Wind River Ear, Nose & Throat

NOTICE OF PRIVACY PRACTICES

This notice describes how information about you or your dependent(s) (herein after “you” and/or “your”) may be used and disclosed and how you can get access to this information. Please review it carefully.

As a patient of Wind River Ear, Nose & Throat you are entitled to have notice of our privacy practices which indicates how we may use and disclose your protected health information under different circumstances. This Notice explains how we use and disclose your personal information and the choices and rights you have about how your personal health information may be used and disclosed.

Wind River Ear, Nose & Throat is required to maintain the privacy of your Protected Health Information (“personal health information”) and to provide you with a notice about our legal duties and privacy practices with respect to your personal health information. Any time we use or disclose your personal health information we are required to follow the terms of this Notice.

How We Use and Disclose Your Protected Health Information:

Uses and Disclosures with Consent. As a condition of receiving treatment, you will be asked to sign a written consent form for use of your personal health information for treatment, payment and health care operations. Upon obtaining consent, we will use and disclose your personal health information in the following ways:

(1) For Treatment. We will use and disclose your personal health information to plan, provide and coordinate your health care services. For example, we may provide your personal health information to a physician we have referred you to in order to ensure the physician has the necessary information to provide your health care.

(2) For Payment. We will use and disclose your personal health information to obtain payment for health care services we have provided you. For example, we may use and disclose your personal health information to obtain payment from your insurance carrier.

(3) For Health Care Operations. We may use or disclose your protected health information for our health care operations. For example, we may use or disclose your personal health information for quality assessment and improvement activities.
Uses and Disclosures with Authorization. For uses and disclosures or your personal health information not involving treatment, payment and health care operations, we will receive your written authorization prior to using or disclosing any personal health information (unless we are required or permitted by law to use or disclose your information as set forth below). You have the right to revoke any authorization previously granted. If you have any questions about written authorizations, please contact our Privacy Officer.
Uses and Disclosures without Consent or Authorization.

(1) Disclosures without Consent or Authorization. We may use or disclose your personal health information for treatment, payment and health care operations without consent or authorization in order to administer emergency treatment, to treat you when we are required by law but your consent cannot obtained, and to treat you when we are unable to obtain your consent due to communication barriers.

(2) Notification of Family or Close Friends. We may use or disclose your personal health information to notify a family member, personal representative or another person responsible for your care, provided you have the opportunity to agree or object to the disclosure. If you are unable to agree or object, we may disclose this information as necessary if we determine that it is in your best interests based upon our professional judgment.

(3) Public Health Activities. We may use or disclose your personal health information for public health activities and purposes in compliance with applicable laws for the purpose of controlling disease, injury or disability; reporting child abuse and neglect; reporting information about products and services under the jurisdiction of the United States Food and Drug Administration; alerting authorities of persons who may have been exposed to a communicable disease; and reporting information to your employer as required under Workers’ Compensation laws.

(4) Health Oversight Activities. We may make disclosures of your personal health information to a health oversight agency charged with overseeing the health care industry.

(5) Marketing. We may contact you to remind you of appointments or to provide you with information about treatment alternatives or other health-related products or services.

(6) Legal Proceedings. We may disclose your personal health information in nay judicial or administrative proceeding in response to orders, subpoenas and other valid legal processes.

(7) Law Enforcement. We may disclose your personal health information to law enforcement officials in compliance with applicable law.

(8) Abuse or Neglect. We may disclose your personal health information to public authorities authorized by law to receive reports of child abuse, neglect or domestic violence.

(9) Limited Government Functions. We may disclose your personal health information to certain government agencies charged with special government functions (e.g., the U.S. Military).

(10) Funeral Directors. We may disclose your personal health information to funeral directors in accordance with applicable law.

(11) Organ Procurement. As allowed by law, we may disclose your personal health information to organ procurement organizations for organ, eye or tissue donation purposes.

(12) Coroners. We may disclose you personal health information to a coroner or medical examiner in accordance with applicable laws.

(13) Health and Safety. We may disclose your personal health information to prevent or lessen a serious threat to a person’s or the public’s health and safety.

(14) Workers’ Compensation. We may disclose your personal health information in accordance with workers’ compensation laws.

Your Rights. You have the right to do the following:

Right to Receive a Copy of this Notice. Upon request, you have the right to receive a paper copy of this Notice.
Right to Receive Further Information. You have the right to contact our Privacy Officer if you want additional information about our privacy practices, your privacy rights, or disagree about a decision we made about your personal health information, or if you believe that your privacy rights have been violated. If desired, you may make a formal complaint addressed to our Privacy Officer.
Right to Inspect and Copy Your Health Information. Upon request, you have the right to access and obtain a copy of your health information maintained by us.
Right to Amend Your Health Information. You have the right to request that we amend your health information maintained in your medical record. We will comply with your request in the event that we determine the information that would be amended is false, inaccurate or misleading.
Right to Request Additional Restrictions on Uses and Disclosures of Your Health Information. You have the right to request that we place additional restrictions on how we use or disclose your personal health information. While we will consider any request for additional restrictions, we are not required to agree to your request.
Right to Request an Accounting of Disclosures. You have a right to request an accounting of the disclosures made by us of your personal health information. For each disclosure, the accounting will include the date the information was disclosed, to whom, the address of the person or entity that received the disclosure (if known), and a brief statement of the reason for the disclosure.
Right to Request Confidentiality in Certain Communications. You have the right to request and receive your health information by alternative means of communication or at alternative locations. We will accommodate any such reasonable written request made on your behalf.
Right to File a Complaint. If you believe you privacy rights have been violated you have the right to file a written complaint with us or the Office of Civil Rights of the United States Department of Health and Human Services. Under no circumstances will we retaliate against you for filing a complaint.

Changes to this Notice. We reserve the right to change our privacy practices and 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. In the event that our Notice changes we will post a revised copy in the office and provide you with a copy upon your request.

Privacy Officer. To contact the Privacy Officer, please address all requests to Wind River Ear, Nose & Throat, Attention: Privacy Officer, 125 Wyoming Street, Lander, Wyoming, 82520. The Privacy Officer can also be contacted by calling 307-335-7555 or 800-375-4327 or via the internet at www.windriver-ent.com.

Effective Date of this Notice. This Notice is effective as of September 1, 2002.