Personal Information Privacy Statement

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

ConneXions Notice of Privacy Practices
Effective April 14, 2003, Revised July 1, 2005

Important Information About Privacy...

ConneXions, in conjunction with CHOICE Regional Health Network, works to protect the privacy of your personal and health information. We are required by law to maintain the privacy of your personal and health information and to provide you with notice of our legal duties and privacy practices. This notice explains how we may use information about you and when we can share that information with others. It also informs you about your rights with respect to your personal and health information and how you can exercise those rights. We are required to abide by the terms of this notice.

When we use the term “PHI” in this notice, we are referring to the personal and health information about you that we collect when you fill out forms or when you obtain our services. We maintain this information and use it to facilitate application and enrollment assistance.

When we use the term “CHOICE”, “we” or “us” in this notice, we are referring to CHOICE Regional Health Network. CHOICE oversees the electronic aspects of ConneXions.

Internally, we protect your oral, written and electronic information by requiring all employees and others with access to such information to follow specific confidentiality and technology usage policies. All employees and contractors coming in contact with client information must sign an Oath of Confidentiality, affirming that PHI will be protected, and that such protection continues even after the employee or contractor leaves CHOICE. An employee or contractor’s use of protected information is limited to the minimum amount of information necessary to perform a legitimate job function. Employees and contractors also are required to comply with this privacy notice, and may not use or disclose your information except as described in this notice.

Using and Disclosing Client Information for Services Offered through ConneXions

CHOICE may use and share the client information we collect for screening, referral and application assistance that may include enrollment, care management, customer services, and quality assurance. We may share your client information as permitted by law to non-affiliated third parties with whom we contract to help us operate CHOICE, and with others who are involved in providing services for you. ConneXions uses shared data among community partners that:

• Makes it easier for you to be referred to services.
• Automates the work of filling out applications for services.
• Makes it easier for you to seek other services later by not having to repeat information.
• Makes it easier for community agencies to help you by eliminating the need for them to repeat information that has already been collected and verified.
• Only uses the minimum amount of information about you that is necessary for you to receive services and/or referrals from ConneXions’ community partners and other enrollment sites.

The following ways explain some of the ways information about you helps us:

• We may use or share your client information for certain types of public health or disaster relief efforts.
• We may use or share your client information to send you a reminder if you have an appointment with us.
• We may use or share your client information to show the need for services so that ConneXions can apply for grants or to solicit donations from the community. In the event data is used, no personal identifying data will be included in the published information.
• We may release your client information to a friend or family member who is authorized by law to act on your behalf.

Your Client Rights

The following are your rights with respect to your client information. If you would like to exercise the following rights, please contact us as described below, under “Who to Contact”.

• You have the right to ask us to restrict how we use or disclose your client information for services. You have the right to deny access to your client information to any participating ConneXions partner. If you choose to change your mind at any time, a written request will need to be made. You also have the right to ask us to restrict client information that we have been asked to give to family members or to others who are involved in your care. We may be required by law to give out information to those who are involved in your care and not able to agree to these restrictions.
• You have the right to ask to receive confidential communications of information. For example, if you believe that you would be harmed if we send your information to your current mailing address (for example in situations involving domestic disputes or violence), you can ask us to send the information by alternative means, for example, by fax or to an alternative address. We will try to accommodate reasonable requests.
• You have the right to inspect and obtain a copy of PHI that we maintain about you.
• You have the right to ask us to amend PHI we maintain about you. We will make the change but require that the new information be accurate. Please note that we are not required to agree to a request to amend.
• You have the right to receive an accounting of certain disclosures of your PHI made by us during the six years prior to your request. Please note that we are not required to provide you with a list of all disclosures we make. For example, we are not required to provide you with all client information collected prior to April 14, 2003 or information disclosed to you or pursuant to your authorization.
• You have a right to receive a paper copy of this notice upon request at any time.

Your request to exercise any of the above client rights must be in writing and be signed by you or your representative. We may ask you to complete a form when making a request.

Using and Disclosing Client Information for Other Purposes

There are also state and federal laws that require us to release your client information to others in some of the following situations:

• We may have to report information to public health agencies if we believe there is a serious health or safety threat to yourself or others.
• We may have to provide information to a court or administrative agency (for example, pursuant to a court order, search warrant, subpoena or discovery request). We may have to report information for law enforcement purposes if this is a legal procedure that orders us to do so.
• We may have to report information to a government authority regarding abuse, neglect or domestic violence.

If one of the above reasons does not apply, we must get your written permission to use or disclose your client information. If you give us written permission and change your mind, you may revoke your written permission at any time. The revocation will not apply to any information we have already disclosed. Your request to exercise any of the above client rights must be in writing and be signed by you or your representative. Once you give us authorization to release your client information, we cannot guarantee that the person to whom the information is provided will not disclose the information.

Changes to this Privacy Statement

We may from time-to-time change the contents of this notice and reserve the right to do so. If we do so the new notice will be effective for all of the electronic data maintained by us. Once revised, we will provide the new notice to you by mail and post it on our website.

Who to Contact

If you have any questions about this notice or about how we use or share client information, you may contact Marika Bertolini at: 2409 Pacific Avenue SE, Olympia, WA 98501. You may also call us at (360) 493-4550 or 1-800-981-2123 or send us an email.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us by contacting the Privacy Officer as noted above, or filing a grievance with the CHOICE Board of Directors. You may also notify the Secretary of the U.S. Department of Health and Human Services of your complaint. We will not take any action against you for filing a complaint.

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