I am required by law to maintain the privacy of protected health information and must inform you of our privacy practices and legal duties. You have the right to obtain a paper copy of this Notice upon request.

I am required to abide by the terms of the Notice of Privacy Practices that is the most current. I reserve the right to change the terms of the Notice at any time. Any changes will be effective for all protected health information that I maintain. You may request a copy of the revised Notice at any time.

I have a designated a Privacy Officer to answer any of your questions about our privacy practices and to ensure that we comply with the applicable laws and regulations. The Privacy Officer will also take your complaints and can give you information about how to file a complaint.

The Privacy Officer is Robert Poe, PsyD. You can contact the Privacy Officer at 503-957-2497.

Use and disclosure of your protected health information that I may make to carry out treatment, payment, and health care operations.

I may use information in your record to provide treatment to you. I may disclose information in your record to help you get health care services from another provider, a hospital, etc. For example, if I want an opinion about your condition from a specialist, I may disclose information to the specialist to obtain that consultation.

I may use or disclose information from your record to obtain payment for the services you receive. For example, I may submit your diagnosis with a health insurance claim in order to demonstrate to the insurer that the service should be covered.

I may use or disclose information from your record to allow “health care operations.” These operations include the activities like reviewing records to see how care can be improved, contacting you with information about treatment alternatives, and coordinating care with other providers.

The examples provided in each category are not meant to be exhaustive but instead are meant to describe the types of uses and disclosures that are permissible under federal and state law.

You may ask me to restrict the use and disclosure of certain information in your record that otherwise would be allowed for treatment, payment, or health care operations. However, I do not have to agree with these restrictions.

Your Rights

You have the right to receive confidential communications from me. For example, if you want to receive bills and other information at an alternative address, please notify me.

You have the right to inspect the information in your record, and may obtain a copy of it. This may be subject to certain limitations and fees. Your request must be in writing.

If you believe information in your record is inaccurate or incomplete, you may request an amendment of the information. You must submit sufficient information to support your request for amendment. Your request must be in writing.

Except as described in this Notice, I may not make any use or disclosure of information from your record unless you give your written authorization. You may revoke an authorization in writing at any time, but this will not affect my use or disclosure made by me before the revocation. In addition, if the authorization was obtained as a condition of obtaining insurance coverage, the insurer may have the right to contest the policy or a claim under the policy even if you revoke the authorization.

Use or disclosure of your protected health information that I am required to make without your permission.

In certain circumstances, I am required by law to make a disclosure of your health information. For example, state law may require me to report suspected child abuse or neglect. Also, I may disclose information to the Department of Health and Human Services, if requested, to prove that I am complying with regulations that safeguard your health information.

Use or disclosure of your protected health information that I am allowed to make without your permission.

There are certain situations where I am allowed to disclose information from your record without your permission. In these situation I must use my professional judgment before disclosing information about you. Usually, I must determine that the disclosure is in your best interest and may have to meet certain guidelines and limitations.

If you receive mental health care, including treatment for substance abuse, information related to that care may be more protected than other forms of health information. Communication between a psychotherapist and patient in treatment is privileged and may not be disclosed without your permission, except as required by law.

For example, psychotherapists still must report suspected child abuse, and may have to breach confidentiality if you appear to pose an imminent danger to yourself or others, in order to reduce the likelihood of harm to you or others.

I may use or disclose information from your record if I believe it is necessary to prevent or lessen a serious or imminent threat to the safety of a person or the public. I may report suspected cases of abuse or neglect, or domestic violence involving adult or disabled victims.

I may assist in health oversight activities, such as investigations of possible health care fraud.

I may disclose information from your record as authorized by workers’ compensation laws.

I may disclose information from your record if ordered to do so by a court, grand jury, or administrative tribunal. Under certain conditions, I may disclose information in response to a subpoena or other legal process, even if it is not ordered by a court.

If you tell me that you have committed a past violent crime in a counseling or psychotherapy session, or in the course of treatment for this sort of behavior, I may not disclose that information to law enforcement officials.

However, if you tell me of your intent to commit a serious crime in the future, I may be required to report that information to law enforcement.

I may disclose information from your record to a law enforcement official if certain criteria are met. For example, if such information would help locate or identify a missing person, I am allowed to disclose it.