I. Who We Are
This Notice describes the privacy practices of Greater Oregon Behavioral Health, Incorporated’s (hereinafter referred to as GOBHI) physicians, Administrative staff, and provider agencies. It applies to services furnished to you at 400 East Scenic Drive, Suite 2343, The Dalles, Oregon 97058. This notice explains how, when and why, we may use or disclose your PHI. Except in specified circumstances, we must use or disclose only the minimum necessary Protected Healthcare Information (PHI) to accomplish the intended purpose of the use of disclosure. We train and require all of our employees to maintain the privacy and confidentiality of your PHI.

II. Our Privacy Obligations
We are required by law to maintain the privacy of your health information (“Protected Health Information” or “PHI”) and to provide you with this Notice of our legal duties and privacy practices with respect to your Protected Health Information. When we use or disclose your Protected Health Information, we are required to abide by the terms of this Notice (or other notice in effect at the time of the use or disclosure). GOBHI uses and discloses PHI in a number of ways connected to your treatment, payment for your care, and our health care operations. Some examples of how we may use or disclose your PHI are listed below. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose your PHI will fall within one or more of these categories.

III. Permissible Uses and Disclosures Without Your Written Authorization
In certain situations, which we will describe in Section IV below, we must obtain your written permission in order to use and/or disclose your PHI. Depending upon applicable law this permission may be called a “consent” or it may be called an “authorization”. Throughout this Notice, we will refer to your written permission to use and/or disclose your PHI as, “Your Authorization”. However, unless the PHI is Highly Confidential Information (as defined in Section IV.C below) and the applicable law regulating such information imposes special restrictions on us, we may use and disclose your PHI without Your Authorization for the following purposes:

A. 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 as detailed below:
• Treatment. We use and disclose your PHI to provide treatment and other services to you—for example, to diagnose and treat your illness. In addition, we may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you. “We may also disclose PHI to other officers or employees of that provider, its agents or cooperating providers who are currently acting within the scope of their duties to evaluate treatment programs, to diagnose or treat or to assist in diagnosing or treating you when your PHI is to be sued in the course of diagnosing or treating you.” “And, your PHI may be transferred among providers of the Department of Human Services, The Department of Corrections, a local correctional facility, or a community mental health and developmental disabilities program when the transfer is necessary or beneficial to your treatment.”
• Payment. We may use and disclose your PHI to obtain payment for services that we provide to you from Medicare, the Oregon Medicaid program or another governmental program that arranges or pays the cost of some or all of your health care. We will obtain Your Authorization to disclose PHI to your private health insurer, HMO or other private payer.
• Health Care Operations. We may use and disclose your PHI 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 xample, we may use PHI to evaluate the quality and competence of our psychologists, social workers and other health care workers. We may disclose PHI to our Complaint Coordinator in order to resolve any complaints you may have.

B. Disclosure to Others.
We may use or disclose your PHI to any person including for example, a family member, other relative, a close personal friend or any other person identified by you, to the extent necessary to meet a medical emergency. If your identity is disclosed, we will prepare and include in our records, a written statement indicating the reasons for the disclosure, the written accounts disclosed, and the recipients of the disclosure

We may also disclose your PHI if in the case of your incompetence, your legal guardian gives voluntary and informed consent in writing that is signed and dated by your guardian and otherwise meets applicable provisions of federal and state laws.

C. Disclosures to Avert Immediate Danger.
We may disclose your PHI to the extent that it, in our professional judgment, indicates a clear and immediate danger to others or to society.
Examples may include, but not be limited to, the following public health activities:
(1) to report health information to public health authorities for the purpose of preventing or controlling immediate disease, injury or disability;
(2) to report immediate danger of child abuse and neglect to the Oregon Department of Children and Family Services or other government authorities authorized by law to receive such reports;
(3) to report information about immediately dangerous products and services under the jurisdiction of the U.S. Food and Drug Administration;
(4) to alert a person who may have been exposed to an immediately dangerous, communicable disease or may otherwise be at risk of contracting or spreading such a disease or condition; and
(5) to report information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance that qualify under this section or other applicable deferral or state laws. However, PHI may not be disclosed if it is learned by us wither:
(a) In the course of treatment to affect the propensity to commit the criminal conduct that is the basis for the disclosure: or
(b)through a request by the individual to initiate or to be referred for the treatment, counseling or therapy.

D. Victims of Abuse, Neglect or Domestic Violence. If we reasonably believe you are a victim of abuse, neglect or domestic violence, we may disclose your PHI to the Oregon Department of Children and Family Services, the Oregon Department of Human Services or other governmental authority, including a social service or protective services agency, authorized by law to receive reports of such abuse, neglect, or domestic violence.

