Notice Applies to Virginia Mason Medical Center including Virginia Mason Hospital, Regional Medical Center and Clinics, Ambulatory Surgery Centers, Bailey-Boushay House, Center for Integrative Medicine at Virginia Mason, P.C. and Benaroya Research Institute at Virginia Mason

Our mission at Virginia Mason is to improve the health and well-being of the patients we serve. This commitment extends to caring about our patients’ privacy.

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

We keep a record of the health care services we provide you. You may ask to see and to obtain a copy of that health information. You may also ask us to correct that health information. We will not disclose your health information to others unless you direct us to do so or unless the law authorizes or compels us to do so.

Who will Follow This Notice This joint notice of privacy practices applies to the above Virginia Mason facilities, its medical staff, and other independent health care providers that provide services at Virginia Mason facilities and have agreed to follow this notice. The independent health care providers likely will have separate notices of privacy practices for care delivered at non-Virginia Mason facilities.

Your Health Information Rights You have certain rights over the use and disclosure of your health information, including the rights listed below. You may contact our Release of Information Department at 206-223-6975 or visit our website at www.virginiamason.org for more information about how to exercise these rights.   In most cases, we require you to submit a written form to exercise your rights.

Inspect and Copy You have the right to inspect and obtain a copy of your health information in most cases. If we maintain your health information electronically, you may also request that we provide your information in an electronic form and format. If the requested electronic form and format is not readily producible, we may provide the information in another readable electronic form and format.   If you request a copy, we may charge a fee for the costs of copying, mailing or other supplies and the electronic media associated with your request.

Request Amendment You have the right to request in writing an amendment to your health information if we created it and we agree that it is either wrong or incomplete. If we do not agree to make the amendment, you may add a statement of disagreement to your health information.

Accounting of Disclosures You have the right to obtain an accounting of certain disclosures.

Request Restrictions You have the right to ask us not to let your insurance company know about an item or service we provide if you pay in full before we send a bill. There are certain conditions that must be met for us to comply with your request. You also have the right to ask us in writing to restrict certain other uses and disclosures of your health information. We are not required to grant all of these requests, but we will honor any requests we do grant.

Revoke You have the right to revoke any written authorization to use or disclose health information, except to the extent that we have already acted. Researchers may also keep information they have already collected.

Alternative Communications You have the right to request in writing that we contact you by alternative means or at alternative locations.

Obtain Notice of Privacy Practices You have the right to obtain a paper copy of this notice by asking for it, even if you previously agreed to accept a notice by e-mail or over the Internet.

Receive Notification of a Breach You have the right to receive notice from us if we discover a breach of your unsecured health information according to the requirements of federal and state law.

Our Responsibilities We are required to protect the privacy of your information, provide this notice about our privacy practices, and follow the privacy practices that are described in this notice.

For More Information or to Make a Complaint If you have questions or would like to make a complaint, you may call the Virginia Mason Privacy Office at 206-223-7505.

If you have a complaint, you may also contact the federal Office for Civil Rights, Region X, U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Notice Changes We reserve the right to change our notice of privacy practices and to make any new notice effective for all health information that we maintain now or in the future. If our privacy practices change, we will post the new notice at each Virginia Mason facility and on our website at www.virginiamason.org.

Uses and Disclosures for Treatment, Payment and Health Care Operations The following categories describe the ways that we may use and disclose your health information for treatment, payment and health care operations.

Treatment We will use and disclose your health information for treatment. Treatment means providing and arranging for your health care and health-related services with other providers. It may also include coordinating your care with a third party, obtaining a consultation from another provider, or making a referral.

Some examples: Information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of your treatment. We will also provide other health care providers with copies of various health information or electronic access to your health information that could assist them in treating you.

Payment As permitted by law, we will use and disclose your health information for payment activities. Payment activities generally include billing, collections, and obtaining prior approval from your insurance plan for the care that we provide. Public and private insurance plans may require us to disclose your health information for the purposes of audits, inspections, and investigation.

Some examples: We may send a bill to your insurance plan. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used so we can get paid for the treatment we provide. We may disclose certain information to consumer reporting bureaus for collection of payment.

