Page 18 - 2016 WFF Guide 1
P. 18
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F or R esearc h Purp oses: U ses an d D i sc losures R eq ui ri n g Y ou to H av e an O p p ortun i ty to O b j ec t:
in certain circumstances, and the P lan may share P H I w ith your family, friend , or other person inv olv ed in your
und er strict superv ision of a care, or payment for your care. W e may also share P H I w ith these people to
priv acy board , the P lan may notify them about your location, general cond ition, or d eath. H ow ev er, the P lan
d isclose P H I to assist med ical may d isclose your P H I only if it informs you about the d isclosure in ad v ance and
and psychiatric research. you d o not obj ect ( but if there is an emergency situation and you cannot be giv en
T o A v ert T hreat to H ealth your opportunity to obj ect, d isclosure may be mad e if it is consistent w ith any
or S af ety: in ord er to av oid prior ex pressed w ishes and d isclosure is d etermined to be in your best interests;
a serious threat to health or you must be informed and giv en an opportunity to obj ect to further d isclosure as
safety, the P lan may d isclose soon as you are able to d o so) .
P H I as necessary to law Y our R ights R egard ing Y our P rotected H ealth I nformation
enforcement or other persons
w ho can reasonably prev ent or Y ou hav e the follow ing rights relating to your protected health information:
lessen the threat of harm. T o R eq uest R estri c ti on s on U ses an d D i sc losures: you hav e the right to ask
For Speciic Government that the P lan limit how it uses or d iscloses your P H I . The P lan w ill consid er your
F un c ti on s: the P lan may req uest, but is not legally bound to agree to the restriction. To the ex tent that
d isclose P H I of military it agrees to any restrictions on its use or d isclosure of your P H I , it w ill put the
personnel and v eterans agreement in w riting and abid e by it ex cept in emergency situations. The P lan
in certain situations, to cannot agree to limit uses or d isclosures that are req uired by law .
correctional facilities in certain T o C hoose H ow the Plan C on tac ts you: you hav e the right to ask that the
situations, to gov ernment P lan send you information at an alternativ e ad d ress or by an alternativ e means.
programs relating to eligibility To request conidential communications, you must make your request in writing to
and enrollment, and for the Privacy Oficial. We will not ask you the reason for your request. Your request
national security reasons. must specify how or w here you w ish to be contacted . The P lan must agree to
U ses an d D i sc losures R eq ui ri n g your req uest as long as it is reasonably easy for it to accommod ate the req uest.
A uthori z ati on : for uses and T o I n sp ec t an d C op y Y our PH I : unless your access is restricted for clear
d isclosures beyond treatment, and d ocumented treatment reasons, you hav e a right to see your P H I in the
payment, and operations purposes, possession of the P lan or its v end ors if you put your req uest in w riting. The
and for reasons not includ ed in P lan, or someone on behalf of the P lan, w ill respond to your req uest, normally
one of the ex ceptions d escribed w ithin 3 0 d ays. I f your req uest is d enied , you w ill receiv e w ritten reasons for the
abov e, the P lan is req uired to hav e d enial and an ex planation of any right to hav e the d enial rev iew ed . I f you w ant
your w ritten authoriz ation. F or copies of your P H I , a charge for copying may be imposed but may be w aiv ed ,
ex ample, uses and d isclosures of d epend ing on your circumstances. Y ou hav e a right to choose w hat portions of
psychotherapy notes, uses and your information you w ant copied and to receiv e, upon req uest, prior information
d isclosures of P H I for mark eting on the cost of copying.
purposes, and d isclosures that
constitute a sale of P H I w ould T o R eq uest A m en dm en t of Y our PH I : if you believ e that there is a mistak e or
req uire your authoriz ation. Y our missing information in a record of your P H I held by the P lan or one of its v end ors
authoriz ation can be rev ok ed you may req uest in w riting that the record be corrected or supplemented . The
at any time to stop future uses P lan or someone on its behalf w ill respond , normally w ithin 6 0 d ays of receiv ing
and d isclosures, ex cept to the your req uest. The P lan may d eny the req uest if it is d etermined that the P H I is:
ex tent that the P lan has alread y ( i) correct and complete; ( ii) not created by the P lan or its v end or and / or not part
und ertak en an action in reliance of the P lan’ s or v end or’ s record s; or ( iii) not permitted to be d isclosed . A ny d enial
upon your authoriz ation. w ill state the reasons for d enial and ex plain your rights to hav e the req uest and
d enial, along w ith any statement in response that you prov id e, append ed to your
P H I . I f the req uest for amend ment is approv ed , the P lan or v end or, as the case
may be, w ill change the P H I and so inform you, and tell others that need to k now
about the change in the P H I .
