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.

Your health information with Planned Parenthood of Western Washington is confidential.

We understand and respect your desire to receive discreet, professional services and to be certain that information about you is kept confidential. To protect your privacy we will do things like: obtain your permission before releasing your medical information to another health care provider, in public areas of our clinics we will use only your first name, we will not tell family members or friends if you are a patient or if you are in the clinic without your permission, and we will not leave phone messages for you identifying Planned Parenthood without your permission. We extend these practices to all of our patients. While you are our patient we will create a paper record, or "chart", and an electronic account in our patient database for you. These things will contain the personal information you provide to us, such as your name, date of birth and social security number, as well as information that records your health, the healthcare you receive from us and information about the billing and payment for your health care. All of this information is "protected health information" (or PHI) under the Health Insurance Portability and Accountability Act (or HIPAA) which is a federal regulation. As your healthcare provider, there are a variety of ways we will routinely need to use the PHI we have about you. This notice is to inform you how the information we have about you might be used or disclosed and your right regarding this information.

Planned Parenthood of Western Washington wants you to know about your privacy rights.

This notice will explain those rights to you. These rights are backed up by federal and state law. Under federal law we are required to:

• Make sure that health information that identifies you is kept private.
• This means that all of our staff must maintain the confidentiality of your health information. All of our
  staff receives privacy training so that they understand this commitment.
• Give you this notice explaining our legal duties and practices with respect to your PHI.

Follow the terms of the notice that is currently in effect.

The effective date of this notice is: April 1, 2004

If you have any questions about this notice, please ask our clinic staff or contact the Planned Parenthood of Western Washington Privacy Official at 206-328-7716.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

For treatment:We will use your PHI to provide you with healthcare treatment and services. This means that doctors, nurses, technicians, health students, volunteers or other staff who are directly involved in taking care of you at PPWW may have access to your PHI. We will also send the lab specimens we collect for you to an outside lab for testing; we may need to share information about you with a pharmacist in order for you to have a prescription filled; we will not share information about you with other doctors outside of Planned Parenthood who are involved in your care without your permission or consent.

For Payment: We may use and share your PHI so that we may be paid for the treatment and services we provide to you. For instance, we may use your PHI to: bill your insurance plan or Medicaid, determine or confirm your eligibility under Medicaid programs or to assist with your enrollment in Medicaid programs like Take Charge. Additionally, in some cases, we may need to use information about you to gain prior approval or to determine your coverage and eligibility prior to delivering services to you. We might also use information we have about you to send billing statements for healthcare that you need to pay for.

For Heathcare Operations: We may use and share your PHI to review our delivery of care, ensure quality and make decisions about how to run our practice. For example, we may use health information to review the quality of our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many patients to decide what additional services we should offer, whether certain new treatments are effective, or to compare how we are doing with others and to see where we can make improvements. Information used in this way would not identify you directly.

To fulfill our legal and public health requirements: As with every healthcare provider, Planned Parenthood of Western Washington may be required to share information about you or the services you receive without your authorization in the following situations:

1. To avert a serious threat to health or safety. This would only be to someone able to help prevent the threat.
2. For public health and safety such as:

• To prevent or control the spread of disease, injury or disability (such as reporting positive results for sexually transmitted diseases to the Department of Public Health);
• To report vital statistics (such as reporting the incidence of abortion to the Department of Public Health);
• To report reactions to medications or problems with products;
• To notify you in the event of a product recall;
• To notify the appropriate government authority if we believe a patient has been the victim of child abuse, physical abuse or neglect.

3. Health oversight activities.These include; audits, investigations, inspections, and licensure that are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
4. To a coroner or health examiner. If we needed to help identify a deceased person or help determine the cause of death.
5. Lawsuits and disputes. If we receive a court order, subpoena, discovery request, or other lawful process.
6. Law enforcement. If a warrant is issued for information about you in the investigation of a felony or homicide we are compelled to release the information. We may also release information to help identify or locate a suspect, fugitive, material witness, or missing person; to report a crime; or if criminal conduct occurs at our facility.
7. As otherwise required by federal, state or local law. Other ways we may use information about you. In limited circumstances we may need to use information about you without for the following purposes.

