Our organization is committed to providing you with medical care that meets your needs. An important aspect of our service commitment to you is the protection and security of the protected health information that we obtain about you. We have always safeguarded your health information and our written privacy policy gives us an opportunity to share with you our policies that protect your health information.
We are required by law to provide you with this notice. It will describe to you what protected health information we collect about you and how that information might be used.
Sections:
Demographic Information: including your name, address, date of birth, phone number(s), name of your employer, your spouse or other family members, and emergency contact.
Insurance Information: including your insurance carrier, the name of the insured person, insurance identification numbers, and benefits and eligibility information.
Health Information: including your health history, past illnesses or injuries, family medical history, your social activities including use of tobacco, alcohol, or drugs, family life and living situation, your current and/or ongoing health problems, including medications, allergies, advised treatment and outcomes of that treatment.
Payment Information: including your insurance carrier, your record of charges, adjustments, and payments to our organization.
We are not obligated to have your consent when using or disclosing protected health information for the following purposes:
We may use and disclose your health information to provide, coordinate or manage your health care and any related services. We may disclose information about you to doctors, dentists, nurses, technicians, office staff or other personnel who are involved in taking care of you and your health.
For example:
We may use and disclose your information to obtain payment for services you receive. If you pay in full for service out of pocket you have the right to restrict your information being given to any health plan.
For example:
We may use or disclose protected health information about you in order to evaluate our care for you or to meet a business need of the organization. These activities include quality assessment activities, employee review activities, training students, compliance audits by your insurance carrier, and conducting or arranging for other business activities.
For example:
We may also use or disclose protected health information to our Business Associates in the performance of health care operations. A Business Associate is an entity or person engaged by this organization to perform a business activity on behalf of the organization. Our Business Associates are obligated by contract to protect health information they receive or generate about you.
For example:
We are not obligated to have your consent when using or disclosing protected health information for the following purposes:
Examples:
Emergencies:
We may use or disclose protected health information in the case of a medical emergency.
Required by Law:
We may use or disclose your protected health information if the disclosure is required by law.
Public Health:
We may disclose protected health information about you for public health activities. These activities generally include the following:
Health Oversight:
We may disclose protected health information to health oversight agencies that oversee our activities. These activities may include audits, investigations and inspections and are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.
Lawsuits or Disputes:
If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. Subject to legal requirements, we may also disclose medical information about you in response to a subpoena.
Law Enforcement:
We may disclose protected health information, so long as all applicable legal requirements are met, for law enforcement purposes.
Coroners, Medical Directors and Funeral Directors:
We may disclose protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release information about patients to funeral directors as necessary to carry out their duties.
Workers Compensation:
We may disclose medical information about you for programs that provide benefits for work-related injuries or illness.
Military Activities, National Security and Intelligence Activities:
If you are a member of the armed forces, or part of the national security or intelligence communities, we may be required by military command or other government authorities to disclose protected health information about you. We may also disclose information about foreign military personnel to the appropriate foreign military authority.
Organ and Tissue Donation:
If you are an organ or tissue donor, we may disclose protected health information to organizations that handle organ or tissue procurement when necessary to facilitate organ or tissue donation or transplantation.
Inmates:
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. The release would be necessary
Serious Threats:
As permitted by applicable law and standards of ethical conduct, we may use or disclose protected health information if we, in good faith, believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Information that is not personally identifiable:
We may use or disclose information about you in a way that does not personally identify you.
Protected Health Information Use and Disclosure That Requires an Opportunity for You
to Agree or Object
We may disclose your protected health information to your family or friends or any other individual identified by you when they are involved in your care or the payment of your care. We will only disclose the protected health information directly relevant to their involvement in your care or payment. If you are available, we will give you an opportunity to object to these disclosures, and we will not make these disclosures if you object.
If you are not available, we will determine whether a disclosure to your family or friends is in your best interest, and we will disclose only the protected health information that is directly relevant to their involvement in your care.
How we may use and disclose protected health information about you:
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below.
You may revoke this authorization by notifying us in writing at any time.
You may inspect and obtain a copy of your protected health information maintained in our office. We may charge you for the cost of copying, mailing or associated supplies.
Under federal law, however, you may not inspect or copy psychotherapy notes or information compiled in reasonable anticipation of a civil, criminal or administrative action or proceeding. Certain documents pertaining to laboratory services are also exempt under federal law.
You have the right to an electronic copy of your records.
You have the right to request your records be sent via e-mail with the understanding that we will try and verify your email before sending. E-mail is not always secure and you are acknowledging this fact. This request must be done in writing.
Under certain circumstances, we may not grant your request. If we deny your request, then you may appeal our decision.
We require that requests to access your protected health information be made in writing. You
can arrange to do this through our Privacy Officer.
You may ask us not to disclose your protected health information for treatment, payment or
health care operations. You may also request that any part of your protected health information not be disclosed to friends and/or family members involved in your care.
We are not required to agree to your request. If we do agree, we will comply with your request
unless the information is needed to provide you with emergency care.
In order to request a restriction, you must do so in writing. The request must specifically state
what information is restricted and to whom the restriction applies.
You may request a restriction form from our Privacy Officer
If you believe that protected health information we have about you is incorrect or incomplete,
you may request an amendment to this information.
We may not grant your request if we determine that the protected health information that is the subject of your request:
Amendment requests must be made in writing and must include a reason for requesting the
amendment. If you wish to amend your record, you may contact our Privacy Officer for a form.
You have the right to receive an accounting of disclosures of protected health information made by us to individuals or entities other than you, except for disclosures:
You are allowed one free disclosure per each twelve-month period. If you wish additional
disclosures within that twelve-month period, we may charge you the cost of providing the
disclosure list.
Your request for a disclosure accounting must be made in writing. Please contact our Privacy
Officer to obtain a form.
If you believe that your privacy rights have been violated, you have a right to file a complaint in
the form of a written letter with our office and with the Secretary of Health and Human Services without fear of retaliation.
A letter of complaint filed with this office should be sent to our Privacy Officer at the address
listed below.
Privacy Officer
Address: 11782 SW Barnes Rd #300, Portland, OR 97225
Phone Number: 503-214-5200
We are required to abide by the terms of this Privacy Notice. We may change the terms of our
notice at any time. The new notice will be effective for all protected health information that we maintain at that time. This notice is in effect as of September 23, 2013. Upon your request, we will provide you with a revised Privacy Notice. You may obtain this by calling our office and
requesting that a revised copy be sent to you in the mail, or by asking for one at the time of your next appointment.
If you have questions about this document, or have questions about privacy or patient rights,
please contact our Privacy Officer.
Privacy Officer
Address: 11782 SW Barnes Rd #300, Portland, OR 97225
Phone Number: 503-214-5200