THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
For more information, or to report a problem, please contact our Privacy Officer at (503) 691-0901.
This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry
out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It
also describes your rights to access and control your protected health information. “Protected health information” is
information about you, including demographic information, that may identify you and that relates to your past, present or
future physical or mental health or condition and related health care services. We recognize that health care information
about you is personal. We are committed to protecting the confidentiality of your health care information.
We are required by law to maintain the privacy of your medical information. We are also required to notify you of our
legal duties and privacy practices regarding your medical information, and abide by the practices of this notice.
The following sections and categories describe different ways we use and disclose health care information about you. For
each category, we explain what we mean, and for some categories we try to give you a meaningful example about the use
or disclosure. All of the ways we are permitted to use and disclose health care information about you will fall into the
Permitted Use and Disclosure of Your Health Care Information
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health
care and any related services. This includes the coordination or management of your health care with a third party. For
example, if your personal physician refers you to a specialist; we will send the specialist healthcare information about you
Payment: We are permitted to use and disclose your health care information in order to bill and receive payment from
you, your insurance company or a third-party payer for the services you received. For example, we may need to disclose
information about your treatment to your insurance company so that your insurance company will pay us or reimburse
you for the treatment. We may also tell your insurance company about treatment you are going to receive in order to
obtain approval or to determine whether your insurance will cover the treatment.
We may disclose your health care information with other providers who are involved in your care for their payment
purposes. For example, we may release information to emergency responders to allow them to obtain payment or
reimbursement for services provided to you.
Health Care Operations: We are permitted to use your health care information for our business operations. For
example, we may use your health care information to assess the quality of care you receive and to ensure that our clinic
continues to provide the quality of care you and other patients deserve. Other examples of business operations include:
training of medical personnel, peer review, licensure and accreditation, audits by regulatory agencies, and compliance
with all federal and state regulations.
We may disclose your information to another health care provider or health plan if they have a relationship with you and
need the information for their own business operations.
Business Associates: We may disclose your health care information to third parties whom we contract with to perform
business services for us, such as billing companies, quality assurance reviewers, and translator services. We require that
all business associates implement appropriate safeguards to protect your health care information.
Health Care Information with Additional Protection: In some instances, Oregon law provides additional privacy
protections for HIV, substance abuse, mental health and genetic testing. For more information on Oregon law related to
these specially protected records, please contact our Privacy Officer.
Appointment Reminders: We may use and disclose your health care information to contact you as a reminder that you
have an appointment for at our clinic.
Treatment Alternatives: We may communicate to you to tell you about or recommend possible treatment options or
alternatives that may be of interest to you.
Health-Related Benefits and Services: We may communicate to you about a product or service that may be of interest
to you concerning your treatment, management, or ongoing care.
Fund-Raising: We may use demographic information about to you contact you about our fundraising activities. We
will release only contact information (such as your name, address and phone number) and information about when you
received treatment or services. Our fund-raising communications sent to you will offer you the opportunity to opt-out of
receiving future fund-raising material.
Directory Information: Unless you object, you will be included in our patient directory. This information may include
your name, physical location, phone number and email address.
Individuals Involved in Your Care or Payment for Care: We may disclose to your family, friends or anyone else
whom you identify, medical and/or billing information relevant to that person’s involvement in your care. If you are
unable to make a health care decision yourself, we may disclose your health care information as necessary if we determine
that it is in your best interest.
Use and Disclosure of Your Health Care Information for Special Purposes
Coroners, Medical Examiners and Funeral Directors: We will disclose health care information to a coroner, medical
examiner or funeral director as required by or applicable to law.
Disaster Relief: We will disclose health care information about you to federal, state, or local government agencies
engaged in disaster relief efforts, as well as to private organizations chartered to assist in disaster relief, such as the
American Red Cross. The information about you is disclosed so that these agencies can help family members or friends
locate you, can inform them about your general condition or can help you obtain medical care.
Health Oversight Activities: We may disclose health care information to a health oversight agency for activities
authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.
These activities are necessary in order for the government to monitor the U.S. health care system, government programs,
and compliance with civil rights laws.
Incidental Disclosures: Incidental disclosures of your health care information may occur as a by-product of permitted
use and disclosures of your health care information. For example, a visitor may overhear a discussion about your care in
the front office area. These incidental disclosures are permitted if we have applied reasonable safeguards to protect the
confidentiality of your health care information.
Law Enforcement: We may disclose your health care information to law enforcement officials as required by law or
as directed by court order, warrant, criminal subpoena or other lawful process, and in other limited circumstances for
purposes of identifying or locating suspects, fugitives, material witnesses, missing persons or crime victims.
Legal Proceedings: If you are involved in a lawsuit or a dispute, we may disclose health care information about you in
response to a court or administrative order. We also may disclose medical information about you in response to a civil
subpoena, discovery request, or other lawful process by someone involved in the disagreement, but only if efforts have
been made to tell you about the request or to obtain an order protecting the information requested.
Limited Date Set Information: We may disclose limited health care information to third parties for purposes of
research, public health and health care operations. Before disclosing this information, we remove direct identifiers and
have the recipient of the information enter into a contract agreement that limits how the date may be used or disclosed.
The agreement must contain assurances that the recipient of the information will use appropriate safeguards to prevent
inappropriate use or disclosure of the information.
Military and Veterans: If you are a member of the armed forces, we may release health care information about you as
required by military command authorities.
National Security, Intelligence Activities, Protection Services for the President and Others: We will disclose health
care information about you to authorized federal officials for lawful intelligence, counterintelligence or other national
security activities authorized by law; for protection of the U.S. President, other authorized persons or foreign heads of
state; or for special authorized investigations.
Public Health Activities: We may disclose health care information about you for public health activities as authorized
by law. These activities typically include reports to such agencies as the Oregon Department of Human Services. The
disclosures are usually made for the purpose of preventing or controlling disease, injury or disability. Examples are:
reporting of disease, injury, and vital events such as births and deaths, reporting of child and elder abuse; and reporting of
reactions to medications and problems with products.
Required by Law: We will disclose health care information about you when required to do so by federal, state, or local
To Avert a Serious Threat to Health or Safety: We will use and disclose health care information about you when
necessary, to prevent a serious threat to your health and safety or the health and safety of others.
Workers’ Compensation: We will release health care information about you for workers’ compensation or similar
programs as authorized by law. These programs provide benefits for work-related injuries or illness.
Other Uses and Disclosure of Your Health Care Information
Authorization: Uses and disclosures of your health care information not described in this notice or in the laws
that apply to us require your written authorization. Most uses and disclosures of psychotherapy notes, uses and
disclosures of protected health information (PHI) for marketing purposes, and disclosures that constitute a sale
of PHI require your authorization. If you provide True Health Medicine, PC with an authorization to use or
disclose health care information about you, you may revoke that authorization, in writing, at any time. If you
revoke your authorization, we will no longer use or disclose your health care information about you for the
reasons covered by your written authorization. You are to understand that we cannot take back any disclosures
we have already made with your authorization, and that we are required to retain our records of the care we
Your Rights Regarding Health Care Information
Breach Notification: You have the right to be notified following a breach of your unsecured protected health
information. True Health Medicine takes every precaution to ensure that your personal health care information is
protected at all times. In the unforeseen event that there is a breach, True Health Medicine will notify all affected
individuals and follow all federal, state and local laws regarding to breach notification.
Right to Inspect and Copy: With certain exceptions, you have the right to inspect medical and billing records used to
make decisions about you and/or to receive a copy of the records.
To inspect records and/or obtain a copy, you must submit your request in writing. If you request a copy of the
information, we may charge a fee to cover the cost of producing and mailing the copy.
In some cases, we may deny your request to inspect records and/or obtain a copy. If you are denied access to medical
information, you may request that the denial be reviewed.
To make a request to inspect your records or obtain a copy, please contact our Health Information Management (Medical
Records) Manager at (503) 691-0901, and you will be provided the necessary form.
Right to Amend: If you believe that the health care information that we may use to make decisions about you is
incorrect or incomplete, you may ask us to amend the information. The request must be in writing and include a reason
We may deny your request if the records are complete and accurate, if the records were not created by us, and if the
records’ author is available; if the records are not maintained by us or if the records are otherwise not subject to your
access. We will explain our reasons for denial in a written response to you. You have the right to respond in writing to
All documents about a requested amendment are retained in your records and are included in any future disclosures that
you authorize or that are otherwise allowable by law.
To make a request to amend your records, please contact our Health Information Management (Medical Record) Manager
and you will receive the necessary form. For all other types of records ask your health care provider or contact our
Right to an Accounting of Disclosures: You have the right to a listing of the disclosures we made of your health care
information after September 23, 2013, except for the following: disclosures made for the purpose of treatment, payment
or health care operations; disclosures you authorized; disclosures to you; incidental disclosures; disclosures from the
facility directory; disclosures to family or other persons involved in your care; disclosures to correctional institutions and
law enforcement in some circumstances; disclosures of limited date set information; and disclosures for national security
or intelligence purposes. Health oversight agencies and law enforcement may request that we temporarily suspend your
right to a specific disclosure.
To request a list of disclosures please contact the Health Information Management (Medical Record) Manager or our
Privacy Officer to obtain the necessary form.
Right to Request Restrictions: You have the right to request a restriction or limitation on the health care information
we use or disclose about you for treatment, payment or health care operations. You have the right to restrict certain
disclosures of PHI to health plans/insurance companies if you pay out of pocket in full for the health care service.
You must submit your request for a restriction in writing. You can obtain the request form from out Privacy Officer. In
your request, you must tell us what information you want to limit; whether you want to limit our use, disclosure or both;
and to whom you want the limits to apply. There are some restrictions that True Health Medicine, PC management is
authorized to approve. Our Privacy Officer must approve all other requests.
We are not required to agree to your request for a restriction. If we do agree, we will comply with your request unless the
information is needed to provide emergency treatment for you.
Right to Request Confidential Communications: You have the right to request that we communicate with you about
health care matters in a certain way or at a certain location. For example, you can ask us to not call you at home, but
rather to communicate only by mail.
You must submit your request for confidential communication in writing. You can obtain the form from our Privacy
Officer. In your request, you must explain to us your communication needs. There are some communications that True
Health Medicine, PC management is authorized to approve. Our Privacy Officer must approve all other requests. We
will honor all reasonable requests.
Right to a Paper Copy of This Notice: You may obtain a paper copy of this notice at any time by requesting a copy
from our True Health Medicine, PC front office staff or our Privacy Officer. You also may obtain a copy from our
We reserve the right to change our health information privacy practices and the terms of this notice, and to make the new
provisions effective for all health care information we maintain, including health care information created or received
prior to the effective date of any such revised notice. Should our privacy practices change, we will post the revised notice
at a prominent location within our clinic and make the revised notice available to you at your request.
You may complain to us or to the Secretary of the U.S. Department of Health and Human Services if you believe your
privacy rights have been violated. You may file a complaint with us by notifying our Privacy Officer. We will not
retaliate against you for filing a complaint.
True Health Medicine, PC
Tualatin, OR 97062
You may call us at (503) 691-0901
Office for Civil Rights
Secretary of the U.S. Department of Health and Human Services
2201 Sixth Avenue – Suite 900
Seattle, WA 98121-1831
(206) 615-2287 (Voice) (206) 615-2296 (TTD)
(206) 615-2297 (Fax) OCRComplaint@hhs.gov (email)
Effective Date: August 1, 2003
Revised September 19, 2013