Public
Health
Notice
of Privacy Practices
Effective Date: April
14, 2003
This notice describes how health information about you may
be used and disclosed and how you can get access to this information.
Please review it carefully.
If you have questions, please contact our Privacy Officer at
303-413-7569.
Who Will Follow This
Notice?
This Notice of Privacy Practices describes the
privacy practices of Boulder County Public Health (BCPH), our legal
duties, and your rights concerning your health information. It applies to health care services you receive at Boulder
County Public Health and will be followed by BCPH
staff, volunteers/interns, and business associates or partners with whom
we share health information.
Our Confidentiality Pledge
Boulder County Public Health is committed to the
protection of your privacy and to enforcement of your rights under the
Health Insurance Portability and Accountability Act (HIPAA). Federal and state laws
require that we maintain the privacy of your “protected health
information” (PHI). PHI
includes information we have either created or received regarding your
health, your health care, and payment for your health care. When we use or disclose (share) your PHI, we are required to follow
the terms of this Notice. By
law, we must:
- Keep
your medical records private.
- Give
you a copy of our Notice of Privacy Practices.
- Follow
the terms of the Notice of Privacy Practices currently in effect.
Changes to this
Notice
We reserve
the right to change the terms of this Notice at any time.
If we make changes, the revised Notice will be posted at all BCPH
sites. Copies of revised
Notices will be available at all Boulder County Public Health sites and on
our Web site at www.BoulderCountyHealth.org. We also reserve the right to apply these changes to PHI we already
have about you as well as any medical information we receive in the
future. The effective date of
revised Notices will be displayed on Page 1 below the document title.
How We May
Use/Disclose Medical Information About You
Boulder County Public Health will not use or disclose
your PHI without your written authorization, except as provided for in
this Notice or as required by law. Following
are examples of how your PHI may be used or disclosed:
Treatment: We may share
information about your health with doctors, nurses, counselors, and other
health care providers who also provide health services to you, both at
BCPH and outside our organization. This
is done to improve coordination of services on your behalf.
Payment: We
may use or share your health information with others to request payment
for treatment provided to you by BCPH. This could include Medicare or Medicaid and other third party
payers.
Health
Care Operations: We may use or disclose your
health information to manage our programs and activities and improve the
quality of care you receive at BCPH. For example, we may use your PHI to review employee performance,
conduct training activities, complete record audits, evaluate the
effectiveness of program services, and similar administrative functions. We may also use and disclose your health information to contact you
by telephone, mail, or E-mail in order to remind you of an appointment or
to inform you of test results.
- Special Situations:; There are special situations when we may disclose
your PHI because of legal requirements or for the protection of others.
Examples of these situations are:
- As Required by Law:We may
disclose health information about you when required to do so by federal,
state, or local law.
- To Prevent a Serious Threat
to Health or Safety: We may
disclose your health information to the appropriate authorities if we
suspect you are a possible victim of abuse, neglect, or domestic violence,
or are a possible victim of other crimes. We may also disclose your health information to avert serious
threat to your health or safety, or to the health and safety of others.
- For Public Health Risks: We may disclose health information about you for
public health activities which may include:
- Preventing
or controlling disease, injury, or disability.
- Reporting
births or deaths.
- Reporting
child abuse or neglect.
- Notifying
a person who may have been exposed to a communicable disease or may be at
risk for contracting or spreading a disease or condition.
- Reporting
information about products and services under the jurisdiction of the U.S.
Food and Drug Administration.
- Assisting
in disaster relief efforts.
- For Judicial and
Administrative Proceedings: We may
disclose your health information in the course of a judicial or
administrative proceeding in response to a legal order, such as a court
order or subpoena, or for other lawful processes.
- For Law Enforcement: We may disclose health
information with the police or other law enforcement officials as
required or permitted by law.
- To Coroners and Funeral
Directors: We may
disclose health information to a coroner or medical examiner, or funeral
director to allow them to carry out their duties.
- For National Security: We may disclose your health information to authorized
government officials for intelligence, counterintelligence, or other
national security activities.
- For Health Oversight
Activities:We may disclose your health
information to a health oversight agency for activities authorized by law.
These oversight activities include audits, investigations,
inspections, and licensure. These activities are necessary for the government to monitor
the health care system, government programs, licensing functions, and
compliance with civil rights laws.
- For Research: We may use and disclose health information about you
for research purposes. All
research projects are subject to a special approval process.
This process evaluates a proposed research project and its use of
health information, while balancing research needs with the client’s
need for privacy of their health information.
- To Relatives, Close Friends, or Other Caregivers:
With your approval, we may disclose your health information to a
family member, friend, or other person involved in your health care or who
helps pay for your care. If
you want this information restricted, please follow the procedures
outlined below under “Right to Restriction.”
- For Military or Veterans: If you are a member of the
Armed Forces, we may disclose your health information as required by
military command authorities.
- For Workers’ Compensation: We may disclose health information
about you for workers’ compensation or similar programs that provide
benefits for work-related injury or illness.
- For Inmates: If you are an inmate of a
correctional institution or under the custody of a law enforcement
official, we may disclose your health information to that correctional
institution.
- For Fundraising: We may contact you to participate in fundraising activities that
benefit BCPH clients and services.