E. 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 such as Medicare or Medicaid.

F. 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. Further, unless specifically authorized by a court order, we may not use or disclose PHI identifying you as a recipient of substance abuse program services if the purpose is to initiate or substantiate any criminal charges against you or to conduct any investigation of you.
G. Law Enforcement Officials. We may disclose your PHI to the police or other law enforcement officials as required or permitted by applicable law or in compliance with a court order or a grand jury or administrative subpoena.

H. Decedents. We may disclose your PHI to a coroner or medical examiner as authorized by applicable law.

I. Health or Safety. We may use or disclose your PHI to prevent or lessen a serious and imminent threat to a person’s or the public’s health or safety.
 
J. Specialized Government Functions. We may use and disclose your PHI to units of the government with special functions, such as the U.S. military or the U.S. Department of State under certain circumstances.

K. Workers’ Compensation. We may disclose your PHI as authorized by and to the extent necessary to comply with applicable state law relating to workers’ compensation or other
similar programs.
 
L. As required by law. We may use and disclose your PHI when required to do so by any other applicable law not already referred to in the preceding categories.

IV. Uses and Disclosures Requiring Your Written Authorization
For any purpose other than the ones described above in Section III, we only may use or disclose your PHI when you give us Your Authorization on our [consent or] authorization form.

A . Private Payors. We must obtain Your Authorization to disclose PHI to your HMO, health insurer or other private payor.

B . Uses and Disclosures of Your Highly Confidential Information. In addition, federal and Oregon law imposes special privacy protections for “Highly Confidential Information”), which is Psychotherapy Notes and the subset of Protected Health Information that is related to:
 (1) treatment of a mental illness;
 (2) alcohol and drug abuse treatment program services;
 (3) HIV/ AIDS testing;
 (4) child abuse and neglect;
 (5) sexual assault; and
 (6) genetic testing. In order for us to disclose your Highly Confidential Information for a purpose other than those permitted by laws regulating Highly Confidential Information, we must obtain Your Authorization.

V. Your Rights Regarding Your Protected Health Information
A. For Further Information; Complaints. If you desire further information about your privacy rights, are concerned that we have violated your privacy rights, or disagree with a decision that we made about access to your PHI, you may contact our Privacy Office and you may file a complaint with the Privacy Officer at Greater Oregon Behavioral Health at 400 East Scenic Drive, Suite 2343, The Dalles, Oregon. All complaints must be submitted in writing. For more information on how to file written complaint, call the Privacy Office at 1-541-298-2101. You may also file written complaints with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. Upon request, the Privacy Office will provide you with the correct address for the Director. We will not retaliate against you if you file a complaint with us or the Director.

B. 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 (such as a family member, other relative, close personal friend or any other person identified by you) involved with your care or with payment related to your care, or
(3) to notify or assist in the notification of such individuals regarding your location and general condition. While we will consider all requests for additional restrictions carefully, we are not required to agree to a requested restriction. If you wish to request additional restrictions, please obtain a request form from our Privacy Office and submit the completed form to the Privacy Office. We will send you a written response.
C . 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.

D. Right to Revoke Your Authorization. You may revoke Your Authorization, except to the extent that we have taken action in reliance upon it, by delivering a written revocation statement to the Privacy Office identified below. [A form of Written Revocation is available upon request from the Privacy Office.]

E. 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 desire access to your records, please obtain a record request form from the Privacy Office and submit the completed form to the Privacy Office. If you request copies, we will charge you [$0.10)] for each page. We will also charge you for our postage costs, if you request that we mail the copies to you.

F. Right to Amend Your Records. You have the right to request that we amend Protected Health Information maintained in your medical record file or billing records. 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. We will comply with your request unless we believe that the information that would be amended is accurate and complete or other special circumstances apply.

G. 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. [164.528; 164.520(b)(1)(iv)(E)]

H. Right to Receive Paper Copy of this Notice. Upon request, you may obtain a paper copy of this Notice, even if you have agreed to receive such notice electronically.

VI. Effective Date and Duration of This Notice
A. Effective Date. This Notice is effective on April 14, 2003.

B. Changes to Privacy Practices and Notice. We reserve the right to change our privacy practices and the terms of this Notice at any time and to make the new notice terms effective for all Protected Health Information that we maintain, including any information created or received prior to issuing the new notice as well as any information we receive in the future. If we change this Notice, we will post the new notice in waiting areas around Greater Oregon Behavioral Health located at: 400 East Scenic Drive, Suite 2343, The Dalles, Oregon. You also may obtain any new notice by contacting the Privacy Office at the locations specified below.
 
VII. Privacy Office

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You may contact the Privacy Office at:
Privacy Office
Greater Oregon Behavioral Health, Inc.
400 East Scenic Drive – Suite 2343
The Dalles, Oregon 97058
Telephone Number: (541) 298-2101