ADCAS Notice Of Privacy Practices
This notice describes how confidential information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
This Notice of Privacy Practices is being provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). This Notice describes how we may use and disclose your protected health information to carry out student services, payment, health care operations, and other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information in some cases. Your "protected health information" means any of your written and verbal health information, including demographic data that can be used to identify you. This is information about you that is created or received by Alcohol and other Drug Consultation and Assessment Services (ADCAS), and that relates to your past, present, or future physical or mental health condition.
I. Uses and Disclosures of Protected Health Information
The Alcohol and other Drug Consultation and Assessment Services (ADCAS) program may use your protected health information for purposes of providing student services, confirming completion of services required from specified sources (see section D for detail), obtaining payment for services, and conducting service operations including coordination of care options and/or referrals. Your protected health information may be used or disclosed only for these purposes unless ADCAS has obtained your authorization, or if the use or disclosure is otherwise permitted by the HIPAA Privacy Regulations or State law. Disclosures of your protected health information for the purposes described in this Notice may be made in writing, orally, or by facsimile.
A. Student Services. Your protected health information will be used and disclosed to provide, coordinate, or manage your health care and any related services. This includes the coordination of your health care with a third party for the purpose of facilitating care or referral. For example, your protected health information may be disclosed to physicians or health care providers, including counselors at WWU, who may be treating you or consulting with your ADCAS service provider with respect to your care. In some cases, disclosure may be made of your protected health information to an outside treatment provider for purposes of referral, coordination of care, or the treatment services of the other provider.
B. Payment. For students required to attend an ADCAS service which entails a fee, payment may be paid at the WWU cashier or be billed directly to your student account under the general heading "Prevention/Intervention Services."
C. Operations. Your protected health information, as necessary, may be used or disclosed for the purpose of service operations and function of ADCAS and to provide quality care. In most cases, information will be utilized with personal identifying data omitted and it will often be compiled with other student data in aggregate form. Service operations include such activities as:
- Service quality assessment and improvement activities.
- Employee review activities.
- Training programs including those in which peer educators, trainees, or practitioners in health care learn under supervision.
- Review and auditing, including compliance reviews, service reviews, and maintaining legal compliance.
- ADCAS service management and general administrative activities.
In certain situations, disclosure of student information may be made to another counselor or health service provider for their services, referral to other health care services or consultation.
D. Other Uses and Disclosures. As part of services, payment and administrative operations, your protected health information may be used or disclosed for the following purposes:
- To remind you of an appointment, or follow up after a "missed" or "no show" appointment.
- To inform you of potential treatment alternatives or options.
- To inform you of health-related benefits or services that may be of interest to you.
- To confirm your attendance and completion of required services with the referral source.
- To provide requested recommendations regarding follow-up or further services indicated.
- To notify a referral source that you have not completed the required service by the specified date.
NOTE: "Referral Source" may include: Resident Director, Residence Life administrators, the University Judicial Officer, a sports team coach requiring service as a condition of continued participation on the team, an agent of the Liquor Control Board, or Bellingham Municipal Court.
II. Uses and Disclosures Beyond Services, Payment, and Service or Administrative Operations Permitted Without Authorization or Opportunity to Object
Federal privacy rules allow us to use or disclose your protected health information without your permission or authorization for a number of reasons including the following:
A. When Legally Required. Your protected health information may be disclosed when ADCAS is required to do so by any Federal, State, or local law.
B. To Report Abuse, Neglect, or Domestic Violence. Government authorities may be notified if we believe that a student is the victim of abuse, neglect, or domestic violence. We will make this disclosure only when specifically required or authorized by law or when the student agrees to the disclosure.
C. To Conduct Health Oversight Activities. Your protected health information may be disclosed to a health oversight agency for activities including audits; civil, administrative, or criminal investigations, proceedings, or actions; inspections; or other activities necessary for appropriate oversight as authorized by law. We will not disclose your health information if you are the subject of an investigation and your health information is not directly related to your receipt of health care or public benefits.
D. In Connection with Judicial and Administrative Proceedings. Your protected health information may be disclosed in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena in some circumstances.
E. For Law Enforcement Purposes. Your protected health information may be disclosed to a law enforcement official for law enforcement purposes as follows:
- Pursuant to court order, court-ordered warrant, subpoena, summons, or similar process.
- For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
- Under certain limited circumstances, when you are the victim of a crime.
- To a law enforcement official if the provider has a suspicion that your death was the result of criminal conduct.
- In an emergency in order to report a crime.
F. For Research Purposes. Your protected health information, normally with personal identification data omitted and often combined into aggregate data records with other student data, may be used or disclosed for research when the use or disclosure for research has been approved by an institutional review board or privacy board that has reviewed the research proposal and research protocols to address the privacy of your protected health information.
G. In the Event of a Serious Threat to Health or Safety. Consistent with applicable law and ethical standards of conduct, your protected health information may be used or disclosed if we believe, in good faith, that such use or disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health or safety of the public.
H. For Specified Government Functions. In certain circumstances, the Federal regulations authorize the provider to use or disclose your protected health information to facilitate specified government functions relating to military and veterans' activities, national security and intelligence activities, protective services for the President and others, medical suitability determinations, correctional institutions, and law enforcement custodial situations.
III. Uses and Disclosures Permitted Without Authorization But With Opportunity to Object
Your protected health information may be disclosed to a member of your family member or a close personal friend if it is directly relevant to the person's involvement in your care. Your information may be disclosed in connection with trying to locate or notify family members or others involved in your care concerning your location, condition or death.
