THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED.  
IT ALSO DESCRIBES HOW YOU CAN GET ACCESS TO THIS INFORMATION.  
PLEASE REVIEW IT CAREFULLY.

WHO WILL FOLLOW THIS NOTICE :

• Any health care professional authorized to enter information into a patient's chart.
• All departments and services of Olympic Medical Center.
• All employees, medical staff, students, volunteers, and other Olympic Medical Center personnel.
• All of our business entities, sites and locations will follow the terms of this notice.   In addition, these entities (including our medical staff), sites and locations may share medical information with each other for payment, treatment, or other operational purposes described in this notice.  

OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal.   We create a record of the care and services you receive.   This record is needed to provide you with quality care and to comply with certain legal requirements.   This notice applies to all of the records of your care generated by Olympic Medical Center (OMC), whether made by medical center personnel or your personal doctor while you are a patient at an OMC facility.   Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your medical information created in the doctor's office or clinic.  

This notice will tell you about the ways in which we may use and disclose medical information about you.   We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.  

We are required by law to:

• Ensure that medical information that identifies you is kept private
• Give you this notice of our legal duties and privacy practices with respect to medical information about you
• Follow the terms of the notice that are currently in effect

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose medical information based on your consent.   For each category of uses or disclosures we will explain and try to give some examples.   Not every use or disclosure in every category will be listed.   However, all of the ways we are permitted to use and disclose information will fall within one of these categories.

• For treatment. We may use medical information about you to provide you with medical treatment or services.   For example, a doctor treating you for a broken leg may need to know if you have diabetes because it may slow the healing process.   In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals.
• For payment. We may use and disclose medical information about you so that the treatment and services you receive at the hospital may be billed to, and payment may be collected from you, or an insurance company or a third party.   For example, your health plan may request information about services you received at the medical center in order to reimburse or pay for such services.  
• For health care operations. We may use and disclose medical information about you for Olympic Medical Center operational reasons.   For example, we may use and disclose medical information to review our treatment and services.   It may also be used to evaluate the performance of our staff in caring for you, or by accrediting agencies that evaluate our performance. 
• Appointment reminders, treatment alternatives, and health-related benefits and services. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care.   Additionally, it may be used to tell you about or recommend possible treatment options or alternatives that may be of interest to you, or to tell you about health-related benefits or services that may be of interest to you.  
• Hospital directory. We may include certain limited information about you in the hospital directory while you are a patient at the hospital.   This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation.   The directory information, except for your religious affiliation, may be released to people who ask for you by name.   Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don't ask for you by name.   You will have the opportunity to have your information not listed in the directory.
• Individuals involved in your care or payment for your care. We may release medical information about you to friends or family members who are involved in your medical care.   We may also give information to someone who helps pay for your care.   If possible, we will ask your permission prior to discussing your care with others.  
• Research. Under certain circumstances, we may use and disclose medical information about you for research purposes.   For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process.   Medical information about you may be disclosed to people preparing to conduct a research project.

We will generally ask for your specific permission if the researcher is to have access to your name, address or other information that reveals your identity, or if they will be involved in your care at the hospital.

• As required by law. We will disclose medical information about you when required to do so by federal, state or local law.
• To avert a serious threat to health or safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or to the health and safety of the public or another person.   Any disclosure, however, would only be in order to prevent the threat.  
• Organ and tissue donation. If you are an organ donor, we may release medical information to organizations as necessary to facilitate organ or tissue donation and transplantation.    These organizations may direct the following:   organ procurement; organ, eye or tissue transplantation; and organ donation.
• Military and veterans. We may release medical information about military personnel to the appropriate military authority.
• Workers' compensation. We may release medical information about you for workers' compensation or similar programs.   These programs provide benefits for work-related injuries or illness.
• Public health risks. We may disclose medical information about you for public health activities.   These activities generally include items such as:
  • To prevent or control disease, injury or disability.
  • To report abuse or neglect.
• Health oversight activities. We may disclose medical information to a health oversight agency for activities authorized by law.   These oversight activities include, for example, audits, investigations, inspections, and licensure.
• Lawsuits and disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. 
• Law enforcement. We may release medical information if asked to do so by a law enforcement official for the purpose of:
  • Responding to a court order, subpoena, warrant, summons or similar process; identifying or locating a suspect, fugitive, material witness, or missing person; assisting the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement; reporting a death we believe may be the result of criminal conduct; reporting criminal conduct at the Medical Center.
• Coroners, medical examiners and funeral directors. We may release medical information to a coroner, medical examiner, or funeral director.  
• National security and intelligence activities, protective services for the president and others. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, protection to the President, other authorized persons or foreign heads of state or conduct special investigations, and other national security activities authorized by law.  
• Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information we maintain about you:

• Right to inspect and copy. You have the right to inspect and obtain copies of medical information that may be used to make decisions about your care.   Usually, this includes medical and billing records.
  • To exercise this right, you must submit your request in writing to our Health Information Management Department.   If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other costs associated with your request. 
  • We may deny your request to inspect and copy in certain, very limited, circumstances.   If you are denied access to medical information, you may request that the denial be reviewed.
• Right to amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information.   You have the right to request an amendment for as long as the information is kept by or for Olympic Medical Center.  
  • To request an amendment, your request must be made in writing and submitted to our Health Information Management Department.   In addition, you must provide a reason that supports your request.  
  • We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.   In addition, we may deny your request if you ask us to amend information that:
    • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment.
    • Is not part of the medical information kept by or for Olympic Medical Center.
    • Is not part of the information which you would be permitted to inspect and copy.
    • Is accurate and complete as is.
• Right to an accounting of disclosures. You have the right to request an "accounting of disclosures".   This is a list of the disclosures we made of medical information about you to others that was not authorized by you and not for the purpose of payment, treatment, or health care operations.
  • To request this list, you must submit your request in writing to our Health Information Management Department.   Your request must state a time period.   The first list you request each year will be free.   For additional lists, we may charge you for the costs of providing the list.   We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. 
• Right to request restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for payment, treatment, or health care operations.   We are not required to agree to your request .   If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.   To request restrictions, you must make your request in writing to our Privacy Officer at the address listed at the end of this notice.   In your request, you must tell us (1) what information you want to limit, (2) whether you want to limit our use, disclosure, or both, and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
• Right to request confidential communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.   For example, you can ask that we only contact you at work or by mail.  

You may obtain a copy of this notice at our website, www.olympicmedical.org  

To obtain a paper copy of this notice, please contact our Privacy Officer at the address listed at the end of this notice.  

CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time.   We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future.   We will post a copy of the current notice in the hospital and most outpatient facilities.   The notice will contain the effective date.  

COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with Olympic Medical Center or with the Secretary of the Department of Health and Human Services.   To file a complaint with the medical center, contact our Privacy Officer at the number below.   All complaints must be submitted in writing.

You will not be penalized for filing a complaint .

OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission.   If you provide us permission to use or disclose medical information about you, you may revoke that permission in writing at any time.   To revoke an authorization, please submit your request in writing to the Health Information Management Department at the address below.

If you have any questions about this notice, please call 360-417-7781

Other contact numbers:
Privacy Officer: 360-417-7704
Health Information Management: 360-417-7738

All written materials should be sent to:
Olympic Medical Center
939 Caroline St.
Port Angeles, WA, 98362

Effective 10/01/03