Notice of Privacy Practices

PrimeWest Health is required by law to keep our member’s health information private. This is a commitment we take seriously. PrimeWest Health’s Notice of Privacy Practices explains members’ rights. It also explains PrimeWest Health’s legal obligations regarding the privacy of members’ health information. We are required to do the following:

• We must protect the privacy of health information, whether it is oral, written, or electronic
• We must tell members how we protect their health information. PrimeWest Health has physical, electronic, and administrative safeguards designed to protect health information and to stop unauthorized access.
• We must explain how, when, and why we use or disclose member health information
• We must explain members’ rights related to their health information and how members may exercise them

Are you a PrimeWest Health member? If so, it may help you to know that PrimeWest Health has developed forms to help you. These forms tell you how to inspect, access, amend, disclose, or take other actions regarding your health information. Below are links to the forms. We have included a description of what each form is about.

• Designation of an Authorized Representative/HIPAA Authorization to Release Information – Use these forms to choose an Authorized Representative. An Authorized Representative is a person you authorize to act for you when you are making a claim or Appealing a denied claim. You can also authorize PrimeWest Health to disclose and release information to this person. The information can include benefit eligibility, claim status, and/or claim approval or denial reasons.
• Authorization to Use or Disclose Protected Health Information (PHI) – Use this form to authorize an entity or person to use or disclose your health information to an entity or person other than you.
• Request to Revoke the Authorization to Use or Disclose Protected Health Information – Use this form to revoke (take back) authorization to use or disclose your health information. See the Notice of Privacy Practices to learn more about your right to take back authorization to use or disclose your health information.
• Request to Access Protected Health Information (PHI): Member Inspection – Use this form to ask for access to your health information. You may inspect the data. You may also get a copy of your records. See the Notice of Privacy Practices to learn more about your right to ask for access to your health information.
• Request to Access Protected Health Information (PHI): Member Amendment Request – Use this form to ask PrimeWest Health to amend (change) your health information. The form asks you to explain why you want your health information to be changed. See the Notice of Privacy Practices to learn more about your right to request changes to your health information.
• Request to Access Protected Health Information (PHI): Restriction on Use or Disclosure – Use this form to request a restriction on the use or disclosure of your health information. See the Notice of Privacy Practices to learn more about your right to limit use or disclose of your health information.
• Request for Alternative Communication – Use this form when you would like PrimeWest Health to communicate with you about confidential matters by alternative means. You should also use it if you want PrimeWest Health to communicate with you at alternative locations. See the Notice of Privacy Practices to learn more about your right to request alternative communications.
• Request to Access Protected Health Information (PHI): Accounting of Disclosure – Use this form when you would like to know to whom your health information was disclosed during a specific time period.
• Consent to Disclose Substance Use Disorder Records Subject to 42 CFR Part 2  – Use this form to authorize the sharing of your substance use disorder-related information among PrimeWest Health, your treatment provider, the county, and others.
   

PW_07-17_284
DHS_Approved_03/12/2021
Updated_03/12/2021