BAILEY-201503241001

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. Protected Health Information: Protected health information (PHI) is any information in the medical record or designated record set that can be used to identify an individual and that was created, used, or disclosed in the course of providing a health care service such as diagnosis or treatment. 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 this entire 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. We may use or disclose your PHI to provide treatment to you. For example, doctors or staff may use information in your medical records to diagnose or treat your condition. In addition, we may disclose your PHI to health care providers outside of Trillium so they may help treat you. For example if we seek dental care for a client in residential services we will provide information about their medications to the dentist.
  • Payment. We may use or disclose your PHI so that we, or other healthcare providers, may obtain payment for treatment you received. For example, we may disclose information from your medical records to your health insurance company to obtain pre-authorization for treatment or submit a claim for payment.
  • Health Care Operations. We may use or disclose your PHI for certain health care operations that are necessary to providing health care services and to ensure our patients receive quality care. For example, we may use information from your medical records to review the performance or qualifications of physician and staff, train staff, maintain licensure and accreditation, or make business decisions affecting Trillium and its services.
  • Appointments and Services. We may use or disclose PHI to contact you to provide appointment reminders, or to provide information about treatment alternatives or other health related benefits and services that may be of interest to you.
  • Business Associates. We may disclose protected health information to our third party business associates who perform activities involving your PHI. Our contracts with our business associates require them to protect your PHI.
  • 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.
  • Coroners and Funeral Directors. We may disclose PHI to a coroner or medical examiner to determine cause of death or permit the coroner or medical examiner to fulfill their legal duties. We may disclose information to funeral directors to allow them to carry out their duties.
  • Research. We may use or disclose PHI for research if approved by an institutional review or privacy board and appropriate steps have been taken to protect the information.
  • Fundraising. We may use or disclose limited PHI to contact you when raising funds for Trillium Family Services directly or through the Trillium Family Services Foundation, Inc.
  • Inmates. If you are an inmate or in the custody of law enforcement, we may disclose PHI if necessary for your health care, for the health and safety of others, or for the safety or security of the correctional institution.
  • CCO Membership. If your care is authorized and paid for by an Oregon Coordinated Care Organization, we may use or disclose PHI to other providers within the CCO network to facilitate continuing care when proof of your membership or CCO relationship is provided to us.
  • 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 We May Make Unless You Object

There are certain uses and disclosures we may make where you will have the opportunity to agree or to object to the sharing of your PHI. Any use and disclosure we make would be relevant to your current situation and in your best interests. Unless you instruct us otherwise, and because a written authorization is not required, we may disclosure information to:

  • Persons Involved in Your Health Care – Unless you object, we may disclose limited PHI to a member of your family, another relative, a close friend, or other person you identify who is involved in your health care. We will limit the disclosure to the PHI relevant to that person’s role or level of involvement in your health care or role in payment for your healthcare.
  • Notification – Unless you object, we may use or disclose PHI to notify a family member or other person responsible for your care of your location and condition. We may disclose PHI to a disaster relief agency to help notify family members.

III. Uses and Disclosures Requiring Written Authorization

We will obtain your written authorization before using or disclosing your PHI for purposes other than those summarized above. Examples of where your authorization would be required include, but are not limited to disclosure for enlistment in the armed forces or for employment security clearance inquiry, or if any of your health information would be sold.

IV. Your Rights Regarding Protected Health Information

You have the following rights concerning your PHI.

  • Right to Request Additional Restrictions. You may request additional restrictions on our use and disclosure of your PHI for treatment, payment and health care operations. These requests can be made during your admission process or by contacting the Medical Records Department during your treatment. While we will consider all requests for additional restrictions carefully, we are not required to agree to a requested restriction. The only exception is we are required to comply with your request that we restrict disclosure of your information to your insurance carrier or health plan, when you pay in full for your services at the time of service.
  • Right to Receive Confidential Communications. We normally contact you by telephone or mail at your home address. 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. You will be given the opportunity to make such requests during your admission and patient registration process. During care if you need additional changes, those requests can be communicated to your treatment provider.
  • 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 Receive a Copy Your Health Information. You may request access to or copies of your medical by contacting the Medical Records Department and your billing records by contacting the Billing Department. If you are no longer in care you will be provided with the process and forms for submitting your request in writing. We may charge a reasonable cost based fee for providing the record.
  • Right to Authorize A Copy of Your Health Information Be Provided to a Third Party. You may authorize a copy of your PHI be given to a third party. We may charge a reasonable cost based fee for providing the record. Information about this process and any necessary forms are available through the Medical Records Department.
  • Right to Amend Your Records. You have the right to request that we amend your PHI. If you desire to amend your records, please obtain an amendment request form from the Privacy Office and submit the completed form to the Privacy Office.
  • Right to Receive An Accounting of Disclosures. Upon request, you may obtain an accounting of disclosures of your PHI made by us for a period of up to six (6) years prior to the date of your request. The Accounting may not include all disclosures for treatment, payment, health care operations, to family members or others involved in your health care or payment, or disclosures for notification purposes, but will include disclosures pursuant to your written authorization. You may receive an accounting once within any 12 month period free of charge. We will charge a reasonable cost-based fee for all subsequent or additional requests within the same 12 month period.
  • Right to a Copy of This Notice. You have a right to obtain a paper copy of this Notice upon request. You have this right even if you have agreed to receive the Notice electronically. This Notice can be printed from the Trillium website, can be provided on request from any of our facilities, or may be requested from the Trillium Medical Records Department.

V. Our Responsibilities

We are required by law to maintain the privacy of your health information. We are also required to provide you with a notice of our legal duties and privacy practices with respect to health information. We are required to notify you should there be a breach of unencrypted health information about you. We are required to comply with the terms of the Notice of Privacy Practices currently in effect. We will use and disclose your health information only as described in our Notice or with your authorization.

VI. Questions, Concerns or Complaints

If you have questions, concerns, or wish to register a complaint, you may contact our Privacy Officer. 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 expressing a concern or submitting a formal complaint.

Privacy Officer
Trillium Family Services
4455 NE Highway 20
Corvallis, Oregon 97330
Telephone Number: (541) 757-1852

VII. Effective Date and Changes to This Notice

This Notice is effective on December 15, 2014. 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, https://trilliumfamily.org