WASHINGTON UNIVERSITY
HIPAA Privacy Policy # 16
Restrictions on
Use or Disclosure of Protected Health Information
Statement of Policy
Washington University and its member organizations (collectively, “Washington University” or “WU”) are committed to conducting business in compliance with all applicable laws, regulations and WU policies. As part of this commitment, WU has adopted a policy to provide Individuals with the opportunity to request restrictions on the Uses and Disclosures of their Protected Health Information (PHI) and to accommodate reasonable requests for confidential communication of their PHI.
Scope of Policy
Individuals have the right to request restrictions on the Use or Disclosure of their PHI for purposes of Treatment, Payment or Health Care Operations, on Disclosures made to persons involved in the Individual’s care or on prior authorized research data. Individuals also have the right to request how WU will communicate with them concerning their PHI. This Policy addresses how requests for restrictions on the Use or Disclosure of PHI will be processed and how WU will respond to requests for confidential communications.
Policy
1) Right to Request Restrictions of Uses and Disclosures.
a) Requests for Restrictions on PHI. An Individual may request and WU accept for review a written request from an Individual for restrictions on Uses and Disclosures of the Individual’s PHI to carry out Treatment, Payment or Health Care Operations, and on Disclosures to persons involved in the Individual’s care. WU will inform Individuals that requests for restrictions of Uses and Disclosures of PHI must be submitted in writing on the form attached hereto as Exhibit A.
b) Responses to Requests for Restrictions.
i) General Rule. WU is not required to agree to any requested restriction(s) from an Individual. Prior to agreeing to a requested restriction, a member of the WU Workforce must consult with the Privacy Liaison in his or her Business Unit.
ii) WU must agree to an Individual’s request for restriction if the request is to restrict disclosure of the Individual’s health information to their health plan if the disclosure is not required by law and the health information the Individual is requesting to be restricted pertains solely to a health item or service for which the Individual (or someone on the Individual’s behalf) has paid us for in full at the time the service was provided.
ii) Uses and Disclosures Not Subject to Restriction Requests. Notwithstanding an agreement to the contrary by WU, an Individual’s request for a restriction is not effective to prevent WU from Using or Disclosing PHI permitted or required to be Used or Disclosed: (a) to the Secretary Of Health and Human Services to investigate or determine WU’s compliance with HIPAA; (b) for a facility directory; (c) as Required by Law; (d) for public health activities; (e) concerning victims of abuse, neglect or domestic violence; (f) to health oversight activities; (g) for judicial and administrative proceedings; (h) for law enforcement purposes; (i) to coroners, medical examiners or funeral directors; (j) for cadaveric organ, eye or tissue donation; (k) to avert a serious threat to health or safety; (l) for specialized government functions; or (m) for workers compensation.
iii) Documentation. If WU agrees to a restriction it must document the restriction in writing or electronically and retain a copy of the restriction for six (6) years from the date the restriction was created or last effective, whichever is later. Example: Authorization may allow Use or Disclosure for longer periods.
iv) Emergency Situations. WU may Use or Disclose PHI in violation of an agreed upon restriction if the Individual who requested the restriction is in need of emergency Treatment and the restricted PHI is needed to provide such Treatment. If restricted PHI is Disclosed for emergency Treatment, WU must request that the recipient of the restricted PHI not Use or further Disclose the restricted information.
v) Termination of a Restriction. WU may terminate its agreement to a restriction if: (i) the Individual agrees to or requests the termination in writing; (ii) the Individual orally agrees to the termination and the oral agreement is documented; (iii) WU informs the Individual that it is terminating its agreement to the restriction, in which case the termination is effective only with respect to PHI created or received after the date WU so notifies the Individual.
