NOTICE OF PRIVACY PRACTICES (HIPAA
TO OUR CLIENTS – This notice describes how medical
information about you may be used and disclosed and how you can get
access to this information. Please review it carefully.
Health Information that we maintain about you:
- Demographic information, including your name, address, date of
birth, phone number(s), employer’s name, name of spouse/family, &
- Health information that you report to us during your visit(s) at
Hope Pregnancy Clinic, including any pregnancy-related condition; your
health history, dates of visits, diseases, or diagnoses; medication
and/or substance use or abuses; allergies; HIV/AIDS status or STDs;
social activities; and family &/or living situation
- Nurse and physician notes, medical record number, clinical findings,
such as pregnancy test results, ultrasound exams
Your rights regarding your Health Information:
- To ask to see or get an electronic or paper copy of your medical
record and other health information we have about you
- To correct health information about you that you think is incorrect
or incomplete. We may say “no” to your request, but we’ll tell you why
in writing within 60 days.
- You can ask us to contact you in a specific way (for example, by
home or office phone) or to send mail to a different address. We will
say “yes” to all reasonable requests.
- You can ask us not to use or share certain health information for
treatment, payment, or our operations. We are not required to agree to
your request, and we may say “no” if it would affect your care. If you
pay for a service or health care item out-of-pocket in full, you can ask
us not to share that information for the purpose of payment or our
operations with your health insurer. We will say “yes” unless a law
requires us to share that information.
- You can ask for a list (accounting) of the times we’ve shared your
health information for six years prior to the date you ask, who we
shared it with, and why. We will include all the disclosures except for
those about treatment, payment, health care operations, and certain
other disclosures (such as any you asked us to make). We’ll provide one
accounting a year for free but will charge a reasonable, cost-based fee
if you ask for another one within 12 months.
- You can ask for a paper copy of this notice at any time, even if you
have agreed to receive the notice electronically. We will provide you
with a paper copy promptly.
- If you have given someone medical power of attorney or if someone is
your legal guardian, that person can exercise your rights and make
choices about your health information. We will make sure the person has
this authority and can act for you before we take any action.
- You can complain if you feel we have violated your rights by
contacting us at Hope Pregnancy Clinic Attn: HIPAA Privacy Official 2630
Market Street NE, Salem OR 97301. You can file a complaint with the U.S.
Department of Health and Human Services Office for Civil Rights by
sending a letter to 200 Independence Avenue, S.W., Washington, D.C.
20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices
about what we share. If you have a clear preference for how we
share your information in the situations described below, talk to us.
Tell us what you want us to do, and we will follow your
- Share information with your family, close friends, or others
involved in your care
- Share information in a disaster relief situation
- Contact you for fundraising efforts
If you are not able to tell us your preference, for example, if you
are unconscious, we may go ahead and share your information if we
believe it is in your best interest. We may also share your information
when needed to lessen a serious and imminent threat to health or
In these cases, we never share your information unless you give us
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
HOW WE USE AND DISCLOSE YOUR HEALTH INFORMATION – We
typically use or share your health information in the following
- Treat you: We can use your health information and share it with
other professionals who are treating you.
- Run our organization: We can use and share your health information
to run our practice, improve your care, and contact you when
- Advertising & Promotion
For advertising and promotion, we may use your story and ultrasound
images with all identifying information removed or de-identified to
protect your privacy. https://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
How else can we use or share your health
information? – We are allowed or required to share your
information in other ways – usually in ways that contribute to the
public good, such as public health and research. We have to meet many
conditions in the law before we can share your information for these
- We can share health information about you for certain situations
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or
- We can use or share your information for health research.
- We will share information about you if state or federal laws require
it, including with the Department of Health and Human Services if it
wants to see that we’re complying with federal privacy law.
- We can share health information about you with organ procurement
- We can share health information with a coroner, medical examiner, or
funeral director when an individual dies.
- We can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national
security, and presidential protective services
- We can share health information about you in response to a court or
administrative order, or in response to a subpoena.
We do not create or maintain psychotherapy notes at this
- We are required by law to maintain the privacy and security of your
protected health information.
- We will let you know promptly if a breach occurs that may have
compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this
notice and give you a copy of it.
- We will not use or share your information other than as described
here unless you tell us we can in writing. If you tell us we can, you
may change your mind at any time. Let us know in writing if you change
Changes to the Terms of This Notice We can change
the terms of this notice, and the changes will apply to all information
we have about you. The new notice will be available upon request, in our
office, and on our website.