|BRIDGEWAYS' PRIVACY STATEMENT
A. Uses and Disclosures
for Treatment, Payment, and Operations. (Reference: § 164.506Uses
and disclosures to carry out treatment, payment, or health care operations.)
1. Treatment. We will use and disclose your health
information without your authorization to provide your health care
and any related services. We will also use and disclose your health
information to coordinate and manage your health care and related services.
For example, we may need to disclose information to a case manager
who is responsible for coordinating your care.
We may also disclose your health information among our clinicians
and other staff (including clinicians other than your therapist or
principle clinician), who work at Bridgeways.
For example, our staff may discuss your care at a case conference.
In addition, we may disclose your health information without your authorization
to another health care provider (e.g., your primary care physician
or a laboratory) working outside of Bridgeways for
purposes of your treatment.
2. Payment. We may use or disclose your health information
without your authorization so that the treatment and services you receive
at Bridgeways are billed to, and payment is collected
from, your health plan or other third party payer. For example, we
may need to give your health plan information about psychiatric care
and services you received at our facility so that your health plan
will pay. We may also disclose your health information to another health
care provider so that provider can bill you for services they provided
to you, for example an ambulance service that transported you to the
3. Health Care Operations. We may use and disclose
health information about you without your authorization for our health
care operations. These uses and disclosures are necessary to run our
organization and make sure that our members receive quality care. These
activities may include, by way of example, quality assessment and improvement,
reviewing the performance or qualifications of our clinicians, employee
training in clinical activities, licensing, business planning and development,
and general administrative activities. We may combine health information
of many of our members to decide what additional services we should
offer, what services are no longer needed, and whether certain treatments
We may also provide your health information to other health care
providers or to your health plan to assist them in performing certain
duties of their own health care operations. We will do so only if you
have or have had a relationship with the other provider or health plan.
For example, we may provide information about you to the Mental Health
Division or NSMHA when their representatives inspect the quality of
our operation for licensure purposes and contract compliance. We may
also use and disclose your health information to contact you to remind
you of your appointment. Finally, we may use and disclose your health
information to inform you about possible treatment options or alternatives
that may be of interest to you.
4. Health-Related Benefits and Services. §164.520(b)(iii)(A) We
may use and disclose health information to tell you about health-related
benefits or services that may be of interest to you. If you do not
want us to provide you with information about health-related benefits
or services, you must notify the Compliance Officer in writing at 1220
75th Street SW, Everett, WA 98203. Please state clearly that you do
not want to receive materials about health-related benefits or services.
5. Fundraising Activities. §164.520(b)(iii)(B) We
may use and disclose information about you to contact you in an effort
to raise money for our programs, services, and operations. If you do
not want us to contact you for fundraising purposes, you must notify
the Compliance Officer in writing at 1220 75th Street SW, Everett,
WA 98203. Please state clearly that you do not want to receive any
fundraising solicitations from us.
B. Uses And Disclosures That May Be Made Without
Your Authorization, But For Which You Will Have An Opportunity To Object. §164.520(b)(ii)(B)
1. Facility Directory. We do
not maintain a facility directory at any of our residential facilities.
If asked, we will not confirm orally, in writing or through any other
medium that you are our current or former member, with exceptions
listed below under "Person's
Involved in an Individual's Care." (Reference: § 164.510(a).)
2. Persons Involved In Your Care. § 164.510(b)(1)(i)
and (ii) We may provide health information about you to someone
who helps pay for your care. We may use or disclose your health information
to notify or assist in notifying a family member, personal representative
or any other person that is responsible for your care of your location,
general condition or death. We may also use or disclose your health
information to an entity assisting in disaster relief efforts and
to coordinate uses and disclosures for this purpose to family or
other individuals involved in your health care. In limited circumstances,
we may disclose health information about you to a friend or family
member who is involved in your care. If you are physically present
and have the capacity to make health care decisions, your health
information may only be disclosed with your agreement to persons
you designate to be involved in your care. But, if you are in an
emergency situation, we may disclose your health information to a
spouse, a family member, or a friend so that such person may assist
in your care. In this case, we will determine whether the disclosure
is in your best interest, and if so, only disclose information that
is directly relevant to participation in your care.
