume that you agree to disclosure of your health information to your spouse if you bring your spouse into the examination room with you during a visit with your provider while treatment is being discussed.

In urgent situations where you are not able to authorize disclosure (because you are not present and cannot be reached or due to your incapacity), we may determine that a disclosure to family, relatives, or friends is in your best interest.

Other Uses and Disclosures of Protected Health Information
Uses and disclosures not in this Notice will be made only as allowed or required by law or with your written authorization.

Your Health Information Rights
You have the following rights regarding the health information we maintain about you:

The Right to Inspect and Copy:
You have the right to request to inspect and copy your health information, such as medical and billing records. To make this request, please come to the Medical Records Department or call (360) 428-2551. A request to copy your information must be in writing and we may charge a fee for the costs of copying, mailing or other supplies.

In very limited circumstances we may deny your request to inspect and copy your health information. This denial can be reviewed for a second opinion with another healthcare provider. We will comply with the decision from this review.

The Right To Amend:
If you believe the health information we have about you is incorrect or incomplete, you have the right to request that we amend your information. To make this request, please come to the Health Information Management office in the Medical Records Department or call 360-428-6458. This request must be in writing, using the Medical Record Amendment/Correction Form or a reasonable substitute that supplies the same information for consideration. The completed form should be returned to the Health Information Manager.

In some circumstances we may deny your request to amend your record. These include situations where we did not create the documentation or we believe the information in question to be correct. You have the right to enter a statement of disagreement into your record.

The Right to Revoke an Authorization:
If you have previously provided a written authorization form, you have the right to revoke that authorization at any time. The revocation must be in writing, using the Authorization Revocation Form or a reasonable substitute that supplies the same information. The completed form should be returned to the Health Information Manager. Your revocation will not affect information that has already been released. You cannot cancel an authorization if its purpose was to obtain insurance.

The Right for an Accounting of Disclosures:
You have the right to request an “accounting of disclosures”. This is a record of certain disclosures of your health information that we have made in accordance with this notice. The request must be in writing, using the Request for Disclosures Form or a reasonable substitute that supplies the same information. The completed form should be returned to the Health Information Manager. The accounting will not include disclosures made for treatment, payment or operations. It will also not include any disclosures made based on your written authorization. Only disclosures made after the effective date of this notice (April 14, 2003) will be reported.

You may receive one accounting in a 12-month period free of charge. A fee may be charged for additional accounting requests.

The Right to Request Restrictions:
You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or our operations. You also have the right to restrict the information we disclose about you to someone involved in your care or payment of care. The request must be in writing using the Request for Restrictions/Confidential Communications Form or a reasonable substitute that supplies the same information. The form should be returned to the Health Information Manager.

In some circumstances, we may not be able to comply with your request. If we are able to comply, your health information will be restricted unless a disclosure is required by law or is needed in an emergency situation.

The Right to Request Confidential Communication:
You have the right to request that we communicate with you about your health information in a certain way or at a certain location. For example, you can request that we communicate only by mail to your work address. The request must be in writing using the Request for Restrictions/Confidential Communications Form or a reasonable substitute that supplies the same information. The completed form should be returned to the Health Information Manager. We will accommodate all reasonable requests.

The Right to a Copy of This Notice:
You have the right to a paper copy of this notice. You may ask for a copy of this notice at any time. The notice is available from any reception location and at the Patient Services desk in the main lobby of the Skagit Valley Medical Center facility. It can also be requested when receiving services from our Laboratory or Radiology departments.

Changes To This Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our facilities. You are entitled to a copy of the notice that is currently in effect.

Complaints
If you believe your rights have been violated, you may file a complaint with our offices. To file a complaint, please contact:

Skagit Valley Medical Center
Attn: Health Information Mgr. - Privacy Officer
1400 E. Kincaid St.
Mount Vernon WA 98274
360-428-6458

If we are not able to resolve your concerns, you may also file a complaint with the Secretary of the Department of Health and Human Services.

Filing a complaint will not affect the quality of your health care with Skagit Valley Medical Center, nor will you be penalized in any manner for taking this action.