Joint Notice of Privacy Practices of UW Psychological Services and Training Center and Certain Other Providers

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 Psychological Services and Training Center, The LEARN Clinic, and the Faculty Clinic (collectively, the Providers) when services are provided within UW Department of Psychology facilities, 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 Psychological Services and Training Center. UW Psychological Services and Training Center is composed of multiple affiliated entities that work together to provide health care services and to perform payment and health care operations. UW Psychological Services and Training Center entities will share information, as necessary, to provide health care services (including mental health), and to perform payment and health care operations. UW Psychological Services and Training Center includes the following entities or operations:

• UW Psychological Services and Training Center graduate student training clinic
• The LEARN Clinic, which provides testing services for learning disabilities and other disorders
• Faculty Clinic, which is composed of Psychology Department faculty who provide clinical services to clients

Protected Health Information

This Notice applies to health information -- created or received by the Providers at UW Psychological Services and Training 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; 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 are allowed under federal law to use and disclose protected health information (including mental health information) without your authorization.

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

• Your treatment provider uses your information to determine whether specific diagnostic tests, therapies, and medications should be ordered.
• Clinical Supervisors, clinical graduate students, or other clinic personnel (e.g. the Clinic Director) may need to know and/or discuss your 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. However, under most non-emergency situations, we will ask your verbal or written authorization before doing so.

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 required 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 clinical supervisors review client information with graduate student staff therapists.

Conduct Research (does not apply to The LEARN Clinic). We MAY use and disclose your information for research under certain limited circumstances (e.g., if most or all identifying data has been removed). The University of Washington's Human Subjects Office (206/543-0098) will review each request to use your health care information for research without your consent. For example, a researcher might include your information in a research database that removes most or all of your identifying information. The Human Subjects Office makes sure that using your information without your consent is justified and that steps are taken to limit the use of your information. If the Human Subjects Office gives us permission to use limited information about you without your consent, we may share information about you used for research with researchers at other institutions. In all other cases, we must obtain your authorization to use or disclose your information for a research project.

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 contact you about balances on your account.

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 billing services 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 of minors, elders and the developmentally disabled;
• 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 in response to a court order or a lawful subpoena;
• 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.

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 Psychological Services and Training Center
Attention: Clinic Manager
Box 351635
Seattle, WA 98195-1635
206/543-6511

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. UW Psychological Services and Training Center 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 your treatment 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 by using the form: Patient Request for Access to Protected 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 Psychological Services and Training Center. 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 conspicuous places in our reception area. In addition, any time you check-in for an appointment, you may request a copy of the current Notice in effect from the location of your care provider or you may request a copy of this Notice.

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