If you are not in an emergency situation, but
are unable to make health care decisions, we will disclose your health
information to: " A
person designated to participate in your care in accordance with an
advance directive validly executed under state law," Your guardian
or other fiduciary if one has been appointed by a court, or "If applicable,
the state agency responsible for consenting to your care.
C. Uses And Disclosures That May Be Made Without
Your Authorization Or Opportunity To Object. (Reference: § 164.512
Uses and disclosures for which an authorization or opportunity to
agree or object is not required.)
1. Emergencies. §164.510(a)(3) We
may use and disclose your health information in an emergency treatment
situation. By way of example, we may provide your health information
to a paramedic who is transporting you in an ambulance.
2. Research. §164.512(i) We
may disclose your health information to researchers when their research
has been approved by an Institutional Review Board or a similar privacy
board that has reviewed the research proposal and established protocols
to protect the privacy of your health information.
3. As Required By Law. §164.512(a) We
will disclose health information about you when required to do so by
federal, state, or local law.
4. To Avert A Serious Threat To Health or Safety. §164.512(c)(1)(A) We
may use and disclose health information about you when necessary to
prevent a serious and imminent threat to your health or safety or to
the health or safety of the public or another person. Under these circumstances,
we will only disclose health information to someone who is able to
help prevent or lessen the threat.
5. Organ and Tissue Donation. §164.512(h) If
you are an organ donor, we may release your health information to an
organ procurement organization or to an entity that conducts organ,
eye or tissue transplantation, or serves as an organ donation bank,
as necessary to facilitate organ, eye or tissue donation and transplantation.
6. Public Health Activities. §164.512(b) We
may disclose protected health information about you to agencies when
necessary to prevent a serious threat to your health and safety or
the health and safety of the public. These activities generally include: " Report
to public health authorities for the purpose of preventing or controlling
disease, injury, or disability; §164.512(b)(1)(i) " Report
vital events such as birth or death; §164.512(b)(1)(i) " Report
child abuse or neglect; §164.512(b)(1)(ii) " Notify
the appropriate agency if we believe you have been a victim of abuse,
neglect or domestic violence. We will only notify an agency if we obtain
your agreement or if we are required or authorized by law to report
such abuse, neglect or domestic violence. §164.512(c)(1) " Notify
a person who may have been exposed to a communicable disease or who
is at risk of contracting or spreading a disease or condition; §164.512(b)(1)(iv)
7. Health Oversight Activities. §164.512(d) We
may disclose health information about you to a health oversight agency
for activities authorized by law. Oversight agencies include government
agencies that oversee the health care system, government benefit programs
such as Medicaid, other government programs regulating health care,
and civil rights laws.
8. Disclosures in Legal Proceedings. §164.512(e) We
may disclose health information about you to a court or administrative
agency when a judge or administrative agency orders us to do so. We
also may disclose health information about you in legal proceedings
without your permission or without a judge or administrative agency's
order: " In response to a subpoena for your health information; " In
response to a discovery request; or, " Other lawful process by someone
else involved in the dispute.
9. Law Enforcement Activities. §164.512(f) We
may disclose protected health information to a law enforcement official
for law enforcement purposes when: " §164.512(f)(1)(i)(A) A
court order, subpoena, warrant, summons or similar process requires
us to do so; or, " §164.512(f)(2)(i)(A) The information
is needed to identify or locate a suspect, fugitive, material witness
or missing person; or, " §164.512(f)(4) We report
a death that we believe may be the result of criminal conduct; or " §164.512(f)(5) We
report criminal conduct occurring on the premises of our facility;
or " §164.512(j) We determine that the law enforcement
purpose is to respond to a threat of an imminently dangerous activity
by you against yourself or another person; or " §164.512(a) The
disclosure is otherwise required by law.
