"Helping Children Achieve their Potential"
Achieve Center
Notice of Privacy Practices
Effective Date: April 12, 2004
Notice of Privacy Practices
Effective Date: April 12, 2004
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Privacy Policy
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.
The Achieve Center respects your privacy. We understand that your personal health information is very sensitive. 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.
The law protects the privacy of the health information we create and obtain in providing our care and services to you. For example, your health information includes your symptoms, test results, diagnoses, treatment, health information from other providers, and billing and payment information relating to these services. Federal and state law allows us to use and disclose your health information for purposes of treatment and health care operations. State law requires us to get your authorization to disclose this information for payment purposes.
Examples of Use and Disclosures of Protected Health Information for Treatment, Payment, and Health Care Operations
For Treatment: Information obtained by a therapist, or other member of our health care team will be recorded in your medical record and used to help decide what care may be right for you. We may also provide information to others providing your care. This will help them stay informed about your care.
For Payment: We may request payment from your health insurance plan. Health plans need information from us about your medical care. Information provided to health plans may include your diagnoses, procedures performed, or recommended care.
For Health Care Operations: We 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 and give you 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.
Your Health Information Rights
The health and billing records we create and store are the property of the Achieve Center. The protected health information in it, however, generally belongs to you. You have a right to:
• Receive, read, and ask questions about this Notice;
• Ask us to restrict certain uses and disclosures. You must deliver this request in writing to us. We are not required to grant the request, but we will comply with any request granted;
• Request and receive a paper copy of the most current Notice of Privacy Practices for Protected Health Information (“Notice”);
• Request that you be allowed to see and get a copy of your protected health information. You may submit this request in writing on the applicable form. Have us review a denial of access to your health information—except in certain circumstances;
• Ask us to amend your health information by written request. If your request is denied, you may submit a statement of disagreement which will be stored in your record and included with any release of your records;
• A list of disclosures of your health information. The list will not include disclosures for treatment, payment and/or operations of medical providers of the Hospital or to third party payers. You may receive this information without charge once every 12 months. If you request this information more than once in 12 months, we will notify you of the cost involved;
• Ask that your health information be given to you by another means or at another location. Submit a dated, signed, written request;
• Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released or any action taken before we receive your revocation. In certain circumstances, you cannot cancel an authorization if its purpose was to obtain insurance.
Our Responsibilities
We are required to:
• Keep your protected health information private;
• Give you this Notice;
• Follow the terms of this Notice.
We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice. You may receive the most recent copy of this Notice by calling and requesting one.
To Ask for Help or Complain
If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact:
Privacy Officer
(509) 888-2505
If you believe your privacy rights have been violated, you may discuss your concerns with any staff member. You may also deliver a written complaint to:
Privacy Officer
Achieve Center
1111 N. Mission Suite B
Wenatchee, WA 98801
You may also file a complaint with the U.S. Secretary of Health and Human Services.
We respect your right to file a complaint with us or with the U.S. Secretary of Health and Human Services and will be no repercussions if a complaint is filed.
Other Uses and Disclosures of Protected Health Information
Notification of family and others as follows:
Unless you object, we may release health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may tell your family or friends your condition and that you are in a hospital. In addition, we may disclose health information about you to assist in disaster relief efforts.
You have the right to object to this use or disclosure of your information. If you object, we will not use or disclose it.
We may use and disclose your protected health information without your authorization as follows:
• To funeral directors/coroners consistent with applicable law to allow them to carry out their duties.
• To organ procurement organizations (tissue donation and transplant) or persons who obtain, store, or transplant organs.
• To the Food and Drug Administration (FDA) relating to problems with food, supplements, and products.
• To comply with Workers’ Compensation laws—if you make a workers’ compensation claim.
• To public health or legal authorities as allowed or required by law:
• To protect, prevent, or reduce a serious, immediate threat to the health or safety of person or the public.
• To prevent or control disease, injury, or disability
• To report vital statistics such as births or deaths.
• To report suspected abuse or neglect to public authorities.
• For health and safety oversight activities. For example, we may share health information with the Department of Health.
• For disaster relief purposes. For example, we may share health information with disaster relief agencies to assist in notification of your condition to family or others.
• To correctional institutions if you are in jail or prison, as necessary for your health and the health and safety of others.
• For law enforcement purposes such as when we receive a subpoena, court order, or other legal process, or you are the victim of a crime.
• For work-related conditions that could affect employee health. For example, an employer may ask us to assess health risks on a job site.
• To the military authorities of U.S. and foreign military personnel. For example, the law may require us to provide information necessary to a military mission.
• In the course of judicial/administrative proceedings at your request, or as directed by a subpoena or court order.
• For specialized government functions. For example, we may share information for national security purposes.
• With medical researchers—if the research has been approved and has policies to protect the privacy of your health information. We may also share information with medical researchers preparing to conduct a research project.
Other Uses and Disclosures of Protected Health Information not in this Notice
Uses and disclosures not in this Notice will be made only as allowed or required by law or with your written authorization.
