WILLAMETTE FAMILY

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.

Willamette Family (“WF”) is required by law to maintain the privacy and security of your Protected Health Information (“PHI”), provide you with this Notice of Privacy Practices, and comply with the terms of this Notice currently in effect.

PHI is information that may identify you and relates to your past, present, or future physical or mental health condition, treatment, or payment for health care services.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights regarding your PHI:

Right to Inspect and Obtain Copies
You have the right to inspect and obtain a copy of your PHI maintained by WF, including most clinical and billing records. Requests must be submitted in writing. WF may charge a reasonable, cost-based fee for copying and mailing records as permitted by law. In certain circumstances, access may be denied. If access is denied, you may have the right to request a review of the decision.

Right to Request an Amendment
If you believe information in your record is incorrect or incomplete, you may request an amendment in writing. You must provide a reason supporting your request. WF may deny the request under certain circumstances. If denied, you may submit a written statement of disagreement.

Right to Request Restrictions
You have the right to request restrictions on certain uses or disclosures of your PHI. Requests must be made in writing. While WF will consider all reasonable requests, we are not required to agree to every requested restriction except as otherwise required by law.

Right to Request Confidential Communications
You have the right to request that we communicate with you in a specific way or at a specific location. For example, you may request that we contact you only by mail or at an alternative address. Requests must be made in writing, and WF will accommodate reasonable requests.

Right to an Accounting of Disclosures
You have the right to receive an accounting of certain disclosures of your PHI made by WF. Requests must be made in writing and may cover a period of up to six years prior to the date of the request, subject to applicable legal limitations. The first accounting in any 12-month period is free; additional requests may result in a reasonable fee.

Right to Receive a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice at any time, even if you have agreed to receive it electronically.

OUR USES AND DISCLOSURES OF PHI

The following are examples of how WF may use and disclose your PHI without your written authorization:

Treatment
We may use and disclose your PHI to provide, coordinate, or manage your treatment and related services.

Payment
We may use and disclose your PHI to obtain payment for services provided to you, determine insurance eligibility, obtain prior authorization, and process billing activities.

Health Care Operations
We may use your PHI for activities necessary to operate our organization, including quality improvement, staff training, accreditation, licensing, auditing, and business planning.

Business Associates
We may disclose PHI to business associates who perform services on our behalf. These business associates are required by law and contract to protect the privacy and security of your information.

Individuals Involved in Your Care
When appropriate, we may disclose relevant information to family members, friends, or others involved in your care or payment for your care, unless you object or as otherwise restricted by law.

As Required by Law
We may use or disclose your PHI when required by federal, state, or local law.

Public Health and Safety Activities
We may disclose PHI for public health activities, to report abuse or neglect when required by law, to prevent or lessen a serious threat to health or safety, or for other purposes authorized by law.

Health Oversight Activities
We may disclose PHI to health oversight agencies for audits, investigations, inspections, licensure activities, and other oversight functions authorized by law.

Judicial and Administrative Proceedings
We may disclose PHI in response to a court order, subpoena, or other lawful process as permitted or required by law.

Law Enforcement
We may disclose PHI to law enforcement officials under circumstances permitted or required by law.

SPECIAL PROTECTIONS

Certain records, including substance use disorder treatment records and other specially protected information, may be subject to additional federal and state confidentiality laws. In those cases, WF will comply with the more restrictive requirements.

Minor Patients
WF complies with applicable federal and Oregon laws regarding minors’ rights, parental access, consent, and confidentiality. Access to a minor’s PHI may be limited in circumstances where state or federal law grants the minor confidentiality protections.

OTHER USES AND DISCLOSURES

Uses and disclosures not described in this Notice generally require your written authorization. You may revoke an authorization at any time in writing, except to the extent that WF has already relied upon it.

OUR RESPONSIBILITIES

WF is required by law to:

• Maintain the privacy and security of your PHI.
• Provide you with this Notice of Privacy Practices.
• Abide by the terms of this Notice.
• Notify you following a breach of unsecured PHI when required by law.
• Inform you of any material changes to this Notice.

WF reserves the right to revise this Notice and make the revised Notice effective for all PHI maintained by WF. Current versions of the Notice will be available upon request and on our website, if applicable.

QUESTIONS OR COMPLAINTS

If you have questions about this Notice or believe your privacy rights have been violated, you may contact us.

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.

You will not be retaliated against for filing a complaint.