- To perform health related services, obtain payment, or conduct our operations.
- To participate in research projects approved by an Institutional Review Board, a legally authorized committee that protects research participants' rights and oversees research projects.
- As otherwise required or allowed by law, or with your written authorization.
Any time you wish to contact Free & Clear regarding your privacy rights, please refer to the bottom of this notice.
Free & Clear's Responsibilities:
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), because our services are related to your health we must take steps to protect the privacy of the information you provide to us or that we create on your behalf. This information may include both health information and personal information such as your name, social security number, address, and phone number.
Although our services are related to your health, Free & Clear, Inc. is not a medical treatment provider and our staff cannot provide medical treatment, diagnosis, or monitoring. Free & Clear, Inc. programs should not be relied upon as a substitute for professional medical advice. Free & Clear, Inc. programs are intended to assist you with personal health improvement efforts through coaching, education, and instruction. Free & Clear, Inc. recommends that you seek the advice of your doctor with any questions you may have regarding your medical conditions.
Under Federal Law, We are Required to:
- Protect the privacy of your health information. All employees and associates of Free & Clear, Inc. receive appropriate training to help maintain the confidentiality of health information.
- Provide you with this Notice of Privacy Practices explaining our duties and practices regarding your health information and to follow the practices and procedure set forth in this Notice.
- Adhere to the standards of privacy and security set out by the Secretary of Health and Human Services.
Uses and Disclosures that DO NOT Require Your Authorization:
Federal Law permits Free & Clear to use and share health information for certain limited purposes. Some examples of how Free & Clear, Inc. may use or share your health information without your authorization are listed below.
Health related services.
- Free & Clear, Inc. may share your health information with employees, other members of our workforce and, other health care providers in the course of providing you with treatment and/or other health related services.
Payment purposes.
- Free & Clear, Inc. may share your health information with organizations responsible for payment or administration of your health benefits unless such disclosure is prohibited by law.
Health care related operations.
- Free & Clear, Inc. may share your health information with organizations that assist with the administration and support of our business activities, provided that such organizations agree to protect the privacy of your information.
Research:
Free & Clear, Inc. may use and share your health information for research projects that have been approved by an Institutional Review Board (IRB), a legally authorized committee that protects participants' rights and oversees research. For example:
- When an IRB determines that the need to use your health information without your authorization is justified and steps are taken to ensure only limited use of such information, we may use and share it for a research project without your authorization.
- When the IRB approves the use and sharing of information, or you authorize the use and sharing of information for a research project, your information may be shared with other institutions connected with the research project.
- In all other cases, we must obtain your authorization to use your information for a research project.
Contacting You:
Free & Clear, Inc. may use your health information to contact you or send you reminders by phone, mail, or e-mail.
Other Uses and Disclosures:
We may use or share your health information, if necessary to protect the public health or safety or when otherwise allowed by law. For example, we may provide information to:
- Public health authorities for health surveillance, to investigate or track problems with prescription drugs and medical devices (U.S. Food and Drug Administration).
- Government entities authorized to receive reports regarding suspected abuse, neglect, or domestic violence.
- Health care oversight agencies for the purposes of enforcement, audits, examinations, investigations, inspections, and licensures.
- Courts and law enforcement agencies when required or allowed by law.
- Coroners, medical examiners, and funeral directors.
- Correctional facilities, if we are providing health related services to you while you are incarcerated.
- Government officials as required for specifically identified government functions.
Uses and Disclosures that you have the Right to Object:
- Unless you object, Free & Clear, Inc. will use its professional judgment to provide relevant health information to a family member, friend, or other person you indicate has an active interest in your care.
Uses and Disclosures that Require your Authorization:
- Except in the situations listed in the sections above, we will use and share your health information only with your written authorization.
- You may revoke such authorization in writing at any time. Such revocation shall be effective upon Free & Clear, Inc.'s receipt of your written notice. If you revoke your authorization, Free & Clear, Inc. will no longer use or disclose your information for the purposes covered by your authorization.
In some situations, federal and state laws provide special protections for specific kinds of health information and require authorization from you before we can share such information. In these situations, we will contact you for the necessary authorization.
Your Rights Regarding Your Health Information:
You have specific rights regarding the use and disclosure of your health information. You have the right to:
- Request to receive and inspect copies of your health related record. In most cases, you have the right to look at or order a copy of your health related record by using an Authorization to Release Health Information form provided by calling us at the Free & Clear, Inc. numbers listed below. You may be charged a reasonable fee for copies provided.
- Request an amendment. If you believe that information in your health related record iis incorrect or missing, you have the right to request a correction to your record in writing. In your request, you must provide a reason for the requested change. Although we are not required to amend the record, a copy of your request will be added to the record if you direct us to file it.
- Request to know about disclosures. You have the right to request in writing an accounting of certain disclosures of your health information since April 14, 2003. This accounting of disclosures will not include disclosures made in the course of providing treatment, payment, health care operations, or when you have authorized such disclosures. You may receive one accounting per year at no charge. Additional processing fees may apply to additional requests made within the same twelve-month period.
- Request restricted use. You have the right to request in writing that we restrict certain uses and disclosures of your health information. Although we are not required to grant the request, we will comply with any request we grant.
- Request how we communicate. You have the right to request in writing that we communicate with you by another means. For example, you may ask us to contact you at work or another location. While we are not required to grant the request, we wukk endeavor to honor reasonable requests. We will comply with any request we grant.
- Make a complaint. If you think that we may have violated your privacy rights or you disagree with a decision we have made about access to your health information, you may file a written complaint with our Privacy Officer. You will not be penalized or retaliated against if you file a complaint.
- Right to receive a copy of this Notice. You have the right to receive a paper copy of this Notice, even if you have already received it previously.
To exercise your privacy rights or to make a complaint, you may contact:
Free & Clear, Inc.
Attn: Privacy Officer
999 3rd Avenue, Suite 2100
Seattle, Washington 98104
For matters regarding the Quit For Life® Program:
1.866.QUIT.4.LIFE (1.866.784.8454)
TTY: 1-877-777-6534
For matters regarding the Mind & Body™ Program:
1.866.933.BODY (1.866.933.2639)
TTY: 1-877-777-6534
If you have a complaint you may also contact:
Office for Civil Rights, Region X
U.S. Department of Health and Human Services
2201 6th Avenue, Mailstop RX-11
Seattle, Washington 98121-1831
206-615-2290
Changes to Privacy Practices: Free & Clear, Inc. may change the terms of this Notice at any time. Any revised Notice will apply to all health information that we maintain. We post our current Notice on our web site (www.freeclear.com) and at our facilities. If you have any questions about this Notice or would like an additional copy, please contact our Privacy Officer at the numbers listed above.