§164.512(f)(3)(i) -(ii)(A)-(C) We
may also disclose health information about a member who is
or is suspected to be a victim of a crime. However, we will
do so only if the disclosure has been requested by a law
enforcement official and the victim agrees to the disclosure
or, in the case of the victim's incapacity, the following
occurs: " The law enforcement official represents to us that (i) the
victim is not the subject of the investigation and (ii) an immediate
law enforcement activity to meet a serious danger to the victim or
other depends upon the disclosure; and " We determine that the disclosure
is in the victim's best interest.
10. Medical Examiners or Funeral Directors. §164.512(g)(1)-(2) We
may provide health information about our members to a medical examiner.
Medical examiners are appointed by law to assist in identifying deceased
persons and to determine the cause of death in certain circumstances.
We may also disclose health information about our members to funeral
directors as necessary to carry out their duties.
11. Military and Veterans. §164.512(k)(1)(i)-(iv) If
you are a member of the armed forces, we may disclose your health information
as required by military command authorities. We may also disclose your
health information for the purpose of determining your eligibility
for benefits provided by the Department of Veterans Affairs.
12. National Security and Protective Services for the President
and Others. §164.512(k)(3) We may disclose
medical information about you to authorized federal officials for
intelligence, counter-intelligence, and other national security activities
authorized by law. We may also disclose health information about
you to authorized persons or foreign heads of state so they may conduct
13. Inmates. §164.512(k)(5) If
you are an inmate of a correctional institution or under the custody
of a law enforcement official, we may disclose health information about
you to the correctional institution or law enforcement official.
14. Workers' Compensation. §164.512(l) We
may disclose health information about you to comply with the state's
Workers' Compensation Law.
III. USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
WITH YOUR PERMISSION §164.520(b)(ii)(E)
Uses and disclosures not described in Section
II of this notice of Privacy Practices will generally only be made
with your written permission, called an "authorization." If you revoke
your authorization we will not make any further uses or disclosures
of your health information under that authorization, unless we have
already taken an action relying upon the uses or disclosures you
have previously authorized.
IV. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION §164.520(b)(iv)
A. Right to Inspect and Copy. (Reference: §164.520(b)(iv)(C)) You
have the right to request an opportunity to inspect or copy health
information used to make decisions about your care, whether they are
decisions about your treatment or payment of your care. Usually, this
would include clinical and billing records, but not psychotherapy notes.
You must submit your request in writing to our Compliance Officer at
1220 75th Street SW, Everett, WA 98203. If you request a copy of the
information, we may charge a reasonable fee for the cost of copying,
mailing and supplies associated with your request. We may deny your
request to inspect or copy your health information in certain limited
circumstances. In some cases, you will have the right to have the denial
reviewed by a licensed health care professional not directly involved
in the original decision to deny access. We will inform you in writing
if the denial of your request may be reviewed. Once the review is completed,
we will honor the decision made by the licensed health care professional
B. Right to Amend. (Reference: §164.526
Amendment of protected health information.) For as long as
we keep records about you, you have the right to request us to amend
any health information used to make decisions about your care, whether
they are decisions about your treatment or payment of your care.
Usually, this would include clinical and billing records, but not
psychotherapy notes. To request an amendment, you must submit a written
document to our Compliance Officer at 1220 75th Street SW, Everett,
WA 98203 and tell us why you believe the information is incorrect
We may deny your request for an amendment if
it is not in writing or does not include a reason to support the
request. We may also deny your request if you ask us to amend health
information that: " Was
not created by us, unless the person or entity that created the health
information is no longer available to make the amendment; " Is not
part of the health information we maintain to make decisions about
your care; " Is not part of the health information that you would be
permitted to inspect or copy; or " Is accurate and complete.
If we deny your request to amend, we will send you a written notice
of the denial stating the basis for the denial and offering you the
opportunity to provide a written statement of disagreement, you may
ask that the requested amendment and our denial be attached to all
future disclosures of the health information that is subject of your
request. If you choose to submit a written statement of disagreement,
we have the right to prepare a written rebuttal to your statement of
disagreement. In this case, we will attach the written request and
the rebuttal (as well as the original request and denial) to all future
disclosures of the health information that is the subject of your request.
