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Effective Date of This Notice: Updated 03.31.2017


If you have any questions about this notice or wish to file a complaint, please contact PPCW’s Privacy Official at 503-775-4931, extension 3330.  You may request a copy of this notice.


We understand that health information about you and your healthcare is personal.  We are committed to protecting health information about you.  We will create a record of the care and services you receive from us.  We do so to provide you with quality care and to comply with any legal or regulatory requirements.

This Notice applies to all of the records generated or received by Planned Parenthood Columbia Willamette (PPCW), whether we documented the health information, or another doctor forwarded it to us.  This Notice will tell you the ways in which we may use or disclose health information about you.  This Notice also describes your rights to the health information we keep about you, and describes certain obligations we have regarding the use and disclosure of your health information.

Our pledge regarding your health information is backed-up by Federal law.  The privacy and security provisions of the Health Insurance Portability and Accountability Act (“HIPAA”) require us to:

  • Make sure that health information that identifies you is kept private;
  • Make available this notice of our legal duties and privacy practices with respect to health information about you; and
  • Follow the terms of the notice that is currently in effect. 


The following categories describe different ways that we may use or disclose your health information without your written authorization.  For each category of use or disclosure, we will explain what we mean and give an example.  Not every use or disclosure in a category will be listed.  However, unless we ask for a separate authorization, all of the ways we are permitted to use and disclose information will fall within one of the following categories.

For Treatment:  We may use health information about you to provide you with healthcare treatment and services.  We may disclose health information about you to doctors, nurses, technicians, health students, volunteers or other personnel who are involved in taking care of you.  They may work at our offices, at a hospital if you are hospitalized under our supervision, or at another doctor’s office, lab, pharmacy, or other healthcare provider to whom we may refer you for consultation, to take x-rays, to perform lab tests, to have prescriptions filled, or for other treatment purposes.  For example, a doctor treating you may need to know if you have diabetes because diabetes may slow the healing process. We may provide that information to a physician treating you at another institution.

For Payment:  We may use and disclose health information about you so that the treatment and services you receive from us may be billed to and payment collected from you, an insurance company, a state Medicaid agency or a third party.  For example, we may need to give your health insurance plan information about your office visit so your health plan will pay us or reimburse you for the visit.  Alternatively, we may need to give your health information to the state Medicaid agency so that we may be reimbursed for providing services to you. 

In some instances, we may need to tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

For Healthcare Operations:  We may use and disclose health information about you for operations of our healthcare practice.  These uses and disclosures are necessary to run our practice and make sure that all of our patients receive quality care.  For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you.  We may also combine health information about many patients to decide what additional services we should offer, what services are not needed, whether certain new treatments are effective, or to compare how we are doing with others and to see where we can make improvements.  We may remove information that identifies you from this set of health information so others may use it to study healthcare delivery without learning who our specific patients are.

Appointment Reminders:  We may use and disclose health information to contact you as a reminder that you have an appointment.  Please let us know if you do not wish to have us contact you concerning your appointment, or if you wish to have us use a different telephone number or address to contact you for this purpose.

ResearchThere may be situations where we want to use and disclose health information about you for research purposes.  For example, a research project may involve comparing the efficacy of one medication over another.  For any research project that uses your health information, we will either obtain an authorization from you or ask an Institutional Review or Privacy Board to waive the requirement to obtain authorization.  A waiver of authorization will be based upon assurances from a review board that the researchers will adequately protect your health information.

To Others Involved in Your Care:  We may disclose health information about you to your family members or friends if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection or if we can infer from the circumstances, based on our professional judgment, that you would not object.  For example, we may assume you agree to our disclosure of your personal health information to your spouse or parent when you bring that person with you into the exam room during treatment or while treatment is discussed.  In the event of an emergency or where you are incapable of providing consent, we may determine in our professional judgment that a disclosure to your family member or friend is in your best interest and will disclose only that information which is relevant to the person’s involvement in your care. 

As Required By Law:  We will disclose health information about you when required to do so by federal, state, or local law.  This includes disclosures required to be made by PPCW to the Secretary of the US Department of Health and Human Services (DHHS).

To Avert a Serious Threat to Health or Safety:  We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.  Any disclosure, however, would only be to someone able to help prevent the threat.

Military and Veterans:  If you are a member of the armed forces or are separated or discharged from military services, we may release health information about you as required by military command authorities or the Department of Veterans Affairs as may be applicable.  We may also release health information about foreign military personnel to the appropriate foreign military authorities.

Workers' Compensation: We may release health information about you for workers' compensation or similar programs.  These programs provide benefits for work-related injuries or illness.

