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NOTICE OF PRIVACY PRACTICES
Effective: April 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The Wisconsin State Laboratory of Hygiene (WSLH) is
committed to protecting your health information within Federal and
State regulations. This notice will explain to you ways we may use
and disclose health information about you, and your rights as a patient
in regard to that information. We are required by law to adhere to
the terms of this or any similar updated notice.
Uses and Disclosures of Your Personal Health
Information (PHI)
We may use and disclose your PHI for the purposes of Treatment, Payment, and
Healthcare Operations (TPO) without your authorization. Examples of these occurrences
are:
Treatment – Information
may be shared to determine appropriate medical treatment,
such as the use of laboratory test results by clinicians
to diagnose an illness.
Payment - Medical information
may be shared with third-party payers to ensure proper
payment for your laboratory test. Examples of third-party
payers are Medicaid, private insurance, and Medicare.
Healthcare Operations -
Information may be shared to comply with regulations,
such as Medicare Compliance auditors.
Uses and Disclosures for Public Health Activities
The WSLH is the statutorily-designated public health laboratory for the State
of Wisconsin. As such it has unique responsibilities for supporting the
efforts of local, state and federal public health agencies to protect the
health of all. PHI may be used by the WSLH and/or disclosed to other public
health entities or legal authorities without your authorization when it
is used to prevent or control disease, injury or disability or other for
health oversight activities. Examples include: (a) reporting test results
that may indicate a food or communicable disease outbreak; (b) providing
data for local health departments to investigate potential health problem
such as may occur in a day care center or nursing home; (c) alerting public
health officials of unusual test results that may be an indicator of an
emerging disease in our state such as Hantavirus or West Nile Virus; (d)
conducting epidemiological investigations to determine the effectiveness
of one laboratory procedures compared with another.
There are several other circumstances, often under
the requirement of law, where we may disclose your PHI without obtaining
your authorization. These include:
Disclosures Required by Law – Your
health information may be disclosed when required to
do so by Federal or State laws.
Victims of Abuse, Neglect, or
Domestic Violence – WSLH is required
by law to report any suspected abuse of a child,
and are permitted to report suspected abuse of an
adult.
Health Oversight Activities – We
may be required to disclose information in the course
of audits, inspections, investigations, and other similar
activities.
Judicial and Administrative Proceedings – Information
may be required from us in legal proceedings.
Law Enforcement Purposes – We
must comply with any court orders issued under State
and Federal law.
Coroners, Medical Examiners,
and Funeral Directors – We
must provide information as needed in death investigations.
Organ Donation Purposes – We
must provide information to authorized facilities for
organ donation and transplants.
Military and Veterans Purposes – We
may be required to report medical information to military
command or the Veteran’s Administration.
Research Purposes – WSLH
may use and disclose your health information for research
purposes, which may include contacting you about participation
in research projects. A research review board exists
to protect the rights of all research participants,
including their privacy and confidentiality rights.
To Avert a Serious Health or
Safety Threat – We may be required
to provide information to protect the health and
safety of you, another person, or the public.
Specialized Government Functions – We
must comply with laws regarding national security,
protective services of the President, and correctional
institutions.
Workers’ Compensation – We
must provide information requested for work-related
illness/injury benefits.
Uses and disclosures of your health information that
you may object to or refuse:
Disaster Relief Efforts – Unless
you object, WSLH may provide information to assist
in locating, identifying, or describing the health
of disaster victims.
Personal Representatives – Unless
you object, WSLH may provide information to family
members or someone assisting with patient care or payment
of patient care. This may be provided without an authorization
from the patient if the patient is unable to sign an
authorization or if there is an urgent need for the
information.
Uses and disclosures of your health information requiring
your authorization:
To use or disclose your health information for any
purpose not listed above, WSLH must first obtain your written authorization.
Even if you authorize the use or disclosure for a particular purpose,
you may revoke your authorization. To do this, you must submit a
request in writing to withdraw the authorization. We will comply
with your request if it is received before we have disclosed the
information.
You have the right to:
- Request Restrictions – You
may submit a request in writing to place restrictions
or limitations on certain uses and disclosures of your
PHI. Under law, WSLH reserves the right to deny your
request. If you qualify as a Wisconsin Family Planning
Contract patient, your medical information will be
disclosed to your insurance company only if you sign
the billing authorization on the laboratory test request
form. For all other patients, as noted above, medical
information will be submitted for payment to appropriate
payers.
- Inspect and Receive Copies of
Your Health Information – You may
submit a request in writing to the WSLH Privacy Officer
to examine your PHI. All pertinent information will
be made available, with some exceptions such as for
data compiled for civil, criminal or other legal
proceedings. A fee may be charged for the costs of
copying and mailing the information requested. WSLH
reserves the right to deny your request. However,
if you are denied access to your medical information,
you may request that the denial be reviewed. A different
party will review the denial, and we will comply
with the result of the review.
- Request Confidential Communications – You
may also submit a request in writing to receive your
health information by alternative methods. WSLH has
the right to determine if the request is reasonable.
Examples are to have information requested by you delivered
to you at a location specified by you, or called to
you at a specific phone number.
- Amend Your PHI– You
have the right to submit a request in writing for amendment/correction
of your PHI if you determine that it is inaccurate
or incomplete. WSLH reserves the right to deny your
request if you do not include a reason for the request,
if we conclude that the current information is accurate
and complete, and/or if the information in question
was not created by WSLH. To change information not
created at WSLH, you will need to contact the source
of the information (generally your clinic) to request
an amendment. Your clinic will then submit a written
request to us to amend our record.
- Accounting of Information Released – You
may submit a request in writing to receive an accounting
of disclosures of your information made by WSLH for
a period up to six years before the date of your request,
but not before April 14, 2003 (HIPAA Privacy Regulation
Effective Date).
- Receive a Paper Copy of This
Notice upon your request by calling (608)
262-1293 or writing to the address above.
File a Complaint - If you feel your
privacy rights have been violated, you may contact the Secretary
of DHHS by any of these methods:
- Writing a letter to Region V, Office
for Civil Rights,U.S. Department
of Health and Human Services, 233 N. Michigan Ave.,
Suite 240, Chicago IL 60601 (fax: 312-886-1807)
- Email OCRComplaint@hhs.gov
- Voice phone (312) 886-2359, TDD (312)
353-5693
You should also provide a copy of the letter or other
written notification of your concerns to the WSLH and the University
of Wisconsin Madison HIPAA Privacy Officer, 90B Bascom Hall, 500
Lincoln Dr, Madison WI 53706-1380. You will not be penalized in any
way for filing a complaint.
Administrative Information
Written requests for information in the “Patient
Rights” portion mentioned above may be mailed or faxed to the
appropriate department that received your specimen. If you are faxing
your request, please call to obtain the correct fax number and arrange
for the confidential receipt of your request.
If you have questions about this Notice, please feel
free to contact us at:
Wisconsin State Laboratory of Hygiene
Peggy Hintzman, Associate Director, HIPAA Privacy Coordinator
465 Henry Mall
Madison WI 53706-1578
HIPAA_Officer@mail.slh.wisc.edu
This notice is available on the WSLH website and posted
in the lobby of all WSLH locations. The URL is http://www.slh.wisc.edu.
We reserve the right to revise the Notice of Privacy Practices. Our
website will announce any changes made to this document and the effective
dates of such changes.
WSLH Procedure #: HIPAA001
Reviewed by UW Privacy Officer January
17, 2003
Revised by WSLH February 28, 2003
Approved by Peggy Hintzman March 15,
2003
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