2) Right to Request Alternate Means or Location to Receive Confidential Communications.
a) General Rules for Confidential Communications:
i) WU will accept for review and accommodate reasonable written requests from Individuals for alternative means or alternate locations to receive confidential communication(s) of PHI from WU. WU will inform Individuals that requests for alternative means or alternate locations to receive confidential communications must be submitted in writing on the form attached hereto as Exhibit B.
ii) WU’s Health Plans will accept for review and accommodate reasonable written requests from Individuals to receive communications of PHI from the Health Plan by alternative means or alternative locations, if the Individual clearly states that Disclosure of all or part of the information could endanger the Individual.
b) Request For Alternate Methods to Receive Confidential Communications.
i) WU may not require an explanation from an Individual to support the request for an alternative method to receive confidential communications or as a condition of sending confidential communications in the manner requested.
ii) WU’s Health Plans may require that the request for an alternative method to receive confidential communication contain a statement that Disclosure of all or part of the information related to the request could endanger the Individual.
iii) WU may condition accommodating a request on its receipt of information as to how the Individual will handle Payment, if any, and specification of an alternate address or other method of contact.
Creation Date: November 22, 2002
Effective Date: April 14, 2003
Last Revision Date: January 13, 2003; August 6, 2013
EXHIBIT A
Request for Restrictions on
Uses or Disclosures of Protected Health Information
Washington University will accept for review written requests for certain restrictions on its Use and Disclosures of your Protected Health Information ("PHI") including restrictions on Uses or Disclosures for Treatment, Payment, and Health Care Operations and restrictions on Disclosures to persons involved in your care, such as family or friends. Washington University is not required under federal or state law to agree to abide by any requested restriction except we must agree to your request to restrict disclosure of your health information to your health plan in the disclosure is not required by law and the health information you want restricted pertains solely to a health care item or service for which you (or someone other than your health plan, on your behalf) have paid us for in full at the time the service was provided.
In accordance with federal regulations, requests for restrictions will also not affect Washington University’s Use or Disclosure of PHI in certain circumstances such as disclosures for public health activities, to report victims of abuse, neglect or other violence, to the federal or state health departments, or for law enforcement or judicial purposes.
Request Date: ______
Individual Name: ______
Date of Birth: ______SSN:
Individual Address:______
Telephone Number: (H)______(W)______
1. I hereby request a restriction
2. I hereby request the following restriction(s) on the internal Use of my PHI by Washington University in connection with my medical treatment, payment or other health care operations: . .
3. I hereby request the following restriction(s) on the external Disclosure of my PHI to third parties by Washington University in connection with my medical treatment, payment or other health care operations: ______
4. I understand that Washington University and its members are not required to agree to my requested restriction(s). I further understand that Washington University will not agree to a restriction that prevents uses or disclosures permitted or required as described in the Notice of Privacy Practices.
5. I understand that even if my requested restriction is accepted, Washington University may use or disclose restricted information if such information is necessary to provide me with emergency treatment.
6. I understand that Washington University may terminate an agreed upon restriction, in which case the termination is effective only with respect to PHI created or received after the date that Washington University notifies me of the termination. I further understand that I may terminate an agreed upon restriction orally or in writing.
______
Signature of Individual or Personal Representative Date
For Washington University Use Only:
Date of Response:
Restriction Agreed Upon
Restriction Denied
Signature of Staff Person ______Date ______
Print Name & Title______
EXHIBIT B
Request for Alternative Methods of
Confidential Communications
Washington University will accept for review written requests for alternative means or locations for you to receive confidential communications of your Protected Health Information ("PHI"), such as lab results or other related information. Washington University will accommodate reasonable requests for alternative means or locations, provided that it receives accurate information concerning how you will handle payment for patient services, how it may contact you (or your personal representative), and whether the alternative designated will be administratively difficult for Washington University to follow.
Request Date: ______
Individual Name: ______
Date of Birth: ______SSN:
Individual Address:______
Telephone Number: (H)______(W)______
1. For communications of PHI, please make all contacts as follows:
(complete only the acceptable method(s) of communication)
By U.S. Mail at the following address:
By Telephone at: ( )
By Email at:
Other Alternative Means:
2. Payment information should be sent to: (Must be completed to process request)
3. For other questions, you may contact me at:
( )
For Health Plans Communications Only: Please provide an explanation concerning the reason for your request for alternative means or locations for confidential communications. You must provide a reason that the disclosure of all or part of your PHI could endanger you.
Signature of Individual or Personal Representative Date
For Washington University Use Only:
Date of Response:
Request Agreed Upon
Request Denied
Signature of Staff Person ______Date ______
Print Name & Title______
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