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Steven Gabel, M.D., P.C.
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 READ CAREFULLY
If you have any questions about this notice, please contact the
Privacy Official at
900 SE Oak Street, Suite 201 & 203
Hillsboro, Oregon 97123
503-693-1118
WHO WILL FOLLOW THIS NOTICE
This notice describes the information privacy practices followed by
our employees, staff, and other office personnel. The practices
described in this notice will also be followed by any physician that
you consult by telephone (when your regular physician from our
office is not available) who provide “call coverage” for your
physician.
YOUR HEALTH INFORMATION
This notice applies to the information and records we have about
your health, health status, and the health care and services you
receive at this office. Your health information may include
information created and received by this office, may be in the form
of written or electronic records or spoken words, and may include
information about your health history, health status, symptoms,
examinations, test results, diagnoses, treatments, procedures,
prescriptions, related billing activity and similar types of
health-related information.
We are required by law to give you this notice. It will tell you
about the ways in which we may use and disclose health information
about you and describe your rights and our obligations regarding the
use and disclosure of that information.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
We may use and disclose health information for the following
purposes:
• For Treatment: We may use health information about you to
provide you with medical treatment for services. We may disclose
health information about you to doctors, nurses, technicians, office
staff, or other personnel who are involved in taking care of you and
your health. For example, you may be seeing one of our physicians
for a surgical or medical consult and that physician may use your
medical history to decide what course of treatment is best for you.
The physician may also tell another physician about your condition
so that physician can help determine the most appropriate care for
you. Different personnel in this office may share information about
you and disclose information to people who do not work in our office
in order to coordinate your care, such as phoning in prescriptions
to your pharmacy, scheduling lab work, ordering x-rays, or
scheduling surgery. Family members and other health care providers
may be part of your medical care outside this office and may require
information about you that we have.
• For Payment: We may use and disclose health information
about you so that the treatment and services you receive at this
office may be billed and payment may be collected from you, an
insurance company or a third party. For example, we may need to give
your health plan information about a service you received here so
your health plan will pay us or reimburse you for the service. We
may also tell your health plan about a treatment you are going to
receive to obtain prior approval, or to determine whether your plan
will pay for the treatment.
• For Health Care Operations: We may use and disclose health
information about you in order to run the office and make sure that
you and our other patients receive quality care. For example, we may
use your health information to evaluate the performance of our staff
in caring for you. We may also use health information about all or
many of our patients to help us decide what additional services we
should offer, how we can become more efficient, or whether certain
new treatments are effective. We may also disclose your health
information to health plans that provide your insurance coverage and
other health care providers that care for you. Our disclosures of
your health information to plans and other providers may be for the
purpose of helping these plans and providers provide or improve
care, reduce cost, coordinate and manage health care and services,
train staff and comply with the law.
• Appointment Reminders: We may contact you as a reminder
that you have an appointment for treatment or medical care at the
office.
• Treatment Alternatives: We may tell you about or recommend
possible treatment options or alternatives that may be of interest
to you.
• Health-Related Products and Services: We may tell you about
health-related products or services that may be of interest to you.
Please notify us if you do not wish to be contacted for appointment
reminders, or if you do not wish to receive communications about
treatment alternatives or health-related products and services. If
you advise us in writing (at the address listed at the top of this
Notice) that you do not wish to receive such communications, we will
not use or disclose your information for these purposes.
SPECIAL SITUATIONS
We may use or disclose health information about you for the
following purposes, subject to all applicable legal requirements and
limitations:
• To Avert a Serious Threat to Health or Safety. We may use
and disclose health information about you when necessary to prevent
a serious threat to your health and safety or the health and safety
of the public or another person.
• Required By Law. We will disclose health information about
you when required to do so by federal, state, or local law.
• Research. We may use and disclose health information about
you for research projects that are subject to a special approval
process. We will ask you for your permission if the researcher will
have access to your name, address, or other information that reveals
who you are, or will be involved in your care at the office.
• Organ or Tissue Donation. If you are an organ donor, we may
release health information to organizations that handle organ
procurement or organ, eye, or tissue transplantation or to an organ
donation bank, as necessary to facilitate such donation and
transplantation.
• Military, Veterans, National Security or Intelligence. If
you are or were a member of the armed forces, or part of the
national security or intelligence communities, we may be required by
military command or other government authorities to release health
information about you. We may also release information about foreign
military personnel to the appropriate foreign military authority.
• Workers’ Compensation. We may release health information
about you for workers’ compensation or similar programs. These
programs provide benefits for work-related injuries or illness.
• Public Health Risks. We may disclose health information
about you for public health reasons in order to prevent or control
disease, injury or disability; or report births, deaths, suspected
abuse or neglect, non-accidental physical injuries, reactions to
medications, or problems with products.
• Health Oversight Activities. We may disclose health
information to a health oversight agency for audits, investigations,
inspections, or licensing purposes. These disclosures may be
necessary for certain state and federal agencies to monitor the
health care system, government programs, and compliance with civil
rights laws.
• Lawsuits and Disputes. If you are involved in a lawsuit or
a dispute, we may disclose health information about you in response
to a court or administrative order. Subject to all applicable legal
requirements, we may also disclose health information about you in
response to a subpoena.
• Law Enforcement. We may release health information if asked
to do so by a law enforcement official in response to a court order,
subpoena, warrant, summons, or similar process, subject to all
applicable legal requirements.
• Coroners, Medical Examiners, and Funeral Directors. We may
release health information to a coroner, or medical examiner. This
may be necessary, for example, to identify a deceased person or
determine the cause of death.
