Effective Date June 1, 2019
NOTICE OF PRIVACY PRACTICES
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.
A. PURPOSE OF THIS NOTICE.
Dream Again LLC (“Dream Again”) is committed to preserving the privacy of your health information. In fact, we are required by law to do so for any health information created or received by us. Dream Again is required to provide this Notice of Privacy Practices (“Notice”) to you. The Notice tells you how we can and cannot use and disclose the health information that you have given to us or that we have learned about you when you were a patient in our system. It also tells you about your rights and our legal duties concerning your health information.
Dream Again is required to abide by this Notice. This Notice applies to the practices of:
– All Dream Again employees, contractors, volunteers, students and service providers, including clinicians, who have access to health information.
– Any health care professional authorized to enter information into your Dream Again health record.
For the rest of this Notice, “Dream Again,” “we” and “us” will refer to all services, service areas, and workers of Dream Again. When we use the words “your health information,” we mean any information that you have given us about you and your health, as well as information that we have received while we have taken care of you (including health information provided to Dream Again by those outside of Dream Again).
B. USES AND DISCLOSURES OF HEALTH INFORMATION FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS AT DREAM AGAIN.
1. Treatment, Payment and Health Care Operations.
The following section describes different ways that we use and disclose health information for treatment, payment and health care operations. For each of those categories, we explain what we mean and give one or more examples. Not every use or disclosure will be noted and there may be incidental disclosures that are a byproduct of the listed uses and disclosures. The ways we use and disclose health information will fall within one of the categories.
A. For Treatment. We may use your health information to provide you with therapeutic and rehabilitative services. We may disclose your health information to physicians, nurse practitioners, nurses, paramedics and other personnel involved in your health care and nutrition management.
B. For Payment. We may use and disclose your health information so that we may bill and collect payment from you.
C. For Health Care Operations. We may use and disclose your health information in order to run the necessary administrative, educational, quality assurance and business functions at Dream Again.
2. Uses and Disclosures You Can Limit.
A. Family and Friends. Unless you notify us that you object, we may provide your health information to individuals, such as family and friends, who are involved in your care or who help pay for your care. We may do this if you tell us we can do so, or if you know we are sharing your health information with these people and you don’t stop us from doing so. There may also be circumstances when we can assume, based on our professional judgment, that you would not object. For example, we may assume you agree to our disclosure of your information to your spouse if your spouse comes with you into the room during a consultation or visit. Also, if you are not able to approve or object to disclosures, we may make disclosures to a particular individual (such as a family member or friend), that we feel are in your best interest and that relate to that person’s involvement in your care.
C. OTHER PERMITTED USES AND DISCLOSURES OF HEALTH CARE INFORMATION.
We may use or disclose your health information without your permission in the following circumstances, subject to all applicable legal requirements and limitations:
1. Required By Law. As required by federal, state, or local law.
2. Victims of Abuse, Neglect or Domestic Violence. To a government authority authorized by law to receive reports of abuse, neglect or domestic violence when we reasonably believe you are the victim of abuse, neglect or domestic violence and other criteria are met.
3. Health Oversight Activities. To a health oversight agency for audits, investigations, inspections, licensing purposes, or as necessary for certain government agencies to monitor the health care system, government programs, and compliance with civil rights laws.
4. Lawsuits and Disputes. In response to a subpoena, discovery request or a court or administrative order, if certain criteria are met.
5. Law Enforcement. To a law enforcement official for law enforcement purposes as required by law; in response to a court order, subpoena, warrant, summons or similar process; for identification and location purposes if requested; to respond to a request for information on an actual or suspected crime victim; to report a crime in an emergency; or to report a death if the death is suspected to be the result of criminal conduct.
6. Serious Threat to Health or Safety. To appropriate individual(s) when necessary to prevent a serious threat to your health and safety or that of the public or another person.
D. WHEN WRITTEN AUTHORIZATION IS REQUIRED.
Other than for those purposes identified above in Sections B and C, we will not use or disclose your health information for any purpose unless you give us your specific written authorization to do so.
You can withdraw this written authorization at any time. To withdraw your authorization, deliver or fax a written revocation to Dream Again LLC, 1810 SE 10th Ave., Suite C Portland, OR 97214 (877) 795-7945. If you revoke your authorization, we will no longer use or disclose your health information as allowed by your written authorization, except to the extent that we have already relied on your authorization.
E. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION.
You have certain rights regarding your health information, which we list below. In each of these cases, if you want to exercise your rights, you must do so in writing by completing a form that you can obtain from Dream Again. In some cases, we may charge you for the costs of providing materials to you.
1. Right to Inspect and Copy. With some exceptions, you have the right to inspect and get a copy of the health information that we use to make decisions about your care. For the portion of your health record maintained in our electronic health record, you may request we provide that information to or for you in an electronic format. If you make such a request, we are required to provide that information for you electronically (unless we deny your request for other reasons). We may deny your request to inspect and/or copy in certain limited circumstances, and if we do this, you may ask that the denial be reviewed.
2. Right to Amend. You have the right to amend your health information maintained by or for Dream Again, or used by Dream Again to make decisions about you. We will require that you provide a reason for the request, and we may deny your request for an amendment if the request is not properly submitted, or if it asks us to amend information that (a) we did not create (unless the source of the information is no longer available to make the amendment); (b) is not part of the health information that we keep; (c) is of a type that you would not be permitted to inspect and copy; or (d) is already accurate and complete.
3. Right to an Accounting of Disclosures. You have the right to request a list and description of certain disclosures by Dream Again of your health information.
4. Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use.