Public Health Risks:  We may disclose health information about you for public health activities.  These activities generally include the following:

To prevent or control disease, injury or disability; To report births and deaths; To report child abuse or neglect; To report reactions to medications or problems with products; To notify people of recalls of products they may be using; To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law. In response to a court order, subpoena, warrant, summons or similar process; To identify or locate a suspect, fugitive, material witness, or missing person;If you are the victim of a crime and we are unable to obtain your consent; About a death we believe may be the result of criminal conduct; In an instance of criminal conduct at our facility; and in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description, or location of the person who committed the crime.


We will not use or disclose your health information for any purpose other than those identified in the previous section without your specific written authorization.  Examples of disclosures requiring your authorization include the following:

MarketingWe will not use or disclose your health information for purposes of marketing a product or service without first obtaining your written authorization.  This does not include, however, face-to-face communications with you about products or services that may be of benefit to you or about prescriptions you have already been prescribed.

Sale of Health Information:  We will not use or disclose your health information, including selling your health information for public health purposes or research, unless we first obtain your written authorization.

Psychotherapy NotesWe will not disclose any health information deemed to be psychotherapy notes without first obtaining your written authorization.

If you give us an authorization to use or disclose health information about you, you may revoke that authorization, in writing, at any time.  If you revoke your authorization, we will no longer use or disclose information about you for the reasons covered by your written authorization, but we cannot take back any uses or disclosures already made with your permission.


You have the following rights regarding health information we maintain about you.

Right to Inspect and Copy:  You have certain rights to inspect and copy health information that may be used to make decisions about your care.  Usually, this includes health and billing records.  This does not include psychotherapy notes.  You may also direct us to send a copy of your health information and billing records to a third party.  In accordance with the 21st Century CURES Act, you may request access, use or exchange or electronic health information.

To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing on a form provided by us to: “The Privacy Official at Planned Parenthood Columbia Willamette”.  If you request a copy of your health information, we may charge a fee for the costs of locating, copying, mailing or other supplies and services associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances.  If you are denied access to health information, you may in certain instances request that the denial be reviewed.  Another licensed healthcare professional chosen by our practice will review your request and the denial.  The person conducting the review will not be the person who denied your initial request.  We will comply with the outcome of the review.

Right to Amend:  If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information.  You have the right to request an amendment for as long as we keep the information.  To request an amendment, your request must be made in writing on a form provided by us and submitted to: “The Privacy Official at Planned Parenthood Columbia Willamette.”

We may deny your request for an amendment if it is not the form provided by us and does not include a reason to support the request.  In addition, we may deny your request if you ask us to amend information that:

  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  • Is not part of the health information kept by or for our practice;
  • Is not part of the information which you would be permitted to inspect and copy; or
  • Is accurate and complete.

Any amendment we make to your health information will be disclosed to those with whom we disclose information as previously specified.

Right to an Accounting of Disclosures:  You have the right to request a list (accounting) of any disclosures of your health information we have made, except for uses and disclosures for treatment, payment, and health care operations, as previously described.

To request this list of disclosures, you must submit your request on a form that we will provide to you.  Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003 [The compliance date of the Privacy Regulation].  The first list of disclosures you request within a 12-month period will be free.  For additional lists, we may charge you for the costs of providing the list.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.  We will mail you a list of disclosures in paper form within 30 days of your request, or notify you if we are unable to supply the list within that time period and by what date we can supply the list; but this date should not exceed a total of 60 days from the date you made the request.

Right to Request Restrictions:  You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations.  You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care.  For example, you could ask that access to your health information be denied to a particular member of our workforce who is known to you personally.

While we will try to accommodate your request for restrictions, we are not required to do so if it is not feasible for us to ensure our compliance with law or we believe it will negatively impact the care we may provide you.  If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.  To request a restriction, you must make your request on a form that we will provide you.  In your request, you must tell us what information you want to limit and to whom you want the limits to apply. However, we are required to agree to any request by you to restrict disclosures of protected health information to health insurers if you have fully paid for your health services pertaining to such disclosures using your own money.

Right to Request Confidential Communications:  You have the right to request that we communicate with you about health matters in a certain manner or at a certain location.  For example, you can ask that we only contact you at work or by mail to a post office box.  During our intake process, we will ask you how you wish to receive communications about your health care or for any other instructions on notifying you about your health information.  We will accommodate all reasonable requests.

Right to a Paper Copy of This Notice:  You have the right to obtain a paper copy of this Notice at any time upon request.    You may also obtain a copy of this Notice at our website:  https://www.plannedparenthood.org/ppcw/

Right to Receive Notice of a Breach: We are required to notify you following a breach of unsecured protected health information.


PPCW reserves the right to change this Notice.  We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future.  We will post a copy of the current Notice in our facility and on our website.  The Notice contains the effective date on the first page. 


If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services.  To file a complaint with us, you may contact PPCW’s Privacy Official (503) 775-4931, extension 3330.  All complaints must be submitted in writing.  You will not be penalized for filing a complaint.  You may also contact the Office of Civil Rights (OCR) to report or file a complaint.  OCR contact information can be found at https://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html.



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