Notice of Privacy Practices
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THIS NOTICE DESCRIBES HOW CLINICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
CSP refers to Counseling Services of Portland.
Your Health Information: This notice applies to the information and records CSP has about your health, health status, and the health care and services you receive at the CSP 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 and similar types of health related information.
How May CSP Use & Disclose Health Information About You: CSP may use and disclose health information for the following purposes:
For treatment: CSP may use health information about you to provide you with critical treatment or services. CSP 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. Different personnel in the CSP office may share information about you and disclose information to people who do not work in the CSP office in order to coordinate your care. Family members and other health care providers may be part of your clinical care outside this office and may require information that CSP has.
For substance abuse: Federal and state law require your written consent each time CSP releases health information. The consent will specify who is to receive the information, the purpose of the release of information, and the time period after which the consent will terminate. You may modify or revoke a consent at any time.
Special Situations: CSP 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: CSP 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 another person.
Required by law: CSP will disclose health information about you when required to do so by federal, state, or local law.
Military, veterans, national security, and intelligence: If you are or were a member of the armed forces, or part of the national security or intelligence communities, CSP may be required by military command or other government authorities to release health information about you. CSP may also release information about foreign military personnel to the appropriate foreign military authority.
Workers’ Compensation: CSP may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
Public health risks: CSP may disclose health information about you for public health reasons in order to prevent or control diseases, injury, or disability; or report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medicines, or problems with products.
Health oversight activities: CSP 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 dispute, CSP may disclose health information about you in response to a court or administrative order. Subject to all applicable legal requirements, CSP may also disclose health information about you in a response to a subpoena.
Information not personally identifiable: CSP may use or disclose health information about you in a way that does not personally identify or reveal who you are.
Family and friends: CSP 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 disclosures and you do not raise an objection. CSP 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. In situations where you are not capable of giving consent (because you are not present, or due to your incapacity, or medical emergency), CSP may, using our professional judgment, determine that a disclosure to your family member or friend is in your best interest. In that situation, CSP will disclose only health information relevant to the person’s involvement in your care.
Other Uses and Disclosures of Health Information: CSP 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 CSP authorization to use or disclose health information about you, you may revoke that authorization in writing at any time. If you revoke your authorization, CSP will no longer use or disclose information about you for the reasons covered by your written authorization, but CSP cannot take back any uses or disclosures already made with your permission. In some instances, CSP may need specific written authorization from you in order to disclose certain types of specially protected information such as HIV, substance and mental health information.
Your Rights Regarding Health Information About You: You have the following rights regarding health information CSP maintains about you:
Right to inspect and copy: You have the right to inspect and copy your health information. You must submit a written request to CSP in order to inspect and/or copy records of your health information. If you request a copy of the information, you may be charged a fee for the costs of copying, mailing, or other associated supplies.
Right to amend: If you believe the health information that CSP has about you is incorrect or incomplete, you may ask CSP to amend the information. You have the right to request an amendment as long as the information is kept by the CSP office. To request an amendment, complete and submit a Clinical Record Amendment and Correction Form. CSP 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, CSP may deny your request if we are asked to amend information that:
CSP 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 CSP keeps.
You would not be permitted to inspect and copy.
Is accurate and complete.
Right to an accounting of disclosures: You have the right to request and “accounting of disclosures”. This is a list of the disclosures made of clinical 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 based on your written authorization. To obtain this list, you must submit your request in writing. It must state a time period, which may not be longer than six years, and may not include dates before May 1, 2003. Your request should indicate in what form you want the list (on paper, electronically, etc.)
Right to request restrictions: You have the right to request a restriction or limitation on the health information used or disclosed about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information disclosed about you to someone (such as a family member or friend) who is involved in your care or payment for it. CSP is not required to agree to your request. If CSP does agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you may complete and submit the Request for Restrictions on Use/Disclosure of Clinical Information Form to CSP.
Right to request confidential communications: You have the right to request that CSP communicate with you about clinical matters in a certain way or at a certain location. For example, you can ask that CSP only contact you at work or by mail. To request confidential communications, you may complete and submit the Request for Restriction on Use/Disclosure of Clinical Information and/or Confidential Communication Form to CSP. CSP will not ask you the reason for your request and will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Changes to this notice: CSP reserves the right to change this notice and to make the revised or changed notice effective for clinical information we already have about you—as well as any information we receive in the future. CSP will post a summary of 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.