WHO WILL FOLLOW THIS NOTICE
This notice describes Sacagawea School Based Health Center (Sacagawea SBHC) practices and that of:
Any health care professional authorized to enter information into your medical records.
physicians, staff, volunteers, contracted personnel, trainees, students, and other health center personnel providing services
at Sacagawea SBHC.
OUR PLEDGE REGARDING MEDICAL INFORMATION
Sacagawea SBHC understands
that medical information about you and your health is personal. We are committed to protecting medical information about you.
A record is created of the care and services you receive. We need this record to provide you with quality care and to comply
with certain legal requirements. This notice applies to all of the records of your care generated by Sacagawea SBHC, whether
made by the nurse practitioner, nursing personnel, or other practitioners involved in your care. Your personal doctor may
have different policies or notices regarding the doctor's use and disclosure of your medical information created in the doctor's
office or clinic.
This notice describes the ways in which we may use and disclose your medical information. It
also describes your rights and certain obligations we have regarding the use and disclosure of your medical information.
The law requires us to:
Make sure that your medical information is kept private;
Provide you with this Notice of our legal duties and privacy practices with respect to medical information;
Follow the terms of this Notice.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION
The following categories describe different ways that we use and disclose medical information.
For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure
in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one
of the categories.
For Treatment. We may use your medical information to provide you with medical
treatment or services. We may disclose your medical information to doctors, nurses, technicians, health care students, clergy,
or others who are involved with your care. For example, a nurse practitioner treating you for a broken arm may need to discuss
your case with a consulting pediatrician, orthopedist, or radiologist to establish a treatment plan.
Payment. We may use and disclose your medical information for our payment purposes or the payment purposes of other
health care providers or health plans. For example, we may need to give your insurance company information about the physical
exam you received so your insurance will pay for your care. We may tell your insurance about a treatment you are to receive
to obtain prior approval or to determine whether your insurance will cover the treatment. We may also release medical information
to emergency responders or other health care providers to allow them to obtain payment or reimbursement for services provided
to you. If necessary, we will obtain your authorization.
For Health Care Operations. We may use
and disclose your medical information for our health care operations, which include internal administration and planning and
various activities that improve the quality and cost effectiveness of the care that we deliver to you. For example, we may
use your medical information to evaluate the quality and competence of our nurses and other health care workers. We may disclose
your medical information to our Executive Director in order to resolve any complaints you may have and ensure that you have
a comfortable visit with us. We may disclose your health information to other providers or to health plans for their own health
care operations as allowed by law. We may also disclose information to accreditation agencies, such as the Department of Human
Services School Based Health Center program for purposes of evaluating our facility for accreditation.
Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment
for treatment or medical care or services.
Treatment Alternatives. We may use and disclose medical
information 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 use and disclose medical information to tell you about
health-related benefits, services, or health education classes that may be of interest to you.
Activities. We may disclose certain demographic information about you to a foundation related to the health center
so that the foundation may contact you to invite your philanthropic support to enhance patient care. If you do not want Sacagawea
SBHC to use your information in this manner or to contact you for fundraising efforts, please notify our Executive Director
Individuals Involved in Your Care or Payment for your Care. Health professionals,
using their best judgment, may disclose to a family member or close personal friend, or anyone else you authorize, medical
information relevant to that person's involvement in your care. We may also give information to someone who helps pay for
your care. If you do not want us to make these disclosures, you must notify your care provider.
Research. Under certain circumstances, we may use and disclose your medical information
for research purposes. For example, a research project involving asthma
education and its effect on lung function may involve comparing peak flow measurements in groups of children who receive basic
asthma information vs. extra information. Prior to the research study, the researcher may need access to patient information
in order to prepare a research protocol. All research studies, however, are subject to a special approval process. Before
we use or disclose medical information for research without your authorization, the research study will have been approved
through this research approval process.
