Privacy Policy
TRILLIUM FAMILY SERVICES
NOTICE OF PRIVACY PRACTICES
Recognizing that certain information you provide to us is
confidential, Trillium Family Services has adopted formal
policies regarding access to confidential medical information.
The following notice describes how your protected health
information (PHI) may be used and disclosed, and how you
can get access to this information. Please read both sides
of this notice carefully.
I. Uses and Disclosures That Do Not Require Written Authorization
In certain situations, we will not require your written authorization
in order to use and disclose your protected health information.
These situations include:
- Treatment, Payment and Health Care Operations.
We may use and disclose PHI, in order to treat you, obtain
payment for services provided to you and conduct our health
care operations.
- Public Health Activities. We may disclose
your PHI for the following public health activities: (1)
to report health information to public health authorities
for the purpose of preventing or controlling disease, injury
or disability; (2) to report victims of domestic violence,
child abuse or neglect to the Oregon Department of Human
Services; (3) to law enforcement agencies in order to prevent
or lessen a serious and imminent threat to a person's or
the public's health or safety.
- Health Oversight Activities. We may disclose
your PHI to a health oversight agency that oversees the
health care system and is charged with responsibility for
ensuring compliance with the rules of government health
programs.
- Law Enforcement Officials. We may disclose
your PHI to the police or other law enforcement officials
as required or permitted by law or in compliance with a
court order or a grand jury or administrative subpoena.
- Judicial and Administrative Proceedings.
We may disclose your PHI in the course of a judicial or
administrative proceeding in response to a legal order
or other lawful process including a court order or a grand
jury or administrative subpoena.
- As required by law. We may use and disclose
your PHI when required to do so by any other law not already
referred to in the preceding categories.
II. Uses and Disclosures Requiring Written Authorization
For any purpose other than the ones described above in
Section I, we may only use or disclose your PHI when you
give us written authorization. Typical situations in which
we will request authorization to disclose PHI include coordination
of care with community-based service providers and referrals
for appropriate aftercare planning.
III. Your Rights Regarding Protected Health Information
- For Further Information; Complaints. If
you want further information about your privacy rights,
or wish to register a complaint, you may contact our Privacy
Office (contact information below). You may also file a
complaint with the Office for Civil Rights, U.S. Dept.
of Health and Human Services. Trillium Family Services
will not take action against you for complaints filed.
- Right to Request Additional Restrictions.
You may request restrictions on our use and disclosure
of your PHI (1) for treatment, payment and health care
operations, (2) to individuals involved with your care
or with payment related to your care. While we will consider
all requests for additional restrictions carefully, we
are not required to agree to a requested restriction.
- Right
to Receive Confidential Communications. You may request,
and we will accommodate, any reasonable written request
for you to receive your PHI by alternative means of communication
or at alternative locations.
- Right to Revoke Your Authorization. You
may revoke your authorization, except to the extent that
we have taken action upon it, by delivering a written revocation
to the TFS Privacy Office.
- Right to Inspect and Copy Your
Health Information. You may request access to your medical
record file and billing records maintained by us in order
to inspect and request copies of the records. Under limited
circumstances, we may deny you access to a portion of your
records. If you request copies, we will charge you $0.25
for each page plus postage cost.
- Right to Amend Your Records. You have the
right to request that we amend PHI maintained in your medical
record file or billing records. If you desire to amend
your records, please obtain an amendment request from the
Privacy Office and submit the completed form to the Privacy
Office. We will comply with your request unless we do not
believe that the information that your request be amended
is accurate and complete or other special circumstances
apply.
- Right to Receive An Accounting of Disclosures.
Upon request, you may obtain an accounting of certain disclosures
of your PHI made by us during any period of time prior
to the date of your request provided such period does not
exceed six years and does not apply to disclosures that
occurred prior to April 14, 2003.
IV. Effective Date and
Duration of This Notice
This Notice is effective on April 14, 2003. We may change
the terms of this Notice at any time. If we change this
Notice, we may make the new terms effective for all PHI
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 waiting areas
around Trillium Family Services sites and on our website,
http://trilliumfamily.org
V. Privacy Officer
You may contact our Privacy Officer at: Privacy Officer
Trillium Family Services 4455 NE Highway 20 Corvallis,
Oregon 97330 Telephone Number: (541) 757-1852.
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