Health care operations We will use and disclose your health information for health care operations. Health care operations means a wide range of activities to run our business (or those of other health care organizations as allowed by law) and to ensure patients receive quality care.

Some examples: We may use or disclose your health information to review and improve the care you receive, to train our workforce and others, and to make processes more efficient.

Other Permitted or Required Uses and Disclosures We may use and disclose your health information to make healthcare services better, protect patient safety and public health, make sure we follow government and accreditation standards, and when otherwise required or permitted by law. Such uses and disclosures include:

Organized Healthcare Arrangements We may use and disclose your health information to individuals and organizations that participate in joint health care activities with us. These joint arrangements are referred to as “organized health care arrangements” under federal law. We have organized health care arrangements with our Hospital and its medical staff; Yakima Valley Memorial Hospital, its Medical Staff, and Memorial Physicians; EvergreenHealth; Franciscan Health System; Seattle Children’s and the American Joint Replacement Registry. For more information, you may contact our Privacy Office.

Community Provider Access We provide access to our electronic health information system to certain community providers. Providers with a “need to know” generally have full access to your electronic health information to improve care coordination and quality outcomes.

Some examples: we may provide access to referring community physicians and their staff, hospitals, and nursing facilities.

Health Information Exchanges We participate in health information exchanges with local hospitals, physicians, insurance plans, and other healthcare organizations. These information exchanges allow healthcare organizations to send and receive your health information when there is a need for this information for treatment, payment, or in limited circumstance, healthcare operations.

Some examples: We disclose basic information regarding any emergency department visits you make to a health information exchange. The purpose of this exchange is to enable local emergency departments to coordinate patient care and reduce unnecessary services.

Patient Portal (MyVirginiaMason) We provide you, or individuals authorized by you, with limited access to your electronic health information through MyVirginiaMason, a patient portal. Certain limitations apply to its use by minors and their parents/guardians.

Business Associates We may also share your health information with other businesses that provide services to us such as consulting, legal services, transcription, accreditation, coding, billing, and collections. These “business associates” of ours are required to comply with federal privacy and security laws to safeguard your information.

 To Contact You We may contact you as a reminder that you have an appointment with us, provide test results, inform you about treatment options, ask you if you would like to participate in quality assessments or research, or advise you about health-related benefits and services.

Fundraising We may use and release certain information to our foundation so that it may contact you to make donations that will support our charitable mission. This information would be limited such as your name, address, telephone number, dates and departments of service, age, gender, treating physician, outcome information and health insurance status. If we contact you, we will also provide you with a way to opt- out of receiving fundraising requests in the future.

Directory Unless you notify us that you object, we may use your name, location in the facility, and general condition for directory purposes. This information may be provided to people who ask for you by name. We may also provide your religious affiliation to members of the clergy. In an emergency, we are permitted to use such information in your best interest as determined by our professional judgment.

Notification Unless you notify us that you object, we may use or disclose information to notify (or assist in notifying) a family member, personal representative or another person responsible for your care, of your location in our facility and your general condition.

Communication with family and friends Unless you notify us that you object, we may use our best judgment and disclose your health information to a family member, other relative, personal representative, close personal friend or other person you identify, that is relevant to the person’s involvement in your care or payment for your care.

Professional judgment We are permitted to make disclosures if you are present or if you are otherwise available prior to a disclosure of health information and you either agree to it or we reasonably infer from the circumstances that you would not object. Even if you are not present, we may make a professional judgment that certain disclosures are in your best interests. For example, we may permit someone other than you to pick up your prescription.

Research We may disclose information to researchers with your authorization, or without your authorization in some cases if the research has been approved by an Institutional Review Board (IRB). For example, a researcher may seek permission from an IRB to look at historical medical data in charts without obtaining an authorization from each person. In these cases, the IRB will determine if using your health information without your authorization is justified, and make sure that steps are taken to limit its use. Additionally, we may allow researchers to review your health information to assist them in developing research or we may contact you to ask if you would like to participate in a research study. In all other cases, we must obtain your authorization to use or disclose your health information for research.

