Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

Organizations Covered by This Notice

This Notice applies to the privacy practices of Center For Birth (CFB), and all other healthcare providers with admitting privileges at CFB.

Summary of Privacy Practices

We respect your privacy. We understand that your personal health information is very sensitive. We will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to do so.

The law protects the privacy of the health information we create and obtain in providing our care and services to you. For example, your protected health information includes your symptoms, test results, diagnoses, treatment, health information from other providers, and billing and payment information relating to these services. Federal and state law allows us to use and disclose your protected health information for purposes of treatment and health care operations. State law requires us to get your authorization to disclose this information for payment purposes.

Examples of Use and Disclosures of Protected Health Information for Treatment, Payment, and Health Operations

For treatment:

Information obtained by a nurse, physician, or other member of our health care team will be recorded in your medical record and used to help decide what care may be right for you.
We may also provide information to others providing you care. This will help them stay informed about your care.

For payment:

We request payment from your health insurance plan. Health plans need information from us about your medical care. Information provided to health plans may include your diagnoses, procedures performed, or recommended care.

For health care operations:

We use your medical records to assess quality, improve services, and train staff.
We may use and disclose medical records to review qualifications and performance of our health care providers.
We may contact you about appointments and give you information about health-related issues.
·We may use and disclose your information to conduct or arrange for services, including medical quality review by your health plan; accounting, legal, risk management, and insurance services; audit functions, including fraud and abuse detection and compliance programs.
We may contact you by phone to discuss protected health information. If you are not available to answer the phone, we may leave a message on your answering machine with instructions to call us back. If you would prefer us to leave detailed messages on your answering machine, you need to give your permission on the "Specific Authorizations" form.
It is our practice to organize and participate in fundraising events, both for the birth center and for the broader community. We may send you a letter, postcard, or invitation, or call your home to invite you to participate. We may use your demographic information, your type of insurance, and your children's place and date of birth for fundraising purposes. You have the right to opt out if you wish.

Your Health Information Rights

The health and billing records we create and store are the property of the practice/health care facility. The protected health information in it, however, generally belongs to you. You have a right to:

Receive, read, and ask questions about this Notice;
Ask us to restrict certain uses and disclosures. You must deliver this request in writing to us. We are not required to grant the request. But we will comply with any request granted;
Request that you be allowed to see and get a copy of your protected health information. You may make this request in writing. We have a form available for this type of request.
Have us review a denial of access to your health information-except in certain circumstances;
Ask us, in writing, to change your health information. You may write a statement of disagreement if your request is denied. It will be stored in your medical record, and included with any release of your records.
When you request, we will give you a list of disclosures of your health information. You may receive this information without charge once every 12 months.
Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released. It also does not affect any action taken before we have it. Sometimes, you cannot cancel an authorization if its purpose was to obtain insurance.

Our Responsibilities

We are required to:

Keep your protected health information private
Give you this Notice
Follow the terms of this Notice

We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice. You may receive the most recent copy of this Notice by calling and asking for it or by visiting the birth center to pick one up.

To Ask for Help or Complain

If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact us at info@centerforbirth.com.
If you believe your privacy rights have been violated, you may discuss your concerns with any staff member. You may also deliver a written complaint to our Privacy Officer or file a complaint with the U.S. Secretary of Health and Human Services.

Other Disclosures and Uses of Protected Health Information

Unless you object, we may release health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. Information may be provided to people who ask for you by name. We may use and disclose your name, location, and general condition. You have the right to object to this use or disclosure of your information. If you object, we will not use or disclose it.

We may use and disclose your protected health information without your authorization as follows:

For Medical Research which is approved and has its own safety precautions
To Comply With Workers' Compensation Laws
For Public Health and Safety Purposes as Allowed or Required by Law, to protect public health and safety, to prevent or control disease, injury, or disability, and to report vital statistics such as births or deaths.
To Report Suspected Abuse or Neglect to public authorities.
For Health and Safety Oversight Activities, e.g. with the Department of Health.
For Disaster Relief Purposes, e.g. notification of your condition to family or others.

