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Island Internal Medicine
La Conner Medical Center
Notice of Privacy Practices
This notice describes how medical information about YOU may be used and disclosed, and how you can get access to this information. Please review this CAREFULLY.
Island Internal Medicine (IIM) / La Conner Medical Center (LCMC) respects your privacy. It is required to maintain the privacy of your health information and to provide you with a notice (“Notice”) of its legal duties and privacy practices. We understand that your Personal Health Information is very sensitive. IIM/LCMC will not use or disclose your health information except as described in this notice. 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. This notice applies to all the medical records generated by IIM/LCMC and its personnel.
The law protects the privacy of the health information we create and obtain in providing care and services to you. For example, your Protected 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 Protected 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 operations:
Information obtained by a nurse, physician or other employee will be recorded in your medical record and used to help decide what care is needed for you;
We may also provide information to others providing care for you. This will help them stay informed about your care.
We 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 diagnosis, procedures performed, or recommended care.
For health care operations:
We may use and disclose your information to conduct or arrange for services, including:
Your health information rights:
The health and billing records we create and store are the property of IIM/LCMC. The Protected Health Information in it, however, generally belongs to you.
You have the right to:
Practices for Protected Health information (“Notice”):
When you request a copy of your Protected Health Information, we will give you a list of disclosures of your health information. The list will not include disclosures made for purposes of treatment, payment or health care operations, disclosures you authorized, disclosures to you, disclosures to correctional institutions and law enforcement in some circumstances or disclosures for national security. You may receive this information without charge once every 12 months. We will notify you of the cost involved if you request this information more than once in 12 months. Please sign, date, and give us your request in writing. 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. It also does not affect any action taken before we have it. Sometimes, you cannot cancel an authorization if its purpose was to obtain insurance. For help with these rights during normal business hours, please contact:
Island Internal Medicine
912 32nd Street, Suite A
Anacortes, WA 98221
We are required to:
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 asking for it or by coming in to one of our medical clinics and picking one up.
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 or deliver a written complaint to the Office Manager at IIM/LCMC. If you believe your privacy rights have been violated, you may discuss your concerns with any staff member or the Office Manager. 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. If you complain, we will not retaliate against you.
Other Disclosures and Uses of Protected Health Information:
Notification of Family and Others:
In an emergency we may, unless you object, 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.
We may use and disclose your Protected Health Information without your authorization as follows:
Other Uses and Disclosures of Protected Health Information: