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.
Rooted Pelvic Health & Recovery is required by law to maintain the privacy of your protected health information (PHI), and to provide you with this notice of our legal duties and privacy practices. This notice applies to the information and records we have about your health and health care services received at this office. This information may be in the form of written or electronic records or spoken words. It may include information about your health history, health status, examinations, test results, diagnoses, treatments, procedures, prescriptions, and related billing activity. We are required by law to maintain the privacy of your protected health information.
1.0 Individual Rights Under HIPAA
You have the following rights regarding the protected health information (PHI) we maintain about you.
| Your Rights | What You Can Do |
|---|---|
| Digital & Copies | You may request to see an electronic copy or receive a paper copy of your PHI. We may charge a reasonable, cost-based fee for copying, mailing or supplies. In limited circumstances, we may deny access to your records. |
| Correction | You may request a correction in writing, if you believe there is a mistake in your file. We may deny the request via a written response, within 60 days. |
| Disclosures | You may request a list of and description of certain disclosures we have made of your PHI. |
| Limit Sharing | You may request a restriction on the sharing of your PHI for treatment, payment, or health care operations. We are not required to agree, except under certain limited circumstances not affecting your care. Payment information for our services paid in full and out-of-pocket may be restricted upon request. |
| Confidential Communications | You may request that we communicate with you about medical matters in a certain way or send communications to a different address. We will accommodate reasonable requests. Your written request must specify how or where you wish to be contacted. |
| Paper Notice | You may receive a paper copy of this notice upon request. |
2.0 Use and Disclosure of Protected Health Information (PHI)
2.1 We typically use and disclose your PHI without your authorization to provide, manage and coordinate your health care and any related services. You may request a restriction on the sharing of your PHI for treatment, payment, or health care operations. We are not required to agree, except under certain limited circumstances not affecting your care. Payment information for our services paid in full and out-of-pocket may be restricted upon request.
| Category | How We Use Your Information |
|---|---|
| Treatment | We may share your PHI with your primary doctor or specialists to coordinate your physical therapy plan and treatment. |
| Payment | We may use and disclose your PHI to obtain payment for the services we provide you, with your insurance or other entities. This may include information about your treatment to obtain prior approval or determine plan coverage. |
| Healthcare Operations | We may use and disclose your PHI for necessary business operations, which include quality assessment, planning and various activities that improve the quality and cost effectiveness of the care that we deliver to you. We may disclose anonymized information about our treatments for training purposes. |
2.2 You may decline use of your PHI by advising us in writing if you would like to opt-out of any of the following.
| Category | How We Use Your Information |
|---|---|
| Family and Other Persons | We may disclose your PHI to your family members or other individuals involved in your care, if based on our professional judgment, we believe you would not object. In any of these cases, we may discuss only the information that the person involved needs to know about your care or payment for your care. |
| Appointment Reminders | We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment. |
| Treatment Alternatives | We may use and disclose medical information to tell you about a recommended possible treatment, options or alternatives that may be of interest to you. |
| Other Services | We may use and disclose medical information to tell you about health-related benefits, services or medical education that may be of interest to you. |
2.3 We may use or disclose your PHI when required or permitted by law. For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
| Category | How We Use Your Information |
|---|---|
| Possible Victim | We may disclose your PHI to relevant authorities if we believe you are a possible victim of abuse, neglect, domestic violence, other crimes or animal bites. |
| Public Health | We may disclose your medical information to public health agencies as required or authorized by state law to support public health activities. |
| Research | We may use and disclose your medical information for research purposes. |
| Worker’s Compensation | We may disclose medical information about you for workers compensation or similar programs, to the extent authorized by law. |
| Court Orders | We only release information to law enforcement or courts when a valid Oregon subpoena or judge’s order is provided. |
| Organ Donation | We may disclose your medical information to organizations that handle organ donation, if you are an organ donor. |
| Medical Examiner | We may disclose your medical information to a coroner, medical examiner, or funeral director. |
| Law Enforcement and Government | We may disclose your medical information if asked to do so by law enforcement officials or otherwise designated individuals, including authorized federal officials for national security activities authorized by law, military command authorities, or to public health agencies. |
2.4 We will obtain your written authorization before using or disclosing your PHI for purposes described below.
| Category | How We Use Your Information |
|---|---|
| Marketing | We must obtain your written authorization for most marketing purposes. |
| Sales of PHI | We will not sell your PHI without your authorization. |
3.0 Specific Oregon Protections and Minor Privacy
In Oregon, there are specific rules regarding who can see a patient’s records. While parents generally manage a minor’s healthcare, Oregon law allows minors age 15+ to consent to certain services independently, which may limit a parent’s access to those specific records.
| Category | Oregon-Specific Rule |
|---|---|
| Minors | Oregonians age 15 and older may consent to medical services without parental consent; these records may be kept private from parents upon request. |
4.0 Our Responsibilities and Breach Notification
Our practice is required by law to maintain the privacy and security of your PHI and to let you know if a breach occurs. A breach is any situation where your private information is seen or shared by someone who shouldn’t have access to it.
| Requirement | Our Commitment |
|---|---|
| Policy Changes | We can change the terms of this notice, and the changes will apply to all information we have about you. This notice will be available upon request, in our office, and on our web site. |
| Breach Notice | We will notify you in writing as soon as possible if your information is compromised. |
5.0 Questions and Complaints
If you feel your privacy rights have been violated, you have the right to file a complaint with us or with the Secretary of the Department of Health and Human Services. We will not retaliate against you for expressing a concern about your privacy.
| Reporting Method | Contact Information |
|---|---|
| Internal Privacy Officer | Contact: Stephanie Mentch, Clinic Owner, 541-716-1420, 2149 Cascade Ave. Ste. 106A-144, Hood River, OR 97031 |
| Government Filing | File a complaint with the U.S. Dept. of Health and Human Services (OCR). |