Other Miscellaneous Uses and Disclosures We also use and disclose your health information to enhance health care services, protect patient safety, safeguard public health, ensure that our facilities and staff comply with government and accreditation standards, and when otherwise authorized by law. For example, we disclose information:

• To public health authorities with information on communicable diseases, vital records, health statistics, or acts of violence and at-risk behaviors;
• To appropriate government agencies or law enforcement when we suspect abuse or neglect;
• To the U.S. Food and Drug Administration (FDA) about FDA-regulated drugs and devices;
• To a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
• Your employer regarding medical surveillance of the workplace or evaluation of work-related illnesses or injuries;
• To a school regarding your proof of immunization;
• To a health oversight agency for activities authorized by law such as audits, investigations, inspections, and licensure;
• To government programs providing public benefits such as Medicare and Medicaid if relevant to your eligibility and enrollment;
• In response to a court or administrative order, subpoena, discovery request, or other lawful process;
• To law enforcement when required or permitted by law;
• To coroners, medical examiners, and funeral directors;
• To organ procurement organizations to coordinate organ donation activities;
• To appropriate agencies or persons when we believe it necessary to avoid a serious threat to health or safety of a person or the public or to prevent serious harm;
• To military command authorities or foreign military authority if you are a member of the armed services;
• To federal officials for national security, intelligence, and protective services to the United States President and other officials;
• To correctional institution or law enforcement official if you are an inmate or under custody;
• To workers’ compensation agencies and self-insured employers for work-related illnesses or injuries;
• To cancer registries with information on identified cancer cases;
• To trauma registries with information on the incidence, severity and causes of traumatic injuries;
• To a public or private entity (such as FEMA or the Red Cross) authorized by its charter or law to assist in disaster relief efforts;
• To a public oversight agency, public health authority or an attorney for whistleblowing activities regarding unlawful conduct or potentially endangerment of one or more patients, workers or the public;
• When otherwise required or permitted by federal, state, or local law.

Use and Disclosure Requiring Your Authorization Other than the uses and disclosures described above, we will not use or disclose your health information without your written authorization Virginia Mason requires your written authorization for most uses and disclosures of psychotherapy notes, for marketing (other than a face-to-face communication between you and a Virginia Mason workforce member or a promotional gift of nominal value), or before selling your health information.

Discrimination is Against the Law Virginia Mason complies with applicable Federal and State civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Virginia Mason does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Virginia Mason:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)
• Provides free language services to people whose primary language is not English, such as:
  • Qualified interpreters
  • Information written in other languages

If you need these services, contact the Patient Relations Department. If you believe that Virginia Mason has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

If you believe that Virginia Mason has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Director, Patient Relations, 1100 Ninth Ave. C1-PTR, Seattle, WA 98101, (206) 223- 6616, 800-833-6384(TTY), (206)223-6394. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Patient relations Department is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 800-368-1019, 800-537-7697(TDD). Complaint forms are available at https://www.hhs.gov/ocr/complaints/index.html

Special Health Information Special state and federal protections apply to certain classes of health information. For example, additional protections may apply to mental health, alcohol and drug abuse, sexually transmitted disease and HIV information. When required by law, we will contact you to get written authorization to use or disclose that information.

Release of Information Departments Bailey-Boushay House (206) 322-5300 Downtown and all Regional Medical Center or other clinic Locations (206) 223-6975 

Patient Rights 

While you are a patient at Virginia Mason, you have the right to expect:

Respect. You have the right to be treated and cared for with dignity and respect.

Participation in Your Care. You have the right to relevant, current and understandable information concerning your diagnosis, various treatment options, prognosis and costs. One of our most important jobs is keeping you informed. You have the right to participate in decisions regarding your care, including refusing treatment and agreement to care.

Advance Directives. You have the right to participate in ethical questions that arise in the course of your care, including conveying your wishes regarding end-of-life decisions, such as life-sustaining treatment. You have the right to expect that your health care providers will comply with your decisions.

Privacy and Confidentiality. You have the right to every consideration of privacy, including personal needs. This also means that case discussion; consultation, examination and treatment should be conducted so as to protect your privacy. Similarly, you have the right to expect that all written communications and records about your treatment be treated as strictly confidential, except in cases permitted or required by law, such as suspected abuse or public health hazards. You have the right to be informed about how Virginia Mason will use or share information about you. To facilitate communications between your health care providers, your name may be posted next to your room number on a board at the nursing station. If you have any concerns with your name being posted on this board, please discuss them with your nurse.