C. Right to an Accounting of Disclosures. §164.520(b)(iv)(E) You
have the right to request that we provide you with an accounting of
disclosures we have made of your health information. An accounting
is a list of disclosures. But this list will not include certain disclosures
of your health information, by way of example, those we have made for
purposes of treatment, payment, and health care operations. To request
an accounting of disclosures, you must submit your request in writing
to the Compliance Officer at 1220 75th Street SW, Everett, WA 98203.
For your convenience, you may submit your request on a form called
a "Request for Accounting," which you may obtain from our Compliance
Officer. The request should state the time period for which you wish
to receive an accounting. This time period should not be longer than
six years and not include dates before April 14, 2003. The first accounting
you request within a twelve-month period will be free. For additional
requests during the same 12-month period, we will charge you for the
costs of providing the accounting. We will notify you of the amount
we will charge and you may choose to withdraw or modify your request
before we incur any costs.
D. Right to Request Restrictions. §164.520(b)(iv)(A) You
have the right to request a restriction on the health information we
use or disclose about you for treatment, payment, or health care operations.
To request a restriction, you must request the restriction in writing
addressed to the Compliance Officer at 1220 75th Street SW, Everett,
WA 98203. The Compliance Officer will ask you to sign a request for
restriction form, which you should complete and return to the Compliance
Officer. We are not required to agree to a restriction that you may
request. If we do agree, we will honor your request unless the restricted
health information is needed to provide you with emergency treatment.
E. Right to Request Confidential Communications. §164.520(b)(iv)(B) You
have the right to request that we communicate with you about your health
care only in a certain location or through a certain method. For example,
you may request that we contact you only at work or by e-mail. To request
such a confidential communication, you must make your request in writing
to the Compliance Officer at 1220 75th Street SW, Everett, WA 98203.
We will accommodate all reasonable requests. You do not need to give
us a reason for the request; but your request must specify how or where
you wish to be contacted.
F. Right to a Paper Copy of this Notice. §164.520(b)(iv)(F) You
have the right to obtain a paper copy of this Notice of Privacy Practices
at any time. Even if you have agreed to receive this Notice of Privacy
Practices electronically, you may still obtain a paper copy. To obtain
a paper copy, contact our Compliance Officer at 1220 75th Street SW,
Everett, WA 98203.
V. COMPLAINTS §164.520(b)(vi)
If you believe your privacy rights have been violated, you may file
a complaint with us or with the Secretary of the U.S. Department of
Health and Human Services. To file a compliant with us, contact our
office responsible for receiving complaints at 1220 75th Street SW,
Everett, WA 98203. All complaints must be submitted in writing. Our
Compliance Officer, who can be contacted at 1220 75th Street SW, Everett,
WA 98203, will assist you with writing your complaint, if you request
such assistance. The quality of your care will not be jeopardized
nor will you be penalized for filing a compliant.
VI. CHANGES TO THIS NOTICE §164.520(b)(v)(C)
We reserve the right to change the terms of our Notice of Privacy
Practices. We also reserve the right to make the revised or changed
Notice of Privacy Practices effective for all health information we
already have about you as well as any health information we receive
in the future. We will post a copy of the current Notice of Privacy
Practices at our main office, and at each site where we provide care.
Revised copies will be distributed to you according to company policy
no fewer than 10 days before the effective notice. You may also obtain
a copy of the current Notice of Privacy Practices by accessing our
website at www.Bridgeways.org or
by calling us at (425) 513-8213, and requesting that a copy be sent
to you in the mail or by asking for one any time you are at our offices. §164.520(b)(viii)(3)
This website has been copyrighted by Bridgeways, 1220 75th Street
SW Everett, WA 98203. Phone:(425) 513-8213.
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and disclosure of the Programs, Ancillary Programs and Documentation
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Restricted Rights (June 1987), or FAR 52.227-14, Rights in General
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