Patient Privacy
Patient Privacy
Eastside Cardiology Associates

Each time you visit a hospital, physician, or other health care provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment. This information is often referred to as your health or medical record. At Eastside Cardiology Associates we understand that medical information about you and your health is personal, and we are committed to protecting your medical information.


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 recommend care.

    For health care operations:

  • We may use your medical records to assess quality and improve services.
  • We may use and disclose medical records to review the qualification and performance of our health care providers and to train our staff.
  • We also may use and disclose your medical information to contact you to remind you of an upcoming appointment. We may send a postcard reminder for you to call our office for an appointment or we may leave a message regarding an appointment or test results on your answering machine.
  • 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.

    Your Health Information Rights

    You have the right to look at your own medical information and to get a copy of that information. The law requires us to keep the original record. This includes your medical record, your billing record and other records we use to make decisions about your care. To request your medical information, please fill out a form to be provided by Eastside Cardiology Associates. Standard copy fees will be assessed.

  • If you examine your medical information and believe that some of the information is wrong or incomplete, you may ask us to amend your record. Your request must be made in writing and submitted to the Privacy Officer and a reason must be provided to support your request. This request may be denied and you will receive a written response if your request is denied. Both the request and denial will be stored in your medical record and included with any release of your records.

  • You may request a list of disclosures of your health information. The list will not include disclosure to third-party payors. You may receive this information without charge once every 12 months. There will be a charge involved if you request this information more than once in 12 months.

  • You may request that your health information be given to you by another means or at another location. To make this request, please fill out a form to be provided by Eastside Cardiology Associates.

  • You may 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.


    We are legally required to use or disclose your personal health information without your consent to meet special reporting requirements, to facilitate continuity of care, or for public health or other purposes. For example, we provide:

  • Information about your personal health information to other care providers such as physician, nurses, therapists and others who are involved in your care.
  • Reports for the Food and Drug Administration
  • Data for health oversight activities such as auditing or licensure
  • Reports on communicable diseases
  • Reports to employers for work-related illness or injuries such as in Workers’ Compensation
  • Reports on abuse, neglect or domestic violence
  • Reports to avert a serious threat to health or safety or to prevent serious harm to an individual
  • Communication with designated family members or other individuals who you select as your personal representative about your care.
  • Information for law enforcement purposes such as when we receive a subpoena, court order or other legal process.

    If you have general questions about this notice or would like additional information, please contact the Privacy Officer for Eastside Cardiology Associates. If you are concerned that we have violated your privacy, or you disagree with a decision we made about your access to your record, you may contact our Privacy Officer. All reports related to potential privacy violations will be forwarded to the Privacy Officer for investigation and follow-up.

    Mary Surprenant, Privacy Officer for Eastside Cardiology Associates
    12333 NE 130th Lane Suite 320
    Kirkland, WA 98034 Phone: 425-899-0555

    You may also send a written complaint to:
    Washington State Department of Health
    510 – 4th Avenue West, Suite 404
    Seattle, W 98119

    From time to time, we may change our practices concerning how we use or disclosure patient medical information, or how we will implement patient rights concerning their information. We reserve the right to change this notice and to make the provisions in our new notice effective for all medical information we maintain. If we change these practices, we will publish a revised Notice of Privacy Practices. The revised notice will be posted at our places of service and on our web site at:

    This notice is effective April 14, 2003