Firearms and pets (other than service animals) are not allowed at our clinics.
Soliciting products or information on Providence Health & Services property is strictly prohibited.
If you fail to comply with any Providence Health & Services policy – either stated here or at the clinic – you may be asked to leave the premises.
If you need to cancel an appointment, please give us 24 hours notice.
All Providence Medical Group clinics are tobacco free. Using tobacco of any kind is strictly prohibited on Providence Medical Group campuses, in vehicles owned by Providence and in vehicles parked in parking lots or garages owned by Providence Health & Services.
Smoking is the leading preventable cause of death in the United States. Providence has a responsibility to encourage and promote healthy lifestyles in our community. It is consistent with our mission.
This notice describes how your medical information may be used and disclosed and how you can access this information.
Review the Providence notice of privacy practices.
There are a number of ways your medical information may be used without your authorization, either because they are required by law or for public health and safety purposes. Those include:
Required by law: Your medical information may be used or disclosed by us when required by law. If this happens, we will comply with the law and will only disclose the information necessary. You will be notified, as required by law, of any such uses or disclosures.
Public health: Your medical information may be used for public health activities. Public health authorities are authorized to collect or receive the information for purposes such as controlling disease, injury or disability.
Disaster relief: We may disclose health care information about you to an entity assisting in a disaster relief effort so that your family and friends can be notified about your condition, status and location.
Incidental disclosures: Certain incidental disclosures of your health care information may occur as a by-product of lawful and permitted use and disclosures of your health care information. For example, a visitor may overhear a discussion about your care at the nursing station. These incidental disclosures are permitted if we apply reasonable safeguards to protect the confidentiality of your health care information.
Limited data set information: We may disclose limited health care information to third parties for purposes of research, public health and health care operations. Before disclosing this information, we must enter into an agreement with the recipient of the information that limits who may use or receive the data and requires the recipient to agree not to re-identify the data or to contact you. The recipient of your information is required to have appropriate safeguards to prevent inappropriate use or disclosure of your information.
Communicable diseases: If required by law to do so, we may disclose your medical information to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health oversight: Health oversight agencies are authorized to have access to medical information maintained by us for activities such as audits, investigations, and inspections. Agencies with this authority include government agencies that oversee the health care system, government benefit programs, government regulatory programs and civil rights laws.
Abuse or neglect: We may disclose your medical information to a public health authority that is authorized by law to receive reports of child abuse or neglect. We may also disclose your protected health information to the governmental agency authorized to receive such information if we believe that you have been a victim of abuse, neglect or domestic violence. Any disclosures of this nature will be made consistent with state and federal law.
Food and drug administration: We may disclose your medical information to a person or agency required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, or for product recalls, repairs or replacements.
Legal proceedings: We may disclose your medical information if required to by a court or administrative order to do so for an administrative or judicial proceeding, or in some cases in response to a subpoena, discovery request or other legal process.
Law enforcement: We may disclose your medical information, so long as applicable legal requirements are met, for law enforcement purposes. Examples of these purposes include:
Coroners, funeral directors and organ donation: Your medical information may be disclosed to a coroner or medical examiner for identification purposes, determining cause of death or other legally required duties. Your medical information may also be released to a funeral director in order to permit him/her to perform their duties. Your information may be disclosed if we reasonably anticipate your death, and may also be used and disclosed for cadaveric organ, eye or tissue donation purposes.
Research: Your medical information may be disclosed to researchers, provided the research has been approved by an Institutional Review Board and protocols have been approved to ensure your privacy. We may disclose health care information about you to people preparing to conduct a research project. For example, to help the researcher identify patients with specific medical needs that would relate to the proposed research. Information used for this purpose will not leave Providence Health System.
Criminal activity: As required by state and federal laws, we may disclose your medical information if it is believed that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or of the public. We may also disclose your medical information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military activity and national security: The medical information of Armed Forces personnel may be disclosed under certain circumstances, such as:
Your medical information may also be disclosed to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
Workers compensation: Your medical information may be used or disclosed as necessary to comply with workers compensation laws and other similar legally established programs.
Inmates: Your medical information may be used or disclosed by us if you are an inmate of a correctional facility and your physician created or received your medical information in the course of providing care to you.
Other uses and disclosures of your medical information will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke the authorization, at any time, in writing, except to the extent that we have already taken an action in reliance on the use or disclosure indicated in the authorization.
If you need for us to share your medical information with someone for purposes other than those listed here, you should contact Medical Records for an Authorization Form.
The following information describes your rights with respect to your medical information we maintain.
Right to request restrictions: You have the right to ask us to place restrictions on the way we use or disclose your medical information for treatment, payment, or health care operations. We are not required to agree to the restriction, but if we agree to a restriction, we will not use or disclose your medical information in violation of that restriction, unless it is needed for an emergency. If a restriction is no longer feasible, we will notify you. You should contact a member of our Admitting Team for further details and necessary paperwork.
Confidential communications: We will accommodate reasonable requests to communicate with you about your medical information by different methods or alternative locations if you make your request in writing and give it to a member of the health care team/department providing your service or your health care provider. For example, if you are covered on a health plan but are not the subscriber, and would like your medical information sent to a different address than the subscriber, we can usually do that for you.
Access to your medical information: You have the right to receive a copy of your medical information that we maintain, with some limited exceptions. You may request access to those records in writing and provide us with information about the specific information you need so that we can fulfill your request. We reserve the right to charge a reasonable fee for the cost of producing and mailing the copies. For more information about the cost, contact Medical Records.
Amendment of your medical information: You have the right to ask us to change any of your medical information. You need to request this amendment in writing and submit it to Medical Records, who will coordinate your request. In certain situations we may have to deny your request, such as when the medical information in your records was created by another provider. Any denials will be in writing. You have the right to appeal our denial by filing a written statement of disagreement. For more information about this process, contact the Privacy Officer listed.
Accounting of certain disclosures: You have a right to a listing of the disclosures we make of your medical information, except for those disclosures made for treatment, payment, or health care operations, or those disclosures made pursuant to your authorization. The type of disclosures typically contained in a listing would be disclosures made for mandatory public health purposes, law enforcement, legal proceedings or for other required reporting such as birth and death certificates. If you would like to receive an accounting of your disclosures, you should contact your Facility Privacy.
Questions and complaints: To exercise any of the above rights, or if you are concerned that any of your privacy rights have been violated, please contact your Facility Privacy Officer. You also have the right to complain to the Secretary of Health and Human Services by contacting the U.S. Department of Health and Human Services, 200 Independence Ave. SW, Washington, D.C. 20201. You will not be retaliated against for filing a complaint.
Providence Health System reserves the right to change its privacy practices and its Notice of Privacy Practices at any time. The new notice will be effective for any medical information we create or maintain as of the date of the change. You have the right to a paper copy of this Notice any time, upon request. You may contact a member of our Admitting staff to get a current paper copy.