F or R esearc h Purp oses: U ses an d D i sc losures R eq ui ri n g Y ou to H av e an O p p ortun i ty to O b j ec t:
in certain circumstances, and the P lan may share P H I w ith your family, friend , or other person inv olv ed in your
und er strict superv ision of a care, or payment for your care. W e may also share P H I w ith these people to
priv acy board , the P lan may notify them about your location, general cond ition, or d eath. H ow ev er, the P lan
d isclose P H I to assist med ical may d isclose your P H I only if it informs you about the d isclosure in ad v ance and
and psychiatric research. you d o not obj ect ( but if there is an emergency situation and you cannot be giv en
T o A v ert T hreat to H ealth your opportunity to obj ect, d isclosure may be mad e if it is consistent w ith any
or S af ety: in ord er to av oid prior ex pressed w ishes and d isclosure is d etermined to be in your best interests;
a serious threat to health or you must be informed and giv en an opportunity to obj ect to further d isclosure as
safety, the P lan may d isclose soon as you are able to d o so) .
P H I as necessary to law Y our R ights R egard ing Y our P rotected H ealth I nformation
enforcement or other persons
w ho can reasonably prev ent or Y ou hav e the follow ing rights relating to your protected health information:
lessen the threat of harm. T o R eq uest R estri c ti on s on U ses an d D i sc losures: you hav e the right to ask
For Speciic Government that the P lan limit how it uses or d iscloses your P H I . The P lan w ill consid er your
F un c ti on s: the P lan may req uest, but is not legally bound to agree to the restriction. To the ex tent that
d isclose P H I of military it agrees to any restrictions on its use or d isclosure of your P H I , it w ill put the
personnel and v eterans agreement in w riting and abid e by it ex cept in emergency situations. The P lan
in certain situations, to cannot agree to limit uses or d isclosures that are req uired by law .
correctional facilities in certain T o C hoose H ow the Plan C on tac ts you: you hav e the right to ask that the
situations, to gov ernment P lan send you information at an alternativ e ad d ress or by an alternativ e means.
programs relating to eligibility To request conidential communications, you must make your request in writing to
and enrollment, and for the Privacy Oficial. We will not ask you the reason for your request. Your request
national security reasons. must specify how or w here you w ish to be contacted . The P lan must agree to
U ses an d D i sc losures R eq ui ri n g your req uest as long as it is reasonably easy for it to accommod ate the req uest.
A uthori z ati on : for uses and T o I n sp ec t an d C op y Y our PH I : unless your access is restricted for clear
d isclosures beyond treatment, and d ocumented treatment reasons, you hav e a right to see your P H I in the
payment, and operations purposes, possession of the P lan or its v end ors if you put your req uest in w riting. The
and for reasons not includ ed in P lan, or someone on behalf of the P lan, w ill respond to your req uest, normally
one of the ex ceptions d escribed w ithin 3 0 d ays. I f your req uest is d enied , you w ill receiv e w ritten reasons for the
abov e, the P lan is req uired to hav e d enial and an ex planation of any right to hav e the d enial rev iew ed . I f you w ant
your w ritten authoriz ation. F or copies of your P H I , a charge for copying may be imposed but may be w aiv ed ,
ex ample, uses and d isclosures of d epend ing on your circumstances. Y ou hav e a right to choose w hat portions of
psychotherapy notes, uses and your information you w ant copied and to receiv e, upon req uest, prior information
d isclosures of P H I for mark eting on the cost of copying.
purposes, and d isclosures that
constitute a sale of P H I w ould T o R eq uest A m en dm en t of Y our PH I : if you believ e that there is a mistak e or
req uire your authoriz ation. Y our missing information in a record of your P H I held by the P lan or one of its v end ors
authoriz ation can be rev ok ed you may req uest in w riting that the record be corrected or supplemented . The
at any time to stop future uses P lan or someone on its behalf w ill respond , normally w ithin 6 0 d ays of receiv ing
and d isclosures, ex cept to the your req uest. The P lan may d eny the req uest if it is d etermined that the P H I is:
ex tent that the P lan has alread y ( i) correct and complete; ( ii) not created by the P lan or its v end or and / or not part
und ertak en an action in reliance of the P lan’ s or v end or’ s record s; or ( iii) not permitted to be d isclosed . A ny d enial
upon your authoriz ation. w ill state the reasons for d enial and ex plain your rights to hav e the req uest and
d enial, along w ith any statement in response that you prov id e, append ed to your
P H I . I f the req uest for amend ment is approv ed , the P lan or v end or, as the case
may be, w ill change the P H I and so inform you, and tell others that need to k now
about the change in the P H I .