“The Achieve Center” and “Achieve Center” are registered trade names of Burns and Hunsaker LLC, a Wyoming State limited liability company.
Privacy Policy
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.
The Achieve Center respects your privacy. We understand that your personal health information is very sensitive. 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.
The law protects the privacy of the health information we create and obtain in providing our care and services to you. For example, your health information includes your symptoms, test results, diagnoses, treatment, health information from other providers, and billing and payment information relating to these services. Federal and state law allows us to use and disclose your health information for purposes of treatment and health care operations. State law requires us to get your authorization to disclose this information for payment purposes.
Examples of Use and Disclosures of Protected Health Information for Treatment, Payment, and Health Care Operations
For Treatment: Information obtained by a therapist, or other member of our health care team will be recorded in your medical record and used to help decide what care may be right for you. We may also provide information to others providing your care. This will help them stay informed about your care.
For Payment: We may request payment from your health insurance plan. Health plans need information from us about your medical care. Information provided to health plans may include your diagnoses, procedures performed, or recommended care.
For Health Care Operations: We 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 and give you 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.
Your Health Information Rights
The health and billing records we create and store are the property of the Achieve Center. The protected health information in it, however, generally belongs to you. You have a right to:
• Receive, read, and ask questions about this Notice;
• Ask us to restrict certain uses and disclosures. You must deliver this request in writing to us. We are not required to grant the request, but we will comply with any request granted;
• Request and receive a paper copy of the most current Notice of Privacy Practices for Protected Health Information (“Notice”);
• Request that you be allowed to see and get a copy of your protected health information. You may submit this request in writing on the applicable form. Have us review a denial of access to your health information—except in certain circumstances;
• Ask us to amend your health information by written request. If your request is denied, you may submit a statement of disagreement which will be stored in your record and included with any release of your records;
• A list of disclosures of your health information. The list will not include disclosures for treatment, payment and/or operations of medical providers of the Hospital or to third party payers. You may receive this information without charge once every 12 months. If you request this information more than once in 12 months, we will notify you of the cost involved;
• Ask that your health information be given to you by another means or at another location. Submit a dated, signed, written request;
• Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released or any action taken before we receive your revocation. In certain circumstances, you cannot cancel an authorization if its purpose was to obtain insurance.
Our Responsibilities
We are required to:
• Keep your protected health information private;
• Give you this Notice;
• Follow the terms of this Notice.
We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice. You may receive the most recent copy of this Notice by calling and requesting one.
To Ask for Help or Complain
If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact:
Privacy Officer
(509) 888-2505
If you believe your privacy rights have been violated, you may discuss your concerns with any staff member. You may also deliver a written complaint to:
Privacy Officer
Achieve Center
1111 N. Mission Suite B
Wenatchee, WA 98801
You may also file a complaint with the U.S. Secretary of Health and Human Services.
We respect your right to file a complaint with us or with the U.S. Secretary of Health and Human Services and will be no repercussions if a complaint is filed.
Other Uses and Disclosures of Protected Health Information
Notification of family and others as follows:
Unless you object, we may release health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may tell your family or friends your condition and that you are in a hospital. In addition, we may disclose health information about you to assist in disaster relief efforts.
You have the right to object to this use or disclosure of your information. If you object, we will not use or disclose it.
We may use and disclose your protected health information without your authorization as follows:
• To funeral directors/coroners consistent with applicable law to allow them to carry out their duties.
• To organ procurement organizations (tissue donation and transplant) or persons who obtain, store, or transplant organs.
• To the Food and Drug Administration (FDA) relating to problems with food, supplements, and products.
• To comply with Workers’ Compensation laws—if you make a workers’ compensation claim.
• To public health or legal authorities as allowed or required by law:
• To protect, prevent, or reduce a serious, immediate threat to the health or safety of person or the public.
• To prevent or control disease, injury, or disability
• To report vital statistics such as births or deaths.
• To report suspected abuse or neglect to public authorities.
• For health and safety oversight activities. For example, we may share health information with the Department of Health.
• For disaster relief purposes. For example, we may share health information with disaster relief agencies to assist in notification of your condition to family or others.
• To correctional institutions if you are in jail or prison, as necessary for your health and the health and safety of others.
• For law enforcement purposes such as when we receive a subpoena, court order, or other legal process, or you are the victim of a crime.
• For work-related conditions that could affect employee health. For example, an employer may ask us to assess health risks on a job site.
• To the military authorities of U.S. and foreign military personnel. For example, the law may require us to provide information necessary to a military mission.
• In the course of judicial/administrative proceedings at your request, or as directed by a subpoena or court order.
• For specialized government functions. For example, we may share information for national security purposes.
• With medical researchers—if the research has been approved and has policies to protect the privacy of your health information. We may also share information with medical researchers preparing to conduct a research project.
Other Uses and Disclosures of Protected Health Information not in this Notice
Uses and disclosures not in this Notice will be made only as allowed or required by law or with your written authorization.
“The Achieve Center” and “Achieve Center” are registered trade names of Burns and Hunsaker LLC, a Wyoming State limited liability company.