You may object to these disclosures. We may disclose your protected health information as described. If you do not object to these disclosures or we can infer from the circumstances that you do not object or we determine, in the exercise of our professional judgment, that it is in your best interest for us to make disclosure of information that is directly relevant to the person's involvement with your care.
IV. Uses and Disclosures Which You Authorize
Other than as stated above, we will not disclose your health information other than with your written authorization. You may revoke your authorization in writing at any time except to the extent that we have taken action in reliance upon the authorization.
V. Your Rights
You have the following rights regarding your health information:
A. The Right to inspect and copy your protected health information. You may inspect and obtain a copy of your protected health information that is contained in a designated record set for as long as we maintain the protected health information. (This provision excludes any confidential records or communications from sources outside ADCAS, i.e. police reports, Residence Life conduct or incident information, etc.) A "designated record set" contains contact records and any other ADCAS records or materials that an ADCAS service provider uses for making decisions about you.
Under Federal law, however, you may not inspect or copy the following records: client contact notes; information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to a law that prohibits access to protected health information. Depending on the circumstances, you may have the right to request a review of a decision to deny access to your records.
Your request to inspect or copy your protected health information may be denied if, in our professional judgment, we determine that the access requested is likely to endanger your life or safety or that of another person, or that it is likely to cause substantial harm to another person referenced within the information. You have right to request a review of this decision.
To inspect and copy your file information, you must submit a written request to the ADCAS Coordinator or Prevention and Wellness Services (PWS) Program Director whose contact information is listed on the last pages of this Notice. If you request a copy of your information, we may charge you a fee for the costs of copying, mailing, or other costs incurred by us in complying with your request. Please contact the ADCAS Coordinator or the PWS Program Director if you have questions about access to your ADCAS record.
B. The right to request a restriction on uses and disclosures of your protected health information. You may ask us not to use or disclose certain parts of your protected health information for the purposes of service provision, payment or service operations. You may also request that we not disclose your health information to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
ADCAS is not required to agree to a restriction that you may request. You will be notified if your request to a restriction is denied. If ADCAS does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency care. Under certain circumstances, we may terminate our agreement to a restriction. You may request a restriction by contacting the ADCAS Coordinator or the PWS Program Director.
C. The right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to request that we communicate with you in certain ways. We will accommodate reasonable requests. We may condition this accommodation by asking you for specification of an alternative address or other method of contact. We will not require you to provide an explanation for your request. You can notify ADCAS by writing to the ADCAS Coordinator or the PWS Program Director.
D. The right to have the ADCAS Coordinator or the PWS Program Director amend your protected health information. You may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with ADCAS. We may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Requests for amendment must be in writing and must be directed to the ADCAS Coordinator or the PWS Program Director. In this written request, you must also provide a reason to support the requested amendments.
E. The right to receive an accounting. You have the right to request an accounting of certain disclosures of your protected health information made by ADCAS. This right applies to disclosures for purposes other than services provided, payment or service operations as described in this Notice of Privacy Practices. We are also not required to account for disclosures that you requested, disclosures that you agreed to by signing an authorization form, disclosures for a facility directory, to friends or family members involved in your care, or certain other disclosures we are permitted to make without your authorization. The request for an accounting must be made in writing to the ADCAS Coordinator. The request should specify the time period sought for the accounting. We are not required to provide an accounting for disclosures that take place prior to April 14, 2003. Accounting requests may not be made for periods of time in excess of six years. We 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.
F. The right to obtain a paper copy of this notice. Upon request, we will provide a separate paper copy of this notice even if you have already received a copy of the notice or have agreed to accept this notice electronically.
VI. Our Duties
ADCAS is required by law to maintain the privacy of your health information and to provide you with this Notice of our duties and privacy practices. We are required to abide by terms of this Notice as may be amended from time to time. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all protected health information that we maintain. If ADCAS changes its Notice, we will provide a copy of the revised Notice to students currently involved in ADCAS services by sending a copy of the Revised Notice via email, regular mail or at the time of your next ADCAS service.
You have the right to express comments or complaints about our privacy practices to ADCAS, Counseling, Health and Wellness Services (CHW) Privacy Officer, and to the Secretary of Health and Human Services if you believe that your privacy rights have been violated. You may address complaints , concerns, or comments to ADCAS by contacting the ADCAS Coordinator, the Program Director of PWS or the CHW Privacy Officer verbally or in writing, using the contact information below. We encourage you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
VIII. Contact Person
The contact people for all issues regarding protected health information and your rights under the Federal privacy standards are the Coordinator of ADCAS, the PWS Program Director, or the CHW Privacy Officer. Information regarding matters covered by this Notice can be requested by contacting any of the contact people listed above.
Complaints against the ADCAS program can be directed to the ADCAS Coordinator, PWS Program Director, or the Privacy Officer for Counseling, Health and Wellness Services.
Prevention and Wellness Services, MS - 9039
Attn: Alcohol and Drug Consultation and Assessment Services
Western Washington University
516 High Street
Bellingham, WA 98225
Student Health Services, MS - 9132
Western Washington University
516 High Street
Bellingham, WA 98225
Call or Email
ADCAS Risk Reduction Specialist | 360.650.6865 | email@example.com
Prevention and Wellness Services Director | 360.650.3643 | firstname.lastname@example.org
Privacy Officer for Counseling, Health, and Wellness Services | 360.650.3400 | Privacy.Officer@wwu.edu
IX. Effective Date
This Notice is effective April 14, 2003.