Uses/Disclosures
Requiring Your Written Permission (Authorization)
Uses or disclosures of your health information not
covered by this Notice will be made only as provided by law or with your
written permission (authorization). At
any time, you may revoke (cancel) your authorization for us to use or
disclose your protected health information.
Please refer to “Right to Revoke Your Written Permission”
below.
Your Rights Regarding
Your Protected Health Information
Although your health record is the physical
property of Boulder County Public Health, the information belongs to you
and you have the following rights concerning your health information:
Right to Revoke Your Written Permission
(Authorization):You have the right at any time to revoke (cancel)
your authorization for us to use or disclose your PHI.
This revocation must be submitted in writing to the BCPH Privacy
Officer. You may obtain a
copy of BCPH’s Request to Revoke Authorization form at any BCPH
site. Please note that the
revocation will not affect uses or disclosures that were made prior to the
revocation request.
Right to Inspect and Copy Your Health
Information:
In most cases, you have the
right to inspect and obtain a copy of certain health information.
This includes medical and billing information, but does not include
psychotherapy notes. To look
at and obtain copies of your health information, you must submit a request
in writing to the Boulder County Public Health Privacy Officer. You
may obtain a copy of BCPH’s Request to Inspect and/or Obtain Copy of
PHI form at any BCPH site. You
may be charged for the cost of labor, copying, mailing, or other supplies
associated with your request. In
certain cases, we may deny your request to inspect and copy your PHI.
If your request is denied, you may ask the BCPH Privacy Officer for
a review of our denial. The
person conducting the review will not be the person who denied your
request. You will be advised,
in writing, of the reviewing official’s decision, and Boulder County
Public Health will comply with the outcome of the review.
Right to Have Medical Information Amended:
If you feel that the medical
information we have about you is incorrect or incomplete, you have the
right to request that we correct or supplement the information.
You may obtain a copy of BCPH’s Request for Amendment of PHI
form at any BCPH site. Please
note that your request will be denied if the amendment pertains to
information not created by BCPH (unless the person or entity that created
the information is no longer available to make the amendment), is not part
of the health information kept by or for BCPH, is not part of the
information which you would be permitted to inspect and copy, or we feel
the information is accurate and complete.
You will receive written notification from BCPH stating if your
request has been approved or denied.
If your request has been denied, you have the right to file a
written statement of disagreement, to be attached to your PHI.
You may file a statement of disagreement with the BCPH Privacy
Officer by submitting a copy of BCPH’s Statement of Disagreement form
(available at any BCPH site) or by sending a personal letter.
Right to Receive an Accounting of
Disclosures:
You have the right to request an accounting (detailed
listing) of disclosures of your PHI made by us.
Your request must identify a specific time period for the
accounting, which must be less than six years and cannot include dates
before April 14, 2003. This
right applies to disclosures for purposes other than treatment, payment,
or health care operations, and will not include information provided
directly to you or your family, or information that was sent with your
written authorization. If you
request an accounting more than once every twelve (12) months, you may be
charged a fee to cover the costs of preparing the accounting.
To request this list of disclosures, you may obtain
a copy of BCPH’s Request for Accounting of Disclosures form at
any BCPH site. Your request
must be submitted in writing to the Boulder County Public Health Privacy
Officer.
Right to Restriction:
You have the right to request a
limit or restriction on the way we use or disclose your PHI.
You may obtain a copy of BCPH’s Request to Limit or Restrict
Use/Disclosure of PHI form at any BCPH site. Your request must be submitted in writing to the Boulder
County Public Health Privacy Officer and must indicate:
1) What information you want limited or restricted.
2) Whether you want to limit our use, disclosure, or both.
3) To whom you want the limits or restrictions to apply.
We
are not required to agree to these restrictions. If we agree to honor your request, we will do so except in
cases of emergency.
Right
to Confidential Communication: You
have the right to request that we provide confidential communications to
you. You may ask us to share
information with you in a certain way or at a certain location (for
example, you could ask that we send your information to an address other
than your home address or that all communication be by mail).
You may obtain a copy of BCPH’s Request for Confidential
Communication form at any BCPH site.
Your request must be in writing and must indicate how and where you
wish to be contacted. You do NOT need to explain the reason for your request, and
all reasonable requests will be honored.
Right
to Paper Copy of this Notice:
You have the right to a paper
copy of this Notice and may request a copy at any time.
Copies are available at all BCPH sites and the Notice is also
available on the BCPH Web site at www.bouldercounty.org/health.
Questions and Complaints
If you believe your privacy rights have been
violated, you may file a complaint with Boulder County Public Health’s
Privacy Officer and/or with the Secretary of the U.S. Department of Health
and Human Services, at the addresses listed below.
You may obtain a copy of BCPH’s Privacy Complaint Submission
Form at any BCPH site. You
will not be retaliated against or penalized for filing a complaint.
Privacy Officer
Boulder County Public
Health
3450 Broadway
Boulder, CO 80304
Phone: 303-413-7569
FAX:
303-413-7505
Office for Civil Rights
Medical Privacy, Complaint Division
U.S. Department of Health and Human Services
200 Independence Ave., SW, HHH Building, Room 509H
Washington, D.C. 20201
Phone: 1-866-627-7748
(toll-free)
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