Limited Data Set Information. We may disclose limited
medical information to third parties for purposes of research, public health and health care operations. This limited data
set will not include any information which could be used to identify you directly (such as your name, street address, telephone
number, social security number, or other identifying numbers or photographs). Before disclosing this information, we must
enter into an agreement with the recipient of the information that requires the recipient to protect the privacy of your medical
As Required By Law. We will disclose your medical information when required to do
so by federal, state or local law. For example, clinics are required to
report certain infectious diseases, child abuse, and most animal bites to the appropriate state, county, or law enforcement
Incidental disclosures. Certain incidental disclosures of your medical information
occur as a byproduct of lawful and permitted use and disclosure of your medical information. For example, a visitor may inadvertently
overhear a discussion about your care occurring at the health center. These incidental disclosures are permitted if the health
center applies reasonable safeguards to protect your medical information.
Disclosures to Business Associates.
We contract with outside companies that perform business services for us, such as billing companies, management consultants,
quality assurance reviewers, accountants or attorneys. In certain circumstances, we may need to share your medical information
with a business associate so it can perform a service on our behalf. We will limit the disclosure of your information to a
business associate to the amount of information that is the minimum necessary for the company to perform services for us.
In addition, we will have a written contract in place with the business associate requiring it to protect the privacy of your
Organ and Tissue Donation. If you
are an organ donor, we may disclose your medical information to organizations that handle organ procurement or organ,
eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and
If you are a member of the armed forces, we may disclose your medical information as required by military command authorities.
We may also disclose medical information about foreign military personnel to the appropriate foreign military authority.
Workers's Compensation. We may disclose medical information about you for workers' compensation or
similar programs, to the extent authorized by law. These programs provide benefits for work-related injuries or illness.
Public Health Activities. We may disclose your medical information to public health agencies as required
or authorized by state law to support public health activities. This generally includes, but is not limited to, the following:
to prevent or control disease, injury
to report reactions to medications or problems with products and to enable product
recalls, repairs or replacement;
to notify a person who may have been exposed to a disease or may
be at risk for contracting or spreading a disease or condition;
to notify the appropriate government
authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure
if the patient agrees or when required or authorized by law.
Serious or imminent threat to health or safety.
We may use and disclose medical information about you when necessary to prevent a serious or imminent threat to your health
and safety or the health and safety of the public or another person.
Disaster Relief Efforts.
We may disclose medical information about you to other health care providers and to an entity assisting in a disaster relief
effort to coordinate care and, unless you object, so that your family or other individual involved in your care can be notified
about your condition and location.
Health Oversight Activities. We may disclose your medical
information to a health oversight agency for activities authorized by law. For example, audits, investigations, inspections,
and licensure. These activities are necessary for the government to protect public health, monitor government programs, and
comply with civil rights laws.
Lawful Subpoena or Court Order. If you are involved in a lawsuit
or a dispute, we may disclose your medical information in response to a court or administrative order. We may also disclose
your medical information in response to a subpoena, discovery request, or other lawful process by someone else involved in
the dispute. In most circumstances, we will not disclose your medical information until efforts have been made to notify you
of the request or to obtain an order protecting the information requested.
Law Enforcement. We
may disclose your medical information if asked to do so by a law enforcement official or otherwise designated individual,
including (but not limited to) the following:
in response to a court order, criminal subpoena, warrant,
or other lawful process;
limited information for the purpose of identifying or locating a suspect,
fugitive, material witness, or missing person;
about the victim of a crime, under certain limited
about a death we believe may be the result of criminal conduct; this may be disclosed
to a medical examiner;
about criminal conduct at the health center; and
in emergency circumstances to report a crime; the location of the crime or crime victim; or the identity, description or location
of the person who committed the crime.
to the extent the law requires.
Medical Examiners and Funeral Directors. We may disclose your medical information to a coroner, medical examiner or funeral
director. For example, to identify a deceased person or determine the cause of death. We may also disclose
your medical information to funeral directors as necessary to carry out their duties.
and Intelligence Activities. We may disclose your medical information to authorized federal officials for intelligence,
counterintelligence, and other national security activities authorized by law.
Protective Services for
the President and others. We may disclose your medical information to authorized federal officials so they may provide
protection to the President, other authorized persons or for foreign heads of state or conduct special investigations.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement
official, we may disclose your medical information to the correctional institution or law enforcement official. For
example, medical information may be disclosed to provide you with health care, to
protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.
