NOTICE OF PRIVACY
PRACTICES
THIS NOTICE DESCRIBES HOW PROTECTED
HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION. THIS NOTICE ALSO DESCRIBES YOUR RIGHTS AND SOME
OBLIGATIONS PLASTIC SURGERY NORTHWEST HAS REGARDING THE USE AND DISCLOSURE OF
YOUR PROTECTED HEALTH INFORMATION. PLEASE REVIEW IT CAREFULLY.
This notice is effective as of June
2026. For purposes of this Notice, “PSNW” or “we” means Plastic Surgery
Northwest, including Spa Pavone, and Northwest Breast Center.
PSNW’S PLEDGE AND
RESPONSIBILITIES REGARDING YOUR PROTECTED HEALTH INFORMATION
We understand that information about
you, including your medical and behavioral health information, is personal. We
are committed to protecting your protected health information, or “PHI,” as
required by federal and state law. PHI includes information we create or
receive that identifies you and relates to your health, health care, or payment
for care provided at a PSNW facility by PSNW staff, your personal physician, or
other providers involved in your care. This includes your medical records and
personal details such as your name, Social Security number, address, and phone
number.
•
We
are required by law to maintain the privacy and security of your protected
health information.
•
We
will let you know promptly if a breach occurs that may have compromised the
privacy or security of your information.
•
We
must follow the privacy practices described in this Notice and provide you with
a copy.
•
We will not use or disclose your protected health information except as
described in this Notice unless you give us written permission. If you do, you
may revoke that permission at any time by notifying us in writing.
For more information see: Notice of Privacy Practices | HHS.gov
WHO WILL FOLLOW THIS
NOTICE
This Notice describes the practices of
PSNW and that of:
•
Any
health care professional authorized to enter information into your medical
record at any PSNW facility.
•
All
departments and units of PSNW.
•
All
PSNW employees and personnel including contracted or agency staff.
•
Other
health care providers who have agreed to follow and abide by the “joint notice
of privacy practices” terms described below.
JOINT NOTICE OF
PRIVACY PRACTICES
In addition to the individuals listed
above, certain independent practitioners, including members of the employees of
PSNW, Spa Pavone, and Northwest Breast Center, have agreed to follow this
Notice as a joint notice of privacy practices for care provided at PSNW
facilities, as permitted by federal privacy law. These practitioners may access
your protected health information when necessary for treatment, payment, or
health care operations related to care provided in the joint setting at PSNW
facilities. They may also maintain separate Notices of Privacy Practices for
care provided outside PSNW facilities, such as in a private physician’s office.
We encourage you to ask non-PSNW practitioners about any separate privacy
notices that apply at their offices or other facilities.
YOUR RIGHTS REGARDING
YOUR PROTECTED HEALTH INFORMATION
Unless indicated otherwise, you may
exercise your privacy rights by submitting a written request to:
Plastic Surgery Northwest
530 S Cowley St.
Spokane, WA 99202
For more specific instructions on what
information to include in a written request, contact our front desk by phone (509)
838-1010.
YOU HAVE A RIGHT TO:
Get an electronic or paper copy of
your health record.
•
To
request an opportunity to inspect and/or obtain an electronic copy your
protected health information, visit www.plasticsurgerynorthwest.com/patient-resources to obtain a copy of the authorization
request (release of information) form or contact us at (509) 838-1010.
•
We
will provide the requested information within 15 days of your request. You may
be charged a reasonable, cost-based fee with your request.
•
In
certain limited circumstances, we may deny your request to inspect and/or copy
your protected health information. You may request that the denial be reviewed.
Ask us to correct certain protected
health information –
If you feel that information, we have about you is incorrect or incomplete you
can request an amendment to such information.
•
If
we deny your request, we will provide a written explanation within 60 days.
Request an accounting of certain
disclosures —You may Seek
an accounting of certain disclosures by asking us for a list of the
times we have disclosed your PHI. Your request must be in writing and give us
the specific information we need in order to respond to your request. You
may request one list per year at no charge. These lists will not include
disclosures to other organizations that might pay for your care provided by
Plastic Surgery Northwest.
