HIPAA notice

Our commitment to your privacy

Your health information is personal. We are required by law to maintain the privacy and security of your protected health information, to give you this notice of our legal duties and privacy practices, to follow the terms of the notice currently in effect, and to notify you if there is a breach of your unsecured health information. Oregon and Washington law may give your mental health information additional protection. Where state law is stricter than federal law, we follow the stricter rule.

How we may use and share your information

We may use and share your health information without your written permission for these purposes:

• Treatment. To provide and coordinate your care, for example sending a prescription to your pharmacy or speaking with your primary care provider.
• Payment. To bill and collect payment, for example sending a claim to your insurance plan, Medicare, or Medicaid.
• Health care operations. To run the practice, for example quality review, record keeping, and working with billing, software, or technology vendors who agree in writing to protect your information.
• Appointment reminders and contact. To reach you about appointments or care, using the contact information you give us.

When we need your written permission

We will ask for your written authorization before we use or share psychotherapy notes (except in limited cases the law allows), before we use your information for marketing, and before we sell your information. We need your authorization for any other use not described in this notice. You may cancel an authorization at any time in writing. This will not affect anything we already did based on it.

When the law allows or requires us to share

We may share health information without your permission when the law requires or allows it, including:

• To report suspected abuse or neglect of a child, an older adult, or a vulnerable adult.
• To prevent or reduce a serious and imminent threat to the health or safety of a person or the public.
• For public health activities and to government agencies that oversee health care.
• In response to a court order, or other legal process that meets legal requirements.
• To law enforcement, medical examiners, and coroners, as the law permits.
• For workers' compensation, as the law requires.
• When otherwise required by law.

Your rights

• See and get a copy of your health records, usually within 30 days of a written request. A reasonable fee for copies may apply.
• Ask us to correct information you believe is wrong or incomplete.
• Ask for confidential communications, such as contact at a different phone number or address.
• Ask us to limit what we use or share. We are not always required to agree, but we must agree if you pay for a service in full out of pocket and ask us not to tell your health plan.
• Get a list of certain disclosures we made of your information.
• Get a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Choose someone to act for you, such as a legal guardian or health care representative.
• Be told if there is a breach of your unsecured health information.

Changes to this notice

We may change this notice and the changes will apply to the information we already hold. The current notice is always posted on this website, and you may ask for a copy at any time.

Acknowledgment of receipt

At your first visit, you will be asked to confirm that you received this notice. You can read the acknowledgment form ahead of time. Declining to sign will not affect your care.

Questions and complaints

If you think your privacy rights have been violated, you may contact us or file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. You can file a complaint at hhs.gov/hipaa or call 1-877-696-6775. We will not retaliate against you for filing a complaint.

Privacy contact: Lisa Jimenez, PMHNP-C · (360) 836-9398 · lisa@lisapsych.com · PO Box 803, Astoria, OR 97103