USES AND DISCLOSURES OF SPECIALLY PROTECTED INFORMATION
Oregon and federal law
provide additional confidentiality protections in some circumstances. For example, in Oregon a health care provider generally
may not release the identity of a person tested for HIV or the results of an HIV-related test without your consent and you
must be notified of this confidentiality right. Drug and alcohol treatment records are specially protected and typically require
your specific consent for release under both federal and state law. Mental health records are specially protected in some
circumstances, as is genetic information.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
You have the following rights regarding your medical information:
Right to Inspect and Copy.
You have the right to inspect and obtain copies of your medical information that may be used to make decisions about your
care or payment for your care, not including psychotherapy notes. Records are generally kept at the site where services were
provided. To inspect and obtain copies of your medical information, contact the Executive Director. There is a charge for
the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect
and copy your medical information under limited circumstances. If access to your medical information is denied, you may request
that the denial be reviewed. We will comply with state and federal law when choosing a reviewer. The person conducting the
review will not be the person who denied your request. We will comply with the outcome of the review.
to Amend. If you feel that your medical information is incorrect or incomplete, you may ask us to amend the information.
You have the right to request an amendment for as long as the information is kept by or for Sacagawea SBHC.
request an amendment, contact the facility where you received care. Your request must be submitted in writing to the Executive
Director. You must provide a reason that supports your request.
We may deny your request for an amendment if it
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:
was not created by us, unless the person or entity that created the information
is no longer available to make the amendment;
is not part of the information which you would be permitted
to inspect and copy;
is accurate and complete.
We will put any denial in writing and
explain our reasons for denial. You have the right to respond in writing to our explanation of denial, and to require that
your request, our denial, and your statement of disagreement, if any, be included in future disclosures of the disputed record,
and others as the law requires.
Right to an Accounting of Disclosures. You have the right to
request an accounting of disclosures we made of your medical information in the previous six years, beginning April 14, 2003.
You are not entitled to an accounting of disclosures made for purposes of treatment, payment and health care operations, disclosures
you authorized, disclosures to you, incidental disclosures, disclosures to family or other persons involved in your care,
disclosures to correctional institutions and law enforcement in some circumstances, disclosures of limited data set information
or disclosures for national security or law enforcement purposes.
To request an accounting of disclosures, contact
the facility where you received care. Your request must be submitted in writing to the Executive Director. Your first accounting
in a 12-month period will be free. For additional accountings, we may charge you for the cost of providing the accounting.
Right to Request Restrictions. You have the right to request a restriction or limitation on the
medical 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 medical information we disclose about you to someone who is involved in your care or the payment
for your care, like a family member or friend. For example, you could ask
that we not use or disclose information about a particular procedure you underwent. 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 emergency treatment.
To request a restriction, contact the facility where you are receiving care. Your request must be submitted in writing to
the Executive Director. In your request, you must tell us:
what information you want to limit;
whether you want to limit our use, disclosure or both;
to whom you want the
limits to apply.
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 must complete the designated
request form in writing at the time you receive care. 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 privacy notice. You may ask us to give you a copy
of this privacy notice at any time by requesting a copy from the Executive Director.
TO THIS NOTICE
We may change the terms of the Notice at any time. If we change this Notice, we may make
the new notice terms effective for all medical information that we maintain, including any information created or received
prior to issuing the new notice. If we change this Notice, we will post the new notice in locations where patients receive
services and on our Internet site at www.sacagaweahelathcenter.org. You also may obtain a new notice by contacting Sacagawea SBHC.
If you believe your privacy rights have been violated, you may contact or submit your complaint in writing to
the Executive Director. If we cannot resolve your concern, you also have the right to file a written complaint with the Secretary
of the Department of Health and Human Services.
The quality of your care will not be jeopardized nor will
you be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
All other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made
only with your written authorization. If you provide us authorization to use or disclose your medical information, you may
revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your
medical information for the purposes identified in your written revocation, unless we have already acted in reliance on your
PRIVACY OFFICIAL AND CONTACT PERSON
If you have any questions about
this Notice or wish to object to or complain about any use or disclosure as explained above, please contact our Privacy Official
through the telephone number listed below.
Sacagawea School Based Health Center
1060 Eisenschmidt Lane
St. Helens, OR 97051