Use and Disclosure of Protected Health Information in Fundraising

Statement of Policy

Washington University and its member organizations (collectively, “Washington University” or “WU”) are committed to conducting fundraising in compliance with all applicable laws, regulations and WU policies to protect the privacy of the Protected Health Information (“PHI”) of its constituents. To help strengthen this commitment, WU has adopted this Policy in order to clearly define the circumstances under which PHI may be used in connection with fundraising activities and when an Authorization is required.

Scope of Policy

The scope of this Policy includes fundraising performed by WU.

Policy

a. Generally, WU may not Use or Disclose PHI for fundraising purposes without the Individual’s prior Authorization (see WU HIPAA Policy on Authorization Required to Use or Disclose Protected Health Information).

a. WU Health Care Providers may Use or Disclose the following PHI to an institutionally related foundation or office (i.e. the Alumni & Development Office) or to a Business Associate, for the purpose of raising funds for the benefit of WU or any of its members without prior authorization from the Individual:
(1) demographic information relating to an Individual; and
(2) dates of Health Care provided to an Individual.
b. Demographic information includes an Individual’s name, address and other contact information, age, gender and insurance status. It does not include information about a diagnosis, nature of the services received, or Treatment.

3. Requirements for Fundraising Communications.

a. All fundraising material WU sends to Individuals must include a description of how the Individual may opt out of receiving future fundraising communications.
b. WU must make reasonable efforts to ensure that Individuals who decide to opt out of receiving future fundraising communications are not sent such communications.
c. For all Uses or Disclosures of PHI for fundraising purposes, except those Uses or Disclosures of demographic information discussed above, an Individual’s Authorization must be obtained prior to such Use or Disclosure of PHI (i.e., targeted fundraising). A copy of the Charitable Giving Authorization is attached hereto as Exhibit A. Generally, WU will give all Individuals the opportunity to complete the Charitable Giving Authorization prior to Treatment. However, it should not be assume that a Charitable Giving Authorization has been obtained for any particular Individual. Therefore, one must confirm that a valid Charitable Giving Authorization is on file pursuant to the procedures applicable to this Policy.

a. WU may Disclose PHI for fundraising purposes to Business Associates that are performing fundraising activities on behalf of WU, provided that such Disclosure is in accordance with this Policy (i.e. Charitable Giving Authorization is obtained if necessary). WU must obtain a Business Associate Agreement from the Business Associate agreeing that it will only use the PHI for WU’s fundraising activities (see WU HIPAA Policy on Use or Disclosure of Protected Health Information with Business Associates).

Exhibit A

Charitable Giving Authorization
For the Use and Disclosure of Protected Health Information

Charitable giving to Washington University and its member institutions enables your physician to pursue the most promising research to fight disease and to provide you and your family with the highest quality patient care. Many patients wishing to make a gift often seek guidance in learning how to do so. The Office of Alumni & Development at Washington University can provide you with the information and education you need to realize your charitable objectives. The Health Insurance Portability and Accessibility Act (“HIPAA”) regulates how Washington University can communicate with you about your charitable objectives. This Authorization will allow for an open flow of information between you, Washington University and its members about charitable opportunities.

1. I authorize use and disclosure of the name of my treating physician(s); the nature of my treatment; and my projected outcome (collectively referred to as “Limited PHI”) in accordance with the terms of this Authorization. I understand that my demographic information (i.e. name, contact information, age, gender and insurance status) and dates of health care service may also be disclosed pursuant to the Notice of Privacy Practices.
2. I authorize my physician and/or health care provider(s) to make the authorized use and/or disclosure of my Limited PHI to institutionally related foundations and offices, including the Alumni & Development Office at the Washington University School of Medicine.
3. I authorize use and disclosure of my Limited PHI for the purpose charitable development and fundraising by Washington University and/or its members.
4. This Authorization expires twelve (12) months from the date that I sign this Authorization.
5. I understand that once my Limited PHI is used and/or disclosed pursuant to this Authorization, it may no longer be protected by the HIPAA privacy regulations and may be subject to re-disclosure by the recipient(s).
6. I understand that I have a right to revoke this Authorization at any time. My revocation must be in writing as described in the Notice of Privacy Practices. I am aware that my revocation is not effective to the extent that I have authorized the use and/or disclosure of my PHI and such use and/or disclosure has been relied upon by authorized recipients.
7. I understand that I do not have to sign this Authorization and that my refusal to sign will not affect my ability to obtain treatment from Washington University, nor will it affect my eligibility for benefits.
8. I understand that I have a right to inspect and copy my own protected health information to be used or disclosed in accordance with the Notice of Privacy Practices.
9. I certify that I have received a copy of the authorization.

______________________      ____________________

Signature                                   Date
________________________________
Name
_________________________       _________________________________
Name of Personal Representative     Relationship to Individual