Troy H. Dillard, MD
 Terry Noyes, PA-C
 Jessica Gow-Lee, FNP-BS
6485 SW Borland Road, Suite B, Tualatin, OR 97062  Voice:800.363.6499  Fax:866.600.0813

Notice Privacy Practices

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

The clinic is required by law to maintain your privacy. This notice describes how we may use or disclose your health information. We are required by law to give you this notice, and we are required to follow the terms of this notice.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION

Treatment

We may use or disclose health information about you to provide you with treatment or other services. For example, information may be shared with the clinic doctors, nurses, medical assistants and other healthcare personnel. We may also share information with providers at another clinic or hospital that will be seeing you for treatment purposes.

Payment

We may use or disclose your health information to get payment for the services that you receive at the clinic. For example, we may provide information to your health plan in order to obtain payment for the care that we provided to you.

Healthcare Operations

We may use or disclose your health information for healthcare operations. Healthcare operations include quality improvement for the services you receive at our clinic. We may also give information about you to state and federal agencies for population based activities to improve the health of our patients.

Healthcare Operations includes reporting information for public health activities, such as immunization reporting and communicable disease reporting.

Your health information may be shared by Northwest Endocrinology, LLC  with other providers when necessary for health care operations purposes of the clinic.

Appointment Reminders

We may call you or send you a letter to remind you that you have an appointment at the clinic, unless you tell us not to.

Treatment Alternatives

We may use your health information to tell you about services that may be of interest to you.

Individuals Involved in Your Care or Payment for Your Care

We may disclose your health information to your family or other people who are involved in your health care. You have the right to object to the sharing of your information.

Public Health Activities

We may use or disclose health information about you for public health activities required or permitted by law.

Victims of Abuse, Neglect or Domestic Violence

If we suspect abuse, neglect or domestic violence, we may disclose health information about you as required or permitted by law.

Health Oversight Activities

We may give health information to a health oversight agency that monitors the State health care delivery system.

Judicial and Administrative Proceedings

We may disclose health information about you in response to a court order.

Law Enforcement

We may disclose health information about your when required or permitted by Federal or State law.

Required by Law

We may disclose health information about you when we are required to do by Federal or State law.

Coroners

We may disclose your health information to a coroner, medical examiner or funeral director as authorized by law.

Organ and Tissue Procurement

We may disclose your health information to organizations for organ, eye or tissue procurement, tissue banking or transplantation.

Research

We may disclose your health information for research purposes if you have signed an authorization to disclose your information, or if an Institutional Review Board has waved that requirement.

Health or Safety

We may disclose your health information to law enforcement in order to avoid a serious threat to the health and safety of a person, or the public.

Worker’s Compensation

We may disclose your health information as authorized by law to the Worker’s Compensation Program.

Specialized Government Functions

We may disclose your health information to government agencies with special functions as required or permitted by law.

DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION

Marketing

We may communicate with you about products or services related to your treatment, case management or care coordination. However, we must obtain your authorization prior to using your health information to send you any marketing material that results in payment to us that is above and beyond the cost of providing the service for our clinic.

Sale of Protected Health Information

We are required to obtain your authorization for the sale of your protected health information in exchange for payment.

Other Laws Protecting Health Information

Other laws may require your written authorization to disclose certain mental health, alcohol and drug treatment, HIV/AIDS testing or treatment and genetic testing information.

Other uses and disclosures not described in this notice will be made only with your written authorization.

YOUR PROTECTED HEALTH INFORMATION PRIVACY RIGHTS

Right to Inspect and Copy

You have the right to look at or get copies of your records. You must make that request in writing. You may be charged a fee for copying your records; however, if you are unable to pay, we won’t restrict your right to obtain copies.  You also have a right to request your records in an electronic format.

Right to Request an Amendment

You have the right to request that we amend your health information that we maintain in your medical record or billing records. You must request the change in writing. We may deny your request under certain circumstances.

Right to a List of Disclosures

You have the right to be notified following any unauthorized disclosure of your protected health information. It is the intention of our clinic to notify affected individuals immediately following the discovery of a breach of protected health information.  You also have the right to ask for a list of certain disclosures of your health information that occurred after February 2006. The list will not include disclosures that were made with your authorization.

Right to Opt Out of Fundraising Campaigns

Some clinics participate in fundraising activities using individuals’ names and treatment dates.   If our clinic chooses to participate in any fundraising campaigns using your information, you will be sent a notice about the fundraising activity and you will be given an opportunity to tell us that you don’t want your information used that way. Doing that will mean that you have opted out of participating.  You may also request to opt out of all future fundraising communications, but if you do that,  you will need to opt back in  if you change your mind, by sending us a letter telling us that you would like to start getting those letters or notices, again.

Right to Request Restrictions

You have the right to request restrictions on how your information is used or disclosed. You must make your request in writing.  This includes your right to limit disclosure of information for treatment or services you (or a family member or friend) paid for in-full out of your own pocket.  This does not include services that have been paid for in-whole or in-part by your health plan.

Right to Request Confidential Communications

You have the right to request to receive communications from us in a certain way or to a certain place in order to protect your confidentiality. We will accommodate reasonable requests.

Right to Revoke Your Authorization

You have the right to revoke an authorization that you previously made for release of your health information. In situations where we may have already released your health information, we cannot take the information back. However we will stop releasing any more of your information.

Right to Receive a Paper Copy of this Notice

You have the right to receive a paper copy of this notice at any time.

Complaints

You have the right to file a complaint with Troy Dillard, MD who is the clinic’s Privacy Officer. You may also file a written complaint with the Secretary of the Department of Health and Human Services in Washington, DC. We will not retaliate against you if you file a complaint.

EFFECTIVE DATE OF THIS NOTICE

This notice is effective on 9/1/2013. We reserve the right to change this notice. If we change the notice, we will post a current copy of the notice, and will make a copy of the new notice available to you.

FOR MORE INFORMATION

For more information about this notice, or if you need more information, please contact the clinic’s Privacy Officer.