Information Access. You have the right to review all records pertaining to your medical care and to have the information fully explained to you, except when such disclosure is restricted by law. You also have the right to request an amendment to your medical record.

Appropriate Care. You have the right to expect that Virginia Mason will make a reasonable response to your request for appropriate care and services. We will provide evaluation, service and/or referral as indicated by the urgency of each case. Only when it is medically appropriate and legally permissible will you be transferred to another facility. Your requests to be transferred will be honored based on medical, legal and payer requirements. Quality of care and premature discharge complaints should be addressed to the Patient Relations Department (see other side) and will be referred to a utilization and quality control peer review committee for resolution. You have the right to be informed of unanticipated outcomes.

Pain Management. You have the right to expect information about pain and pain relief measures. We will provide knowledgeable staff members committed to pain prevention that will respond quickly to reports of pain.

Knowledge of Staff Information and Relationships. You have the right to know the names of everyone involved in your care, their titles, education and relationship with the medical center. You have the right to know of business relationships between Virginia Mason and educational institutions and other health care providers.

Freedom to Participate in Research. You have the right to consent or decline to participate in proposed studies or human experimentation affecting care and treatment. You have the right to have studies explained to you prior to your consent. You have the right to be given a description of alternative services that might also prove advantageous to you. If you decide not to participate in research, you are still entitled to the most effective care the medical center can otherwise provide.

Continuity. You have the right to expect reasonable continuity of care and to be informed by physicians and care providers of available and realistic patient care options that Virginia Mason may not be able to directly provide.

Support. You have the right to spiritual care. You have the right to have your family or representative, and your personal physician promptly notified of your admission to the hospital. You have the right to communicate. If communication restrictions are necessary for patient care and safety, we must document and explain the restriction to you and your family.

Free Language Services. You have the right to free language services such as qualified interpreters.

Information about Medical Center Policies. You have the right to be informed of all medical center policies and practices that relate to your care and treatment. You have the right to be informed of available resources for resolving disputes, grievances and conflicts. Similarly, you have the right to be informed of the medical charges for services and available payment methods.

Restraints. You have the right to be free from restraints of any form that are not medically necessary or are used as a means of coercion, discipline, convenience, or retaliation by staff. A restraint may be either physical or a drug that is being used as a restraint.

Safety. You have the right to access protective services and information regarding such services are available at all Virginia Mason locations. You have the right to security and to receive care in a safe setting. You have the right to be protected from abuse, neglect and harassment.

Who Makes Decisions When You Cannot. Under state law, if you are determined incompetent to make medical decisions, then a legally authorized representative may exercise those rights on your behalf. Based on the order of priority set forth in state law, the legally authorized representative may be a court appointed representative, an individual to whom you previously delegated authority to exercise such rights, or other individual as permitted by law.

Visitors. You have the right to receive, subject to patient’s consent, visitors designated by you, including but not limited to a spouse, domestic partner (including same sex partner), another family member, or a friend. These visitors will not be restricted or otherwise denied visitation privileges on the basis of age, culture, employment, ethnicity, expression, gender identity, language, national origin, participation in programs, physical or mental disability, race, religion, service and activities, sex, sexual orientation, socioeconomic status or treatment.

Patient Responsibilities

To give you the best care possible, we need your help. By assuming the following responsibilities, you can contribute to your care in a positive way. We ask that you:

Provide accurate and complete information about present complaints. Past illnesses, hospitalization, medications and other matters relating to your health.

Report unexpected changes in your condition to the physician or other health care provider symptoms of pain when they first begin and discuss pain relief options with your doctor or nurse. Work with your care provider to develop a pain management plan. Tell your care provider if your pain is not relieved.

Follow the treatment plan recommended by our health care team, including following the instructions of your providers. Keeping appointments and notifying your provider’s office if you are unable to do so.

Take responsibility for your well-being.

Follow hospital rules and regulations affecting patient care and conduct.

Be considerate of the rights of other patients and hospital and clinic personnel.

