Notice of Privacy Practices

Elizabeth Hadley, MA, MFT

1308 E First St

Newberg, OR 97132-2928

971-217-7341

Notice of Privacy Practices

This notice describes how your medical records information may be used and disclosed, and how you can get access to this information.

The law protects the privacy of information we create and obtain in providing care and services to you. Your protected health information includes your diagnoses, treatment, information from other providers, and billing and payment information relating to these services. Federal and state laws allow me to use and disclose protected health information for purposes of treatment and health care operations. State law requires me to get your authorization to disclose this information for payment purposes. I understand that your personal health information is very sensitive. I will not disclose your information to others unless you tell me to do so, or unless the law authorizes or requires me to do so. Domestic Violence Treatment Laws do require me to give some specific information to victims and authorities.

Your Health Information Rights

The healthcare and billing records I create and store are the property of Elizabeth Hadley MA, MFT. The protected health information in it belongs to you. You have a right to:

• Receive, read, and ask questions about this Notice.
• Ask me to restrict certain uses and disclosures. You must deliver this request in writing.
• Request and receive from me a paper copy of the most current Notice of Privacy Practices.
• Request that you be allowed to see and get a copy of your records.
• Have me review a denial of access to your records.
• Ask me to change something in your records. Please give me this request in writing. If your request is denied you may write a statement of disagreement. It will be stored in your medical record and included with any release of your records.
• You may request a list of disclosures of your records without charge once every 12 months. Requests made more frequently will require a fee to process. Please sign, date, and give me your request in writing. The list may not include disclosures for treatment, payment or health care operations.
• You may ask that your records be given to you by another means or at another location.
• Cancel prior authorizations to use or disclose health information by giving me a written revocation. Your revocation does not affect information that has already been released. It also does not affect any action taken before I have it. Sometimes, you cannot cancel an authorization if its purpose was to obtain payment.

For help with these rights or to report a problem about your records during normal business hours, please contact me.

If you believe your privacy rights have been violated, you may discuss your concerns with me. You may also deliver a written complaint addressed to me. You may also file a complaint with the U.S. Secretary of Health and Human Services. I respect your right to file a complaint with me or with the U.S. Secretary of Health and Human Services. If you complain, I will not retaliate against you.

My Responsibilities

I am required to:

• Keep your protected health information private unless authorized to give it out.
• Allow you to read this Notice and give you a copy if you want one.
• Update this Notice if we make changes. You may receive the most recent copy of this Notice by calling and asking for it or by visiting my office to pick one up.
• Notify Family and Others for Public Health and Safety Purposes as Required by Law:
• *To prevent or reduce a serious, immediate threat to someone’s health or safety

• *To public health or legal authorities to prevent or control disease, injury, or disability

• *If you are hospitalized I may tell your family or the authorities so that you may receive proper care

• Ask your permission to share information of a personal nature for researchers’ purposes.
• Give Coroners information consistent with applicable law to allow them to carry out their duties.
• Report Suspected Abuse or Neglect to public authorities.
• Give Correctional Institutions information for health and safety purposes if you are in jail or prison.
• Give information for Law Enforcement Purposes or in the course of Judicial Proceedings such as when we receive a subpoena, court order, or other legal process, or you are the victim of a crime.
• Give information for Specialized Government Functions for national security purposes.
• Get your written authorization for other uses and disclosures not in this Notice.