Other Uses and Disclosures of Protected Health Information: Uses and disclosures not in this Notice will be made only as allowed or required by law or with your written authorization.

Birth Announcements
We may use photographs of you and or your baby in birth announcement postings at CFB, and/or for promotional purposes unless you opt out.

Contact Information
If you have any questions or suggestions regarding our privacy policy, please contact us.

Client Bill of Rights

Center for Birth (hereafter known as CFB) is a standalone birth center not part of any hospital. As such, CFB offers care only to low-risk clients as defined by the state of Washington and in accordance with the Midwives Association of Washington State Practice Guideline, during labor and the immediate postpartum period. I understand there are hospitals that serve the Seattle/King County areas as well.

As a Client at Center for Birth, you may exercise the following rights, as required by Chapter 256-329-085 in the Washington Administrative Code (WAC), Chapter 18.46 of the Revised Code of Washington (RCW). You have the right to:

Be informed of the policy and procedures for admission and discharge;
Be informed of the definition of a low risk maternal client, the benefits and risks of out-of-hospital labor and birth and complete a written informed consent, prior to the onset of labor that shall include, but not be limited to, evidence of an explanation by personnel of the birth services offered and potential risks and emergency transfer and transport procedures;
Be informed of what constitutes being ineligible for birth center services and the transfer policy and procedures of clients who, during the course of pregnancy or labor or recovery, are determined to be ineligible, including the birth center's plan for provisions of emergency and non-emergency care in the event of complications to mother and newborn;
Be informed that unexpected neonatal emergencies requiring complex resuscitation are rare, but can occur. Be informed that the birth center staff is prepared to provide initial steps of newborn resuscitation (upper airway clearance with a bulb or DeLee suction device) and provide bag-and-mask ventilation until emergency medical service providers arrive to provide complete resuscitation procedures if required;
Participate in decisions relating to the plan for management of care and all changes in that plan once established including consultation, referral and transfer to other practitioners or other levels of care;
Be informed of the policy and procedures for consultation, referral, transfer of care and transport of a newborn and maternal client to a hospital where appropriate care is available;
Be informed of prenatal screening under chapter 70.54 RCW and chapter 246-680 WAC;
Be informed of newborn screening requirements under chapter 70.83 RCW and chapter 246-650 WAC, including a provision of a copy of the parent information pamphlet "Newborn Screening Tests and Your Baby" which is available from the department's newborn screening program;
Be informed that rapid HIV testing is available for all maternal clients without a documented history of HIV testing during prenatal care;
Be informed of prophylactic treatment of the eyes of the newborn in accordance with WAC 246-100-206 (6)(b);
Be informed that vitamin K administration for the newborn is available;
Be informed that newborn hearing screening tests are offered in most hospitals;
Be provided with a description of the process for submitting and addressing complaints;
Submit complaints without retaliation and to have the complaint addressed by the licensee;
Be informed of the state complaint hotline number: 1-800-633-6828
Be treated with courtesy, dignity, respect, privacy, and freedom from abuse and discrimination
Refuse treatment or services;
Privacy of personal information and confidentiality of health care records;
Be cared for by properly trained personnel, contractors, students and volunteers and be informed of the qualifications of clinical staff, consultants and related services and institutions;
Be informed of all diagnostic procedures and reports, recommendations and treatments;
A fully itemized billing statement upon request, including the date of each service and the charge
Be informed about advanced directives and the licensee's responsibility to implement them;
Be informed of the client's right with regards to participation in research or student education programs;
Be informed of the liability insurance coverage of practitioners on request; and
Be informed of child passenger restraint systems to be used when transporting children in motor vehicles, including information describing the risks of death or serious injury associated with the failure to use a child passenger restraint system.

Registering Complaints

We take your safety and satisfaction seriously. There are two routes for entering a complaint against either your provider or the birth center facility. For more information see the following resources:

Health Systems Quality Assurance Complaint Intake, P.O. Box 47857, Olympi a, WA 98504-7857 Local: 360-236-4700 Email: HSQAComplaintIntake@doh.wa.gov