Refrain from behavior that is threatening or disruptive to the operations of Virginia Mason or is abusive to the staff. Such behavior includes the bringing of weapons of any kind onto hospital or clinic property, which may result in steps to immediately terminate the patient relationship with your provider or the entire medical center.

Regardless of the type of insurance coverage you have, pay your bill promptly or make arrangements with our financial services department before entering the hospital.

Tell us whether you truly understand your care plan and what your role is in the plan.

Patient Relations

Compliments and Complaints/Grievances

We strive to treat all patients with compassion and dignity. If you have a concern about patient safety, quality of care or other problem, we encourage you to first discuss them with your physician or ask to speak with the manager of that area. Compliment/complaint forms are also located throughout the medical center and may be filled out. Please contact the Patient Relations Department at the address below if you have a complaint, concern or grievance:

Virginia Mason Patient Relations 1100 Ninth Ave., C1-PTR / Seattle, WA 98101 PHONE: 206-223-6616

The Patient Relations Department will respond within 48 business hours. The usual expected timeframe for resolution is within seven (7) business days. If a longer period is required, Patient Relations will communicate to the patient the anticipated timeframe. Please be assured that you may share your concerns, complaint or grievance without fear of retribution or denial of care. You have the right to work with us to resolve issues related to your care.

If a problem is not resolved to your satisfaction, the medical center has an Appeals Committee. To file an appeal, contact the Patient Relations Department as noted above. You also have the option to contact the following agencies in addition to, or instead of, the medical center’s Appeals Committee:

• Washington State Department of Health (DOH): Health Systems Quality Assurance, Complaint Intake PO Box 47857 / Olympia, WA 98504-7857 PHONE: 800-633-6828 (toll-free) or 360-236-4700 EMAIL: HSQAComplaintIntake@doh.wa.gov  FAX: 360-236-2626

• Medicare: www.medicare.gov/claims-and-appeals/medicare-rights/get-help/embudsman.html PHONE: 800-MEDICARE

• Joint Commission: PHONE: 800-994-6610 (toll-free)

• Billing Issues: Billing questions can be directed to the Virginia Mason Billing Department at 206-223-6601

Notice of Nondiscrimination and Language Assistance

Virginia Mason complies with applicable Federal civil rights laws and does not discriminate on the basis of age, race, color, creed, ethnicity, religion, national origin, culture, language, marital status, sex, sexual orientation, gender identity or expression, physical or mental disability, association, whether or not an advanced directive has been executed, socioeconomic status, veteran or military status or any other basis prohibited by federal, state, or local law. Virginia Mason does not exclude people or treat them differently because of age, race, color, creed, ethnicity, religion, national origin, culture, language, marital status, sex, sexual orientation, gender identity or expression, physical or mental disability, association, whether or not an advanced directive has been executed, socioeconomic status, veteran or military status, or any other basis prohibited by federal state, or local law.

Virginia Mason:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:

•Qualified sign language interpreters

•Written information in other formats (large print, audio, accessible electronic formats, other formats)

• Provides free language services to people whose primary language is not English, such as:

•Qualified interpreters

•Information written in other languages

If you need these services, contact The Administrative Director, Patient Experience, 206-223-6616.

If you believe that Virginia Mason has failed to provide these services or discriminated in another way on the basis of age, race, color, creed, ethnicity, religion, national origin, culture, language, marital status, sex, sexual orientation, gender identity or expression, physical or mental disability, association, whether or not an advanced directive has been executed, socioeconomic status, veteran or military status, or any other basis prohibited by federal, state, or local law, you can file with: The Administrative Director, Patient Experience, 1100 Ninth Ave.

C1-PTR, Seattle, WA 98101, 206-223-6616, 800-833-6384 (TTY),

206-223-6394, Patient Relations email inbox: VMMCPatientRelations@virginiamason.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, The Administrative Director, Patient Experience, is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office of Civil rights, electronically through the Office for Civil Rights Complaint Portal, available at: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services

200 Independence Ave., SW / Room 509F, HHH Building Washington, DC 20201

800-368-1019 / 800-537-7697 (TDD)

Complaint forms are available at www.hhs.gov/ocr/office/file/index.html