Your Rights with Respect to Your Health Information
You have the following rights regarding your health information that the Trust maintains.
Right to Request Restrictions
You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on the Trust's disclosure of your health information to someone involved in payment for your care. However, the Trust is not required to agree to your request.
Right to Inspect and Copy Your Health Information
You have the right to inspect and copy your health information. This right, however, does not extend to psychotherapy notes or information compiled for civil, criminal or administrative proceedings. The Trust may deny your request in certain situations subject to your right to request review of the denial. A request to inspect and copy records containing your health information must be made in writing to the Privacy Contact Person. (See " Privacy Contact Person" for details.) If you request a copy of your health information, the Trust may charge a reasonable fee for copying, assembly costs and postage, if applicable, associated with your request.
Right to Receive Confidential Communications
You have the right to request that the Trust communicate with you in a certain way if you feel the disclosure of your health information through regular procedures could endanger you. For example, you may ask that the Trust communicate with you only at a certain telephone number or by email. If you wish to receive confidential communications, please make your request in writing to the Privacy Contact Person. (See " Privacy Contact Person" for details.) The Trust will attempt to honor reasonable requests for confidential communications.
Right to Amend Your Health Information
If you believe that your health information records are inaccurate or incomplete, you may request that the Trust amend the records. That request may be made as long as the information is maintained by the Trust. A request for an amendment of records must be made in writing to the Trust's Privacy Contact Person. (See " Privacy Contact Person" for details.) The Trust may deny the request if it does not include a reasonable reason to support the amendment. The request also may be denied if your health information records were not created by the Trust, if the health information you are requesting to amend is not part of the Trust's records, if the health information you wish to amend falls within an exception to the health information you are permitted to inspect and copy, or if the Trust determines the records containing your health information are accurate and complete.
Right to an Accounting
You have the right to request a list of disclosures of your health information made by the Trust. The request must be made in writing to the Privacy Contact Person. (See " Privacy Contact Person" for details.) The request should specify the time period for which you are requesting the information. No accounting will be given of disclosures made: to you; for treatment, payment or health care operations; disclosures made before April 14, 2003; disclosures for periods of time going back more than six years; or in other limited situations. The Trust will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee. The Trust will inform you in advance of the fee, if applicable.
Right to a Paper Copy of this Notice
You have a right to request and receive a paper copy of this notice at any time, even if you have received this notice previously or agreed to receive the notice electronically. To obtain a paper copy, please contact the Privacy Contact Person. (See " Privacy Contact Person" for contact information.) You also may obtain a copy of the current version of the Trust's notice at its web site, www.sdtrust.com. If this notice is modified, you will be mailed a new copy.
Privacy Contact Person/Privacy Official
To exercise any of these rights related to your health information you should contact the Privacy Contact Person listed below. The Trust has also designated a Privacy Official to oversee its compliance with the privacy rules.
Privacy Contact Person
Ms. Charlene Lind
Northwest Administrators, Inc.
2323 Eastlake Ave. E
Seattle, WA 98102
Phone: (206) 726-3281
E-mail: clind@nwadmin.com
Privacy Official
Ms. Charlene Lind
Northwest Administrators, Inc.
2323 Eastlake Ave. E
Seattle, WA 98102
Phone: (206)726-3281
E-mail: clind@nwadmin.com
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