Appointment reminders: For certain appointments, we may use information about you to call and remind you of your appointment.

Research purposes: Some PHI may be used for research Planned Parenthood of Western Washington is in volved in. For example, a research project may compare the effectiveness of one treatment plan over another. Generally if your information is to be used for research, we will obtain consent from you unless a Privacy Board has made assurances that information about you will be adequately protected.

Correctional facilities: If you are an inmate of a correctional facility or under the custody of a law enforcement official, we may release health information about you to the correctional facility or law enforcement official in order for the facility to provide you with healthcare; or to protect your health and safety or the health and safety of others.

OTHER USES OF HEALTH INFORMATION

Any other use or disclosure of your health information that is not covered above may be made only with your written permission or authorization. If you do give us an authorization to use or disclose health information about you, you may revoke that authorization, in writing, at any time. If you do revoke your authorization you understand that we are not able to take back any disclosures we have already made under that authorization.

YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU

You have the right to:
1. Receive and review this notice. Please ask us if there is information that is unclear or contact the Planned Parenthood of Western Washington Privacy Official at 206-328-7716.
2. Inspect and receive a copy of the health information we possess about you. This includes your health and billing records or any record we maintain that was used to make a decision about you. If you wish to see or be given a copy of your health information we will ask you to submit that request in writing on a form we will provide. Under some conditions we may deny your request. If we do, you can request that your records be sent to another healthcare provider for review.
3. Amend your health information. If you feel that health information that we possess about you is incorrect or incomplete, you may ask us to amend the information. If you wish to request an amendment, we will ask you to make your request in writing on a form we provide. You must tell us the reason for the request. We will consider all requests but may not accept your request if what you are asking us to change information that:

• Was not created by us;
• Is not part of the health information kept by or for our practice;
• Is not part of the information which you would be permitted to inspect and copy; or
• Is accurate and complete.

4. Request a list of disclosures of your health information. You are entitled to a list of all disclosures [except those made for the purposes of payment] of the health information we possess about you. To request this list of disclosures, we will ask you to submit your request in writing on a form we provide.
5. Request a restriction or limitation on the way we use and disclose your health information. After you review this notice you may request that we limit how information about you is used. For instance you may request we not release information about you or limit the information we release to someone involved in your care or the payment for your care. You may also request we not use information about you to remind you of your appointment or contact you for public affairs purposes. We will ask you to make this request in writing. If we can accommodate your request we will, but we are not required to. If we do agree to your request we must honor it unless the information is needed to provide you with emergency treatment.
6. Request that communications from us are delivered to you in a confidential way. You can ask us to only contact you in a certain manner or at a certain location. For example, you can ask that we only contact you at work, on a cell phone or at a friend?s house. As you complete our registration forms you will have an opportunity to tell us how you wish to receive communications from us.
7. File a complaint. If you believe your privacy rights listed above have been violated, you may file a complaint with Planned Parenthood of Western Washington or with the Secretary of the Department of Health and Human Services. You will not be penalized by Planned Parenthood of Western Washington for filing a complaint. To file a complaint with Planned Parenthood of Western Washington, we encourage you to submit a written complaint to:

Privacy Officer
2001 E. Madison Street, Seattle, WA 98122
Or if it is more convenient, please phone the Privacy Officer at 206-328-7716.

MINORS

You are generally considered a minor if you are under 18, are not married and are not legally emancipated. A minor has the same rights that are outlined in this notice. You can decide to involve your parent or guardian in your healthcare. PPWW will not release information about you or your care to your parent or guardian without your specific permission or authorization to do so unless a medical emergency requires us to do so.

CHANGES TO THIS NOTICE

We reserve the right to change this notice and to make those changes effective for health information we already have about you. We will post a copy of the current Notice in our facility and on our website at www.ppww.org with the effective date of the notice on the first page.

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