Utah Department
of Health, Children’s Health Insurance Program
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
The Utah Department of Health, Children’s Health Insurance Program
(CHIP) understands that your medical and health information is personal,
and is committed to protecting this information. CHIP is required
by law to keep your medical information private, to give this notice
to you, and to follow the terms of the notice.
CONFIDENTIALITY PRACTICES AND HOW WE USE YOUR HEALTH INFORMATION
CHIP may use your health information for conducting our business.
Examples include:
• Treatment - To appropriately determine approvals or denials
of your medical treatment. For example, CHIP health care professionals
may review your treatment plan by your health care provider for medical
necessity.
• Payment - To determine your eligibility in the CHIP program
and to make payments to your CHIP provider. For example, your health
care provider may send claims for payment to CHIP for medical services
provided to you.
• Health Care Operations - To evaluate the performance of a
health plan or a health care provider. For example, CHIP contracts
with consultants who review the records of hospitals and other organizations
to determine the quality of care you received.
• Informational Purposes - To give you helpful information such
as health plan choices, program benefit updates, free medical exams
and consumer protection information.
YOUR INDIVIDUAL RIGHTS
You have the right to:
• Request restrictions on how we use and share your health information.
We will consider all requests for restrictions carefully but are not
required to agree to any restriction.
• Request that we use a specific telephone number or address
to communicate with you.
• Inspect and copy your health information, including medical
and billing records. Fees may apply. Under limited circumstances,
we may deny you access to a portion of your health information and
you may request a review of the denial. *
• Request corrections or additions to your health information.
*
• Request an accounting of certain disclosures of your health
information made by us. The accounting does not include disclosures
made for treatment, payment, and health care operations and some disclosures
required by law. Your request must state the period of time desired
for the accounting, which must be within the six years prior to your
request and exclude dates prior to April 14, 2003. The first accounting
is free but a fee will apply if more than one request is made in a
12-month period.*
• Request a paper copy of this notice even if you agree to receive
it electronically.
Note: Requests marked with a star (*) must be made in writing.
Contact the CHIP Privacy Officer for the appropriate form for your
request.
SHARING YOUR HEALTH INFORMATION
There are limited situations when we are permitted or required to
disclose health information without your signed authorization. These
situations include activities necessary to administer the CHIP
program and the following:
• For public health purposes such as reporting communicable
diseases, work-related illnesses, or other diseases and injuries
permitted by law; reporting births and deaths; and reporting reactions
to drugs and problems with medical devices
• To protect victims of abuse, neglect, or domestic violence
• For health oversight activities such as investigations,
audits, and inspections
• For lawsuits and similar proceedings
• When otherwise required by law
• When requested by law enforcement as required by law or
court order
• To coroners, medical examiners, and funeral directors
• For organ and tissue donation
• For research approved by our review process under strict
federal guidelines
• To reduce or prevent a serious threat to public health and
safety
• For workers’ compensation or other similar programs
if you are injured at work
• For specialized government functions such as intelligence
and national security
All other uses and disclosures, not described in this notice, require
your signed authorization. You may revoke your authorization at
any time with a written statement.
OUR PRIVACY RESPONSIBILITIES
CHIP is required by law to:
• Maintain the privacy of your health information
• Provide this notice that describes the ways we may use and
share your health information
• Follow the terms of the notice currently in effect.
We reserve the right to make changes to this notice at any time
and make the new privacy practices effective for all information
we maintain. Current notices will be posted in CHIP offices and
on our website, http://health.utah.gov/hipaa. You may also request
a copy of any notice from the CHIP Privacy Officer listed below.
HOW TO CONTACT US
If you would like further information about your privacy rights,
are concerned that your privacy rights have been violated, or disagree
with a decision that we made about access to your health information
contact the CHIP Privacy Officer:
Gayleen Henderson, 801-538-6135;
288 North 1460 West, 4th Floor
PO Box 144102
Salt Lake City, Utah 84114-4102.
We will investigate all complaints and will not retaliate against
you for filing a complaint.
You may also file a written complaint with the Office of Civil
Rights, 200 Independence Avenue, S.W. Room 509F HHH Bldg., Washington,
DC 20201
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