• Information Not Personally Identifiable. We may use or
disclose health information about you in a way that does not
personally identify you or reveal who you are.
• Family and Friends. We may disclose health information
about you to your family members or friends if we obtain your verbal
agreement to do so, or if we give you an opportunity to object to
such a disclosure and you do not raise an objection. We may also
disclose health information to your family or friends if we can
infer from the circumstances, based on our professional judgment
that you would not object. For example, we may assume you agree to
our disclosure of your personal health information to your spouse
when you bring your spouse with you into the exam room during
treatment or while treatment is discussed.
• In situations where you are not capable of giving consent (because
you are not present or due to your incapacity or medical emergency),
we may, using our professional judgment, determine that a disclosure
to your family member or friend is in your best interest. In that
situation, we will disclose only health information relevant to the
person’s involvement in your care. For example, we may inform the
person who accompanied you to the emergency room that you might
require surgery and provide updates on your progress and prognosis.
We may also use our professional judgment to make reasonable
inferences that it is in your best interest to allow another person
to act on your behalf to pick up filled prescriptions, medical
supplies, or x-rays.
OTHER USES AND DISCLOSURES OF HEALTH INFORMATION
We will not use or disclose your health information for any purpose
other than those identified in the previous sections without your
specific, written Authorization. If you give us Authorization to use
or disclose health 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 information about
you for the reasons covered by your written Authorization, but we
cannot take back any uses or disclosures already made with your
permission.
In some instances, we may need specific, written authorization from
you in order to disclose certain types of specially-protected
information such as HIV, substance abuse, mental health, and genetic
testing information.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights regarding health information we
maintain about you:
• Right to Inspect and Copy. You have the right to inspect
and copy your health information, such as medical and billing
records, that we keep and use to make decisions about your care. You
must submit a written request to the Privacy Official in order to
inspect and/or copy records of your health information. If you
request a copy of the information, we may charge a fee for the costs
of copying, mailing, or other associated supplies.
We may deny your request to inspect and/or copy records in certain
limited circumstances. If you are denied copies of or access to
health information that we keep about you, you may ask that our
denial be reviewed. If the law gives you a right to have our denial
reviewed, we will select a licensed health care professional to
review your request and our denial. The person conducting the review
will not be the person who denied your request, and we will comply
with the outcome of the review.
• Right to Amend. If you believe the health information we
have about you is incorrect or incomplete, you may ask us to amend
the information. You have the right to request an amendment as long
as the information is kept by this office. To request an amendment,
complete and submit a MEDICAL RECORD AMENDMENT/CORRECTION FORM to
the Privacy Official.
We may deny your request for an amendment if your request is not in
writing or does not include a reason to support the request. In
addition, we may deny your request if you ask us to amend
information that:
• We did not create, unless the person or entity that created the
information is no longer available to make the amendment,
• Is not part of the health information that we keep,
• You would not be permitted to inspect or copy,
• Is accurate and complete.
• Right to an Accounting of Disclosures. You have the right
to request an “accounting of disclosures.” This is a list of the
disclosures we made of medical information about you for purposes
other than treatment, payment, health care operations, and a limited
number of special circumstances involving national security,
correctional institutions, and law enforcement. The list will also
exclude any disclosures we have made based on your written
authorization. To obtain this list, you must submit your request in
writing to the Privacy Official. It must state a time period, which
may not be longer then six years and may not include dates before
April 14, 2003. Your request should indicate in what form you want
the list (for example, on paper, electronically). The first list you
request within a 12-month period will be free. For additional lists,
we may charge you for the costs of providing the list. We will
notify you of the cost involved and you may choose to withdraw or
modify your request at that time before any costs are incurred.
• Right to Request Restrictions. You have the right to
request a restriction or limitation on the health information we use
or disclose about you for treatment, payment or health care
operations. You also have the right to request a limit on the health
information we disclose about you to someone who is involved in your
care or the payment of it, like a family member or friend. For
example, you could ask that we not use or disclose information about
a surgery you had. We are not required to agree to your request. If
we do agree, we will comply with your request unless the information
is needed to provide you emergency treatment or we are required by
law to use or disclose the information. To request a restriction,
you may complete and submit the REQUEST FOR RESTRICTIONS ON
USE/DISCLOSURE OF MEDICAL INFORMATION to the Privacy Official.
• Right to Request Confidential Communications. You have the
right to request that we communicate with you about medical matters
in a certain way or at a certain location. For example, you can ask
that we only contact you at work or by mail. To request confidential
communications, you may complete and submit the REQUEST FOR
RESTRICTIONS ON USE/DISCLOSURE OF MEDICAL INFORMATION AND/OR
CONFIDENTIAL COMMUNICATION to the Privacy Official. We will not ask
you the reason for your request. We will accommodate all reasonable
requests. Your request must specify how or where you wish to be
contacted.
• Right to a Paper Copy of This Notice. You have the right to
a paper copy of this notice. You may ask us to give you a copy of
this notice at any time. Even if you have agreed to receive it
electronically, you are still entitled to a paper copy. To obtain
such a copy, contact the Privacy Official.
CHANGES TO THIS NOTICE
We reserve the right to change this notice, and to make the revised
or changed notice effective for medical information we already have
about you as well as any information we receive in the future. We
will post the current notice in the office with its effective date
in the top right hand corner. You are entitled to a copy of the
notice currently in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file
a complaint with our office or with the Secretary of the Department
of Health and Human Services. To file a complaint with our office,
contact the Privacy Official. You will not be penalized for
filing a complaint.
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