THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOUR CHILD MAY BE USED AND DISCLOSED AND HOW YOU
CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
If
you have any questions about this notice,
please contact our business office at (425) 747-4004 x4293.
Kindering
Center is required by law to maintain the privacy of your child’s
health and education information, to provide you a notice of our
legal duties and privacy practices, and to follow the information
practices that are described in this notice. Kindering
Center respects your privacy.
We understand that your child and family’s personal information is
very sensitive. For
example, your child’s personal information includes demographics,
treatment plans, documentation of diagnosis, and treatment records.
Described as follow are the ways we may use and disclose information
that identifies your child.
HOW WE MAY USE AND DISCLOSE HEALTH
INFORMATION.
Treatment.
We will use health information to provide treatment to your child.
This includes use and disclosure of health information among
Kindering Center staff and volunteers as it relates to your child’s
treatment. In addition, with your written consent we may disclose
health information to your child’s doctors, nurses, technicians, or
other personnel, including people outside the Center, who are
involved in your child’s medical care.
Payment.
With your authorization, we may disclose health information so that
we or others may bill and receive payment from you, an insurance
company, or a third party for the treatment and services your child
received. For example, we may provide your health plan with
information including diagnosis, procedures performed, progress,
goals or recommended care, so they will pay for your child’s
treatment. If your child participates in IDEA Part C services, your
child’s health and education information will be disclosed to
Washington State Infant Toddler Early Intervention Program; King
County DDD (if eligible); Bellevue or Lake Washington School
District (if applicable); and Children with Special Health Care
Needs. These disclosures include the minimum necessary information
required for payment and may consist of third party reports.
Routine Operations.
We may use your child’s health and education information to carry
out routine operations for the Center, which may include the
disclosure of information to persons with a legitimate educational
interest. Such persons may include, but are not limited to, those
employed at the Center as administrators, supervisors or support
staff; persons serving on our board of directors; and businesses
with whom we contract for services (including consultants,
interpreters, lawyers, auditors). These uses and disclosures are
necessary to make sure that all of our children receive quality care
and to operate and manage the Center.
Transition Services.
At age three if your child will be participating in a qualifying
preschool program, Kindering Center may forward your child’s
education record, including applicable health information, to the
school in which your child intends to enroll.
Fund Raising.
Fund raising is an important
aspect of the operations at Kindering Center. Therefore, we will
include your family on our list of persons to receive notice of our
fund raising efforts. This list is for the benefit of Kindering
Center only and will not be disseminated for other purposes without
your prior written consent.
OTHER USES AND DISCLOSURES
We may also use or disclose
your child’s information to meet special reporting requirements, for
public health reasons, or for other purposes. Such disclosures
permitted by law that do not require your written consent include:
- Family and
friends involved in your child’s care or payment.
- Disclosures
to public health authorities to prevent or control disease.
- Disclosures
to public authorities as part of a report of child abuse, neglect
or domestic violence.
- Data for
health or educational oversight activities, such as audits,
investigations or inspections.
- To avert a
serious threat to health or safety or to prevent serious harm to
an individual.
- To secure
emergency medical treatment for your child in the event of an
accident or injury.
- Participation
in a qualifying research project.
- As required
by law, such as for law enforcement or in response to a lawful
subpoena or court order.
- Coroners or
medical examiners, as necessary, to carry out their duties.
- To provide
you with information about treatment alternatives or new
health-related services that may be of interest to you.
- Appointment
reminders.
All other uses and disclosures will
be made ONLY
with your written authorization, which you have the right to revoke
in most cases.
YOUR RIGHTS
You have the following rights regarding health and education information
we have about your child:
Right to Inspect and Copy.
You have a right to inspect and copy health information that may be
used to make decisions about your child’s care or payment for your
child’s care. This includes medical and billing records, other than
psychotherapy notes. To inspect a copy of this health information,
you must make your request in writing to our Quality Assurance
Coordinator.
Right to Amend.
If you feel that the health or education information we have is
inaccurate or misleading, you may ask us to amend the information.
You have the right to request an amendment for as long as the
information is kept by or for the Center. To request an amendment,
you must make your request in writing to our Quality Assurance
Coordinator. While we accept requests for amendment, we are not
required to agree to the amendment.
Right to an Accounting of Disclosures.
You have the right to request a list of certain disclosures and a
record of access regarding your child’s health and education
information. The list does not include disclosures we made directly
to you, disclosures to friends/family members, disclosures you
specifically authorized in writing, disclosures to third party
payers or disclosures related to our daily business operations. To
request an accounting of disclosures, you must make your request in
writing to our Quality Assurance Coordinator.
Right to Request Restrictions.
You have the right to request a restriction or limitation on the
health information we use or disclose. You also have the right to
request a limit on the health information we disclose to someone
involved in your child’s care or the payment for your child’s care,
like a family member or friend. To request a restriction, you must
make your request in writing to our Quality Assurance Coordinator.
We are not required to agree to your request. If we agree, we will
comply with your request unless the information is needed to provide
your child with emergency treatment.
Right to Request Confidential
Communication. You
have the right to request that we communicate with you in a certain
way or at a certain location. For example, you can ask that we
contact you only by mail or at work. Please contact our Quality
Assurance Coordinator to request confidential communication. Your
request must specify how or where you wish to be contacted. We will
accommodate reasonable requests.
Right to a Paper Copy of This Notice.
You may obtain a copy of this notice at our web site http://www.kindering.org.
You have the right to a paper copy of this notice. You may ask us
to give you a copy of this notice at any time. Even if you have
received this notice electronically, you are still entitled to a
paper copy of this notice.
CHANGES TO THIS NOTICE
We reserve the right to change this
notice. The new notice will apply to health and education
information we already have, as well as any information we receive
in the future. We will post a copy of our current notice at the
Center. The notice will contain the effective date on the first
page.
COMPLAINTS
If you believe your privacy rights
have been violated, you may file a complaint with Kindering Center
or with the U.S. Department of Education.
To file a
complaint with Kindering Center, contact:
Quality Assurance Coordinator
Kindering Center
16120 N.E. Eighth Street
Bellevue, WA 98008
(425) 747-4004 x4293
All complaints
must be made in writing. You will not be penalized for filing a
complaint.
This notice is effective in its
entirety as revised on
August 1, 2003.