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Notice of Privacy Practices – Long form

Notice of Privacy Practices and HIPAA Compliance

This notice describes how your medical information may be used and disclosed and how you may gain access to this information. We will ask you to sign an Acknowledgement that you have received this notice of our Patient Privacy Practices. In accordance with the HIPAA Privacy Regulation, this Notice describes how Hillsboro Wellness may use and disclose your protected health information to carry out treatment, payment, or healthcare operations and for other purposes that are permitted or required by law. The Notice also describes your rights and Hillsboro Wellness’s requirements to protect your health information. 



We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect. This Notice takes effect on 12/22/2022, and will remain in effect until we replace it. 

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all health information we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request. 

You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice. 



Treatment, Payment, and Healthcare Operations

We use and disclose health information about you for treatment, healthcare operations, and payment. For examples:

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to an insurance carrier. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to treat you. 

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. We will bill you and/or a third party payor for the cost of treatment and related services provided to you. 

Healthcare Operations: We may use and disclose your protected health information for all activities that are included within the definition of “health care operations” as defined in the federal Privacy Regulations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing, or credentialing activities. 


Your Authorization: In addition to our use of your health information for treatment, payment, or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. 

Friends and Family and Other Persons Involved in Care: We may disclose your protected health care information to friends and family in the case of an emergency to the extent necessary to help with your health care or with payment of your healthcare. Using their judgment as health care professionals, our staff may disclose protected information with a family member, other relative, close personal friend, or any person you identify as being involved in your healthcare. 

Marketing Health-Related Services: We will not use your health information for marketing communications without your written authorization. 

Required by Law: We may use or disclose your health information when we are required to do so by law. 

Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may disclose your information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others. 

Law Enforcement: We may disclose to law enforcement agencies in response to a court order, subpoena, discovery request, administrative order, or other lawful process by another person involved in a dispute involving a patient.

Other required or permitted disclosures: We may disclose your health information to the following entities when we are required to do so by law. 

      • To authorized federal officials for intelligence, counterintelligence, and other national security activities
      • To the military authorities under certain circumstances when the patient is a member of the Armed Forces
      • To notify, or assist in notifying a family member, personal representative, or another person responsible for the patient’s care, of the patient’s location or general condition
      • To a correctional institution or its agents, if a patient is or becomes an inmate of such an institution, when necessary for the patient’s health or the health and safety of others
      • To public health or legal authorities charged with preventing or controlling disease, injury, or disability (public health and safety)

Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, text messages, emails or letters).



Access to Protected Health Information: You have the right to look at or get copies of your health information, with limited exceptions. You must make a request in writing to obtain access to your protected health information. We will charge you a reasonable cost-based fee for expenses such as copies and staff time. We may deny your request to inspect and copy your protected health information in certain limited circumstances. 

Requests for Restrictions: You have the right to request that we restrict how your protected health information is used or disclosed in carrying out treatment, payment, or healthcare operations. Such requests must be made in writing to our clinic. In your request tell us: 1) the information of which you want to limit our use and disclosure and 2) how you want to limit our use and disclosure of the information. We are not required to agree to the requested restrictions, but if we do, we will abide by our agreement except in an emergency. 

Accounting of Disclosures: You have the right to receive an accounting of the disclosures, if any, we have made of your protected health information. 

Amendment(s) to Healthcare Information: You have the right to request we amend your health information. Your request must be in writing, and it must explain why the information should be amended. If we did not create the information you want amended or for certain other circumstances, we may deny your request. If denied, you have the right to file a statement of disagreement with the decision (to be included in your medical record). 

Alternative Communication: You have the right to request that we communicate with you about your health information by reasonable alternative means or to alternative locations. You must make your request in writing. Your request must specify the alternative means or location, and provide satisfactory explanation how payments will be handled under the alternative means or location you request. 

Electronic Notice: If you receive this Notice on our web site or by electronic mail (email), you are entitled to receive this Notice in written form. 

Notification of a Breach: You have the right to be notified upon discovery of a breach of unsecured protected health information. The Privacy Officer will make reasonable efforts to notify you of the breach without unreasonable delay in the event that such a breach occurs. 



If you have any questions, complaints, or want more information, contact this office. If you believe that your privacy rights have been violated, you may file a complaint with us. 

Hillsboro Wellness Privacy Officer: Mackenzie Ryan
Phone: 503-844-4325
Address: 5295 NE Elam Young Pkwy, Ste 160, Hillsboro OR 97124

If you are not satisfied with the manner in which this office handles your complaint, you also have the right to file a formal, written complaint with the Secretary of the US Department of Public Health and Human Services. 

State of Oregon Department of Human Services Privacy Officer
500 Summer Street NE, E24
Salem, Oregon 97301
Phone: 1-503-945-5780
Toll Free: 1-800-442-5238
Fax: 1-503-947-5396

Office for Civil Rights-Medical Privacy, Complaint Division
U.S. Department of Health and Human Services
200 Independence Ave., SW HHH Building, Room 509H
Washington, D.C. 20201
Phone: 866-627-7748, TTY: 866—788-4989

We support your right to protect the privacy of your protected health and financial information. We will not retaliate in any way if you choose to file a complaint with us or the Department of Health and Human Services.