Pacific Vascular Incorporated

Notice of Privacy Practices

For Our Patients




When you visit or call Pacific Vascular Incorporated or any other type of healthcare provider, a record of the visit or call is made.  The record usually contains information about your health such as your symptoms, examination findings, test results, diagnosis and treatment.  This information serves as a basis for communication between the healthcare professionals involved in your care and it is used to plan for your treatment needs.  Because bills must show what services you received and sometimes have to contain information justifying the need for those services, the bills that we and other healthcare providers send you or your insurers also contain information about your health.

This Notice of Privacy Practices should help you better understand what information is in the medical and billing records Pacific Vascular has about you, who uses this information, and why.  In addition, it should help you understand how you can ensure the accuracy of this information.  We also hope this Notice will help you make more informed decisions if you are asked to authorize us to release your medical or billing records to others.

Pacific Vascular has always been committed to protecting the privacy of your health information. We now are required by law to confirm this commitment to you in writing by furnishing you with this Notice of Privacy Practices.  The Notice describes our legal duties and our practices relating to the privacy of any medical or other personal information about you in our records. We must follow the procedures described in this Notice of Privacy Practices as long as the Notice remains in effect.  We reserve the right to change our privacy practices at any time and, if we make changes, we will apply our new privacy practices to all the information we have in our records about you and to any new information that we get after the change.

If we make significant changes to our privacy practices, we will revise our Notice of Privacy Practices to reflect the changes.  We will always have a copy of our current Notice of Privacy Practices posted in our offices and on our website.  In addition, you may get a paper copy of our current Notice of Privacy Practices at any time by contacting our Privacy Officer at:

Pacific Vascular Inc. / Attn:  Privacy Officer / 11714 N Creek Parkway N, Suite 100 / Bothell, WA  98011-8250 / (425)486-8868.

Pacific Vascular’s Management Team also can answer any questions you may have about this Notice.


When you come to Pacific Vascular for care, we will ask for personal information such as:

  • Your name, birthdate, social security number, address, and phone number
  • Information about your medical history
  • Information about your health insurance
  • Information about other doctors or healthcare providers that you have seen in the past or are seeing now

We also gather medical information about you when we examine you and from tests that we perform.   We may get information about you from others that are part of your “circle of care,” such as your referring physician, other healthcare providers that have seen you, healthcare facilities that have run tests on you, your health insurance plan, and, sometimes, even family members or close friends that help take care of you.  We always create a record of the information we collect, the health findings we make and the care we provide to you.  We also have records of the bills that we send you and your insurer for your care.



Pacific Vascular uses and discloses health information about our patients for a variety of purposes.  We regularly attempt to limit all uses and disclosures of your health information to the minimum amount of information necessary to accomplish the task at hand.  However, to be sure that you receive the best care possible, we will release your entire medical record when it is needed by other healthcare providers who are treating you.

This Notice of Privacy Practices identifies all of the types of uses and disclosures of individually identifiable health information that Pacific Vascularis permitted to make without obtaining a written authorization from you.  We have not described every kind of use or disclosure within each category.  Rather, we have only provided typical examples.  Although we do not expect to use or disclose every patient’s health information for each of the purposes described, all of the types of uses and disclosures that we can make without your written authorization are described below so you can understand how your information may be handled.

Required Disclosures:  We are required by law to release health information to the Secretary of the U.S. Department of Health and Human Services, upon request, if the government needs to check on our compliance with the federal laws governing the privacy of patient information.  We also are required by law to allow you to see and copy your records under most circumstances.  Your right to see your records is described in more detail below.


Uses and Disclosures For Treatment:  We will use and disclose your health information to assist us and those treating you.  For example, we typically consider your symptoms, your medical history, and our examination findings when we determine what is wrong with you.  To help us figure out what is wrong with you, we may also have to give health information about you to or get health information about you from other healthcare organizations that perform tests on you. On occasion, we also may look at information in medical records about you that we get from specialists or general practitioners who are or have been involved in treating you.

We may use your health information to contact you about appointment reminders or notices about the need to schedule a new appointment.

Uses and Disclosures For Payment:  We will use and disclose information about you to bill for our services and to collect payment from you or your insurance company.  For example, we must tell your insurance company what we did for you to get paid properly for the services we provided.  Sometimes, insurance companies make us tell them your diagnosis or give them other health information about you to help them decide how much to pay us.  We also may have to tell the insurance company about any surgery that you may need to get prior approval or to determine whether the insurance company will cover the procedure.

Uses and Disclosures For Healthcare Operations:  We will use health information about you for the general operation of our business.  For example, we may use our patients’ health information to evaluate and improve the quality of the health services we provide.  We also sometimes arrange for auditors or other consultants to review our practices and look at our operations so that they can help us figure out how to improve our services.


We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

For more information see:

We may use or disclose health information about you for any of the following purposes:

Help with public health and safety issues

We can share health information about you for certain situations such as:

  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety

Public health authorities include federal organizations such as the Food and Drug Administration, the Centers for Disease Control, the Occupational Safety and Health Administration, and the Environmental Protection Agency as well as a number of other state and local authorities.

Do research

We can use or share your information for health research.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director 

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests 

We can use or share health information about you:

  • For workers’ compensation claims
  • For law enforcement purposes or with a law enforcement official
  • With health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Disclosures To Our Business Associates:  We sometimes work with individuals and businesses that help us operate our business successfully.  We may disclose personal information about you to these business associates if they need it to perform the tasks that we hire them to do.  To protect your health information, we always include a provision in our contracts with our business associates requiring them to put procedures in place to safeguard the confidentiality of our patients’ health information. Examples of our business associates include consultants that we hire to help us ensure our compliance with applicable federal, state, and local laws, our lawyers, and our accountants. When we undergo voluntary accreditation by the Intersocietal Accreditation Commission (IAC) to assure our patients that we meet certain standards of care, we treat the accreditation organizations as we treat all our other business associates.

Disclosures to Persons Assisting in Your Care or Payment for Your Care:  We may disclose information about you to individuals involved in your care or in the payment for your care.  This includes people that are part of your “circle of care” such as your spouse, your children, or a friend or aide who is helping with your care or with your bills.  We also may use and disclose health information about you for disaster relief efforts and to notify persons responsible for your care about your location, general condition or death.  Generally, we will obtain your verbal permission before using or disclosing your health information for these purposes.  However, under certain circumstances, such as in an emergency, we may make these uses and disclosures without your agreement.


For certain health information, you can tell us your choices about what we share.

If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • Include your information in a hospital directory (We do not create or manage a hospital directory at Pacific Vascular Inc.)

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

  • Marketing purposes
  • Sale of your information
  • Most sharing of psychotherapy notes (We do not create or maintain psychotherapy notes at Pacific Vascular Inc.)

In the case of fundraising:

  • We may contact you for fundraising efforts, but you can tell us not to contact you again.



When it comes to your health information, you have certain rights.This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.

To be sure that we are handling our patients’ requests properly and in timely fashion, we ask patients to complete request forms describing the records they wish to see or have changed or the accounting that they need.  You may get the proper form from our Medical Records Department at:

Pacific Vascular Inc. / Attn:  Privacy Officer / 11714 N Creek Parkway N, Suite 100 / Bothell, WA  98011-8250 / (425)486-8868.


You can complain if you feel we have violated your rights by contacting us using the information on page 1.

You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting




We are required by law to maintain the privacy and security of your protected health information.

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

We must follow the duties and privacy practices described in this notice and give you a copy of it.

We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see:


We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site

This Pacific Vascular Notice of Privacy Practices is version 3.0 and is effective as of June 1, 2014.

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