Request restrictions – You may request in writing that we
limit the way we use and disclose your protected health information.
•
You
also have the right to request a limit on the protected health information we
disclose about you to someone who is involved in your care or the payment of
your care, like a family member or friend.
•
Request
confidential communications – You may request in writing that confidential
communications about medical or behavioral health matters be made in a certain
way or at a certain location.
o
For
example, you can ask that we only contact you at work or by mail to an
alternative address.
•
We
will accommodate all reasonable requests. You do not need to give a reason, but
your request must state how or where you want us to contact you.
•
Ask
us to limit what we use or share – You may ask us not to use or share certain
protected health information for treatment, payment or our operations.
•
We
are not obligated to approve your request, as all requests are subject to
review and may be denied if they are deemed to impact your care.
Choose someone to act for you – If you have given someone medical
power of attorney or if someone is your legal guardian, that person can
exercise your rights and make choices about your protected health information.
•
We
will ask the person to show proof of this authority to act for you before we
take any action.
Receive a paper copy of this notice – You can request a paper copy of
this Notice at any time from any PSNW employee, even if you have agreed to
receive this notice electronically.
USES AND DISCLOSURE
OF YOUR PROTECTED HEALTH INFORMATION BY PSNW
Your Choices: For certain protected health
information, you can tell us your choices about what we share. If you have a
clear preference for how we share your protected health information in the
situations described below, talk to us. Tell us what you want us to do, and we
will follow your instructions. In these cases, you have both the right and
choice to tell us to:
•
Share
protected health information with your family, close friends, or others
involved in your care
•
Share
protected health information in a disaster relief situation
If you are unable to communicate your
preferences, for example if you are unconscious, we may share your protected
health information if we believe it is in your best interest. We may also
disclose your information when necessary to help prevent or reduce a serious
and imminent threat to health or safety.
In these cases, we will not share your
protected health information unless you give us written permission (signed
consent):
•
Marketing
purposes where remuneration is received
•
Limited
information about you may be used to support communication about available
products or services.
•
If
you do not wish to receive such materials, you may opt out
PSNW typically will use or share your
protected health information in the following ways:
Treatment: We may use and disclose your
protected health information to provide you with medical treatment and services
and share it with other professionals who treat you.
•
This
use and disclosure may be for continuity of care or to doctors, nurses,
technicians, health care students, or other health system personnel who are
involved in your care.
•
We
may use and disclose your protected health information to different departments
to coordinate activities such as prescriptions, lab work and x-rays and to
other health care providers who may be involved in your medical care, such as
long-term care facilities, other hospitals or clinics, or remote health care
providers such as the services offered by telemedicine providers who may reside
in other communities, including communities outside of Washington and Idaho.
Payment: As permitted by law, your protected
health information may be used or disclosed to secure payment from health plans
and other responsible entities.
•
This
includes billing for treatment and services you receive at a PSNW facility.
•
In
addition, we may use or disclose your protected health information to collect
payment or to obtain prior approval for treatment and services.
Health system operations: We can use and share your protected
health information to run our business, improve your care, and contact you when
necessary.
•
Running
our business includes activities such as scheduling, infection control,
administering the health plan, and the creation of de-identified data.
o
De-Identified
Information. We may use your health information, or disclose it to a third
party whom we have hired, to create information that does not identify you in
any way. Once we have de-identified your information, it can be used or
disclosed in any way according to law without your authorization or consent,
including but not limited to, research studies, and other advanced
technologies, and health care/health operations improvement activities.
•
We
may also use and disclose your protected health information to other
individuals (such as consultants and attorneys) and organizations that help us
with our business activities.
•
We
may also use your protected health information for internal purposes, like
ensuring the quality of care, identifying training needs, reviewing outcomes,
sending patient satisfaction surveys, and other administrative activities.
•
We
may also disclose your protected health information to Business Associates, or
companies that provide a service to us or on our behalf and have provided
satisfactory assurances that they will protect your protected health
information.
