Reviewed April 14, 2008

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.

Who will follow this notice
This notice describes Southwest Washington Medical Center's (Southwest) practices and that of our workforce. The workforce includes our employees, medical staff, volunteers and others who work at Southwest.

Southwest includes departments and services based at the Medical Center, Memorial Health Center, and other satellite facilities.

Understanding Your Health Record/Information
Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made. The record typically includes your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information is called your health or medical record. It serves as a:

• basis to plan your care and treatment
   
• means to communicate about your care among the many health professionals who have a part in your care
   
• legal document that tells about the care you received
   
• way for you or a third party payor to find out if the services billed for were really given
   
• tool to educate health professionals
   
• source of data for medical research
   
• source of information for public health officials charged with improving the health of the nation
   
• tool used by Southwest to assess and always work to improve the care we provide and the results we achieve

Your Health Information Rights
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. These rights are contained in federal law 45 CFR 164.500 - 528. The actual law can be viewed at: www.hhs.gov/ocr/part1.html

You have the right to:

• receive a copy of our Notice of Privacy Practices
   
• view your health information or health record
   
• submit a written privacy complaint

You also have the right to ask, in writing, for the following:

• a copy of your health information or health record
   
• amendments or changes to your health information
   
• a list of any parties who get your health information
   
• for Southwest to limit certain uses and releases of your health information (Note: Southwest will attempt to honor your right to limit use of your health information, but may not be able to meet all requests)
   
• to take away your consent for Southwest to use or give out your health information, except to the extent we have already given it out
   
• to have Southwest communicate your health information in a different way or in another place
   
• to have Southwest not list you in our patient directory

Our Responsibilities
Southwest is required to:

• make sure we keep your protected health information private
   
• give you this notice to tell you how Southwest may use or give out your health information and what we do to protect your private information
   
• hold ourselves to the terms of this notice
   
• tell you if we are not able to agree to or meet your request to review or access your information, change or amend your health information, find out what Southwest does with your information, restrict or take away your consent for Southwest to use or give out your information
   
• meet your reasonable requests to communicate with you about your health information in a different way or at a different location

We reserve the right to change this notice. You can get a copy of the current notice in the Southwest patient registration department. We also post the notice on our Website at www.swmedicalcenter.org

We will not use or give out your health information if you do not agree to or permit it, except as we tell you in this notice.

How Southwest may use or give out your health information

• For Treatment. We may use health information about you to provide you with healthcare treatment or services. We may give out your health information to doctors, nurses, technicians, healthcare students, clergy, or others who take part in your care. For example, diabetes may slow healing. That means a doctor treating you for a broken leg needs to know if you have diabetes. People with diabetes need proper meals. The doctor may tell the dietitian if you have diabetes so you will get proper meals.
   
  Some parts of Southwest may share health information about you to manage all the care you need. That care may include medicine, lab work, and x-rays. We also may give out health information about you to those outside the hospital who may be involved in your healthcare. This may include long-term care facilities or others that Southwest or your physician use for health services that are part of your healthcare.
   
• For Payment. We may use and give out health information about you so that Southwest may bill an insurance company or a third party for the treatment or services you get at Southwest. For example, if you have surgery at Southwest we may need to give information to your health plan. That is so your health plan will pay us or reimburse you for the surgery. At times Southwest needs to ask your health plan to approve a treatment. Southwest may also need to find out if your health plan will cover the treatment. At those times we may need to give information to your health plan before you receive the treatment.
   
• For healthcare operations. For example: Members of the Southwest medical staff, the risk-management staff or quality improvement staff may use information in your health record to assess the care and outcomes in your case and others like it. Southwest uses this information to improve the quality and effectiveness of the services we provide.

Other Uses or Disclosures
Southwest business associates: Southwest provides some services through contracts with business associates. Examples include:

• physician services in the Emergency Department and Radiology
• some laboratory tests
• a copy service to makes copies of your health record

We may give out your health information to our business associates so that they may:

• provide a service for you
• bill you, your health plan, or third party payor for services they provided

To protect your health information, we require our business associates to also protect your health information.

Directory: You may request that Southwest leave you out of the directory. While you are at Southwest we will use your name, location in Southwest, general condition, and religious affiliation in the directory. Southwest may give this information to members of the clergy. We may give this information, except for religious affiliation, to other people who ask for you by name.

Notification: We may use or give out information about your location and general condition to notify a family member, personal representative, or any other person in charge of your care.

Communication with family or caregivers: Health professionals, using their best judgment, may give out health information to a person who is involved in your care. This may be a family member, a relative, close personal friend, or any other person you name. We may also give out this information to someone who helps to pay for your care.

Research: We may give out information to people doing research when

• you have given specific consent to take part in a study, or
• when the research proposal has been reviewed or approved by an Institutional Review Board

Funeral directors and medical examiners: We may give out health information to funeral directors and Medical Examiners so they may carry out their duties, as the law allows.

Organizations that procure organs: We may give out health information to those that obtain, store, or transplant organs for the purpose of tissue donation and transplant.

Marketing: We may contact you to remind you about appointments, tell you about treatment options, or to tell you about other health-related benefits and services that may be of interest to you.

Fund-raising: Southwest or its Foundation may contact you as part of a fund-raising effort.

Public Health and Safety notifications as required by law: We may be required to give out health information about you for public health activities or when needed to prevent a serious threat to health and safety. In general these disclosures are needed to:

• report births and deaths.
• report reactions to medicine or problems with products
• notify people of recalls of products and devices they may be using
• prevent or control disease, injury or disability
• notify a person who may have been exposed to a disease or may be at risk for getting or spreading a disease or a health condition
• notify the proper government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.
• participate in registry databases; such as cancer or trauma.

Workers Compensation: We may give out health information to the extent allowed by law and needed to abide by laws that relate to workers compensation or other similar programs put in place by law.

Washington/Oregon Healthcare programs: We may give out health information as necessary to comply with the laws requiring state reporting.

Correctional Institution: If you are an inmate of a correctional institution, we may disclose to the institution or its agents, health information needed for your health, and the health and safety of other persons.

Military: If you are a member of the armed forces, we may release health information about you as required by military authorities.

Law Enforcement: We may give out health information to federal, state, or local law enforcement authorities to the extent the law requires.

Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may give out health information about you as required by state and federal law.

Healthcare Oversight: We may give out health information to a healthcare oversight agency. These health oversight activities might include: audits, investigations, inspections, and licensure as needed for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.

For More Information or to Report a Problem
If you have questions or would like more privacy information, you may contact the Southwest Privacy Officer at (360) 514-2712.

If you believe your privacy rights have been violated, you may contact or submit your complaint in writing to the Privacy Officer of Southwest at 400 NE Mother Joseph Place, Vancouver, WA 98664. If we cannot resolve your concern, you also have the right to file a written complaint with the Secretary of the Department of Health and Human Services: Office of Civil Rights, 200 Independence Ave., S.W., Washington, D.C. 20202.

Your treatment will not be affected by any complaints.