PSNW may also use your protected
health information in the following ways:
Public Health and Safety Issues – We may disclose your protected
health information to agencies, when necessary, to support public health
activities. These activities generally include the following:
•
To
prevent or control disease, injury or disability;
•
To
report abuse or neglect;
•
To
report reactions to medications or problems with products;
•
To
notify people of recalls of products they may be using;
•
To
notify a person who may have been exposed to a disease or may be at risk for
contracting or spreading a disease or condition;
•
To
notify the appropriate government authority if we believe a patient has been
the victim of abuse, neglect or domestic violence. We will only
o
make
this disclosure when required or authorized by law.
•
Preventing
or reducing a serious threat to anyone’s health or safety
Workers’ Compensation – We can use or share protected
health information about you for workers’ compensation claims.
Government Requests and Law
Enforcement – We can
use or share protected health information about you:
•
With
health oversight agencies for activities authorized by law
•
For
special government functions such as military, national security, and
Presidential protective services
•
In
limited circumstances, for law enforcement purposes or with a law enforcement
official Lawsuits and Disputes – We may disclose your protected health
information in response to a court or administrative order, subpoena, discovery
request, or other lawful process, if you are involved in a lawsuit or a
dispute.
Contacting You – PSNW may contact you about your
health care using the addresses, phone numbers and email addresses that you
provide us. This may include using an automated phone dialing system,
pre-recorded or synthetic voice messages, texting, or email. When we contact
you in this manner, you will be given the opportunity to opt out of receiving
similar communications going forward.
•
Our
messages may include, but are not limited to, information about appointment
reminders, discharge planning, billing, prescription reminders, and regulatory
notices provided in lieu of first-class mail. Because any texts and emails
would not be encrypted, there is a risk that someone else could read or access
these messages. We therefore take steps to limit the amount of protected health
information that they contain. If you do not wish to receive these types of
text or email messages, please let us know, and we will honor your request.
Treatment Alternatives – We may use or disclose protected
health information to tell you about or recommend possible treatment options or
alternatives.
Health-Related Benefits and Services – We may use or disclose protected
health information to tell you about health-related benefits, services, or
medical education classes.
Inmates – We may disclose your protected
health information to a correctional facility or law enforcement official, if
you are an inmate or in custody.
Incidental Disclosures – Certain incidental disclosures of
your protected health information may occur as a byproduct of lawful and
permitted use and disclosure of your protected health information. Reasonable
safeguards are in place to minimize these disclosures.
Serious and imminent threats – We may share your protected health
information when needed to lessen a serious and imminent threat to the health
or safety of you, the public, or another person.
OTHER SENSITIVE INFORMATION AND
PATIENT RECORDS
Certain types of protected health
information may have additional protection under state (Washington, Oregon,
Idaho) or federal law. For example, protected health information about mental
health, HIV/AIDS and genetic testing results is treated differently than other
types of health information. To the extent applicable, PSNW would need to get
your written permission before disclosing these categories of information to
others in most circumstances.
OTHER USES AND DISCLOSURES OF YOUR
PROTECTED HEALTH INFORMATION
Other uses and disclosures of your
protected health information not covered by our current Notice or applicable
laws will only be made with your written permission. You may revoke any
permission by submitting a request in writing to the PSNW Office. If you revoke
your permission, we will no longer use or disclose your protected health
information for the reasons covered by your written authorization unless
required by law. You understand that we are unable to take back any uses or
disclosures we have already made, while your permission was in effect, and that
we are required to retain our records of the care that we provide to you.
CHANGES TO THIS
NOTICE
PSNW can change the terms of this
Notice, and the changes will apply to all information we have about you. The
new Notice will be available upon request, at our facilities, and on our web
site.
QUESTIONS AND
COMPLAINTS
If you have general questions about
this Notice, please contact us
by phone: (509)838-1010
or email: info@plasticsurgerynorthwest.com.
If you believe your privacy rights
have been violated, you may file a complaint at:
Plastic Surgery Northwest
530 S Cowley ST
Spokane, WA 99202
If we cannot resolve your concerns,
you also have the right to file a written complaint by sending a letter to:
U.S. Department of Health and Human
Services
Office for Civil Rights
200 Independence Avenue,
S.W., Washington, D.C. 20201,
calling 1-877-696-6775, or
visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.
We will not retaliate against you for
filing a complaint and the quality of your care will not be jeopardized.