Notice of Privacy Practices Effective Date: April 14, 2003. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND SHARED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THIS IS YOUR RIGHT TO NOTICE. This Notice is available in other languages and alternate formats that meet the guidelines for the Americans with Disabilities Act (ADA). Contact your Service Provider, or call the general number for the Health Department at: Phone 503-588-5357, TTY/TTD 503-588-5400 or Fax 503-364-6552. In this Notice, the words "we," "us," "our" and "Health Department" mean the Marion County Health Department. The Purpose of this Notice The Marion County Health Department provides many types of services, such as medical care and mental health services. Health Department staff must collect information about you to provide these services. The Health Department knows that information we collect about you and your health is private. We are required to protect this information by federal and state law. We call your individual health information "protected health information" (PHI). This Notice of Privacy Practices will tell you how the Health Department may use or share information about you. Not every situation may be described. If you have any questions about any statements in this notice, please feel free to ask your Service Provider. The Health Department is required to give you a notice of our privacy practices for the information we collect and keep about you. By law, we must follow the terms of the notice currently in effect. How We May Use and Share Your Information For Treatment. The Health Department may use or share information with health care providers who are involved in your health care. For example, information may be shared to create and carry out a plan for your treatment. For Payment. The Health Department may use or share information to get payment or to pay for the health care services you receive. For example, we may provide your health information to bill your heath plan for your medical visit here. For Health Care Operations. The Health Department may use or share information in order to manage its programs and activities. For example, we may use information to review the quality of services you receive. In Organized Health Care Arrangements. We may use and share health information with organizations such as the Marion County Integrated Delivery System and Salem Hospital. We participate in joint health care activities such as ensuring continuing care for you. For Appointment Reminders and Other Notifications To You. The Health Department may call you or send you reminders for medical care, or counseling visits with us. We will call you at the phone number you give us unless you tell us to call you at a different phone number. You can also tell us not to call you at all. We may leave a message on your voicemail machine about these reminders or simply ask you to call us back. We will leave only a limited message with the caller's name and phone number. We will not identify who your Service Provider is or the type of care you are receiving. We also may send you information about health services that may be of interest to you. For Public Health Activities. The Health Department is the public health agency that keeps and updates vital records, such as births and deaths, and we track some diseases. For Health Oversight Activities. We may use or share your information to inspect the work or investigate health care providers such as nurses, counselors and others. For Law Enforcement or Courts. The Health Department will use and share information when required or permitted by federal or state law or by a court order. For Abuse Reports and Investigations. We are required by law to receive and report abuse and neglect to proper state authorities. This may result in a PHI disclosure. For Government Programs. The Health Department may use and share information for public benefits under other government programs. For example, we may share your information to check eligibility for a nutrition program such as WIC. For Coroners, Medical Examiners and Funeral Directors. We may disclose information for the identification of a deceased person, and other activities permitted by law. To Avoid Harm and Special Government Activities. The Health Department may share PHI with law enforcement or the US government in order to avoid a serious threat to the health or safety of any person, the public in general or for protection of the President. For Research. The Health Department uses PHI for public health studies and some reports. These studies and reports do not identify specific people. For Fundraising. We may contact you to request a donation to support our important public health activities. With this contact, we may share your information with our fundraising staff. This information is limited to your name, address, phone number and dates on which we provided health care to you. Exceptions: if you are or were a participant of an alcohol or drug treatment program or tested for HIV, we will not provide your information for fundraising. If you wish to make a donation now or do not want to receive any fundraising contacts in the future, please tell your Service Provider or our Privacy Office at 503-588-5357. For Facility Directories. We may release your name, location, general health condition and religious membership if you are staying in leased homes, apartments, hotel and motel rooms that are provided for or offered by us. The information listed in this section may be placed on a patient directory unless you object to being included in the directory. We will not place your information in a directory that tells you are receiving treatment for mental health, HIV/AIDS or alcohol or drugs. Information in the directory may be shared to anyone who asks for you by name or by members of the clergy. Your religious membership will only be shared with members of the clergy. For Workers' Compensation. We may disclose your health information to comply with laws for workers' compensation or similar programs. Sharing Your Information with Family, Friends and Others. We may share health information with your family or other persons you have identified as involved in your medical or mental health care. You have the right to object to the sharing of this information. Other Uses and Disclosures Require Your Written Authorization For other situations, Health Department will ask for your written authorization before using or disclosing your health information. If you do authorize a certain use or disclosure, you may cancel the authorization at any time in writing. The Health Department cannot take back any uses or disclosures already made with your authorization. Marketing. We must obtain your authorization prior to using your health information to send you any marketing materials. We can though provide you with marketing materials face-to-face or give you a gift of nominal value without your authorization. In addition, we may communicate with you about products or services relating to your treatment, case management or care coordination, or alternative treatments, therapies, providers or care settings without your authorization. Other Laws Protect Your Health Information Many Health Department programs have other federal and state laws to follow for the use and disclosure of your information. These will require your authorization. For example, you must give your written authorization for us to share your mental health and alcohol or drug treatment records. Types of health information that have special privacy protections include: (1) Treatment of a mental illness and session therapy notes; (2) Alcohol and drug abuse treatment services; (3) HIV/AIDS testing and services; (4) Child abuse and neglect; (5) Sexual assault; (6) Genetic testing. Other Health Department Practices Protect Your Health Information We have privacy safeguards built into our programs to protect additional types of health information, and some of those are: (1) Communicable diseases such as TB and Hepatitis B; (2) sexually transmitted infections such as herpes; (3) Women's Clinic services, such as family planning. Your Health Information Privacy Rights When information is kept by the Health Department as a public health authority, other state and federal laws govern the public health records. In this way, we are not subject to the rights described below. A public health authority is charged with certain duties to report on and protect the public from abuse, neglect, disability and disease. Right to See and Get Copies of Your Records. You have the right to ask to see or get copies of your records. You must make the request in writing. You may be charged a fee for the cost of copying your records. Your request will be worked on in a timely manner, as provided by law. We may deny your request to look at your records. If we deny your request, we will send you a letter that tells you why your request is denied and how you can ask for a review of the denial. Right to Request to Correct or Amend Your Records. You may ask us to change or add missing information to your records if you think there is a mistake. You must make the request in writing, and provide a reason for your request. We may deny your request to copy or change your records. If we deny your request, we will send you a letter that tells you why your request is denied and how you can ask for a review of the denial. Right to Get a List of Disclosures. You have the right to ask the Health Department for a list of disclosures made after April 14, 2003. You must make the request in writing. This list will not include the times that information was shared for treatment, payment, or health care operations. The list will not include information provided directly to you or your family, or information that was sent with your authorization. You can request this type of list once per year. Right to Request Limits on Uses or Disclosures of Your Information. You have the right to ask that Health Department limit how your information is used or shared. You must make the request in writing and tell us what information you want to limit and/or to whom you want the limits to apply. We are not required to agree to the limitation. You can request that the limitation be terminated in writing or verbally. Right to Revoke Permission. If you are asked to sign an authorization to use or share information, you can cancel that authorization at any time. You must make the request in writing. This will not affect information that has already been shared. Right to Choose How We Communicate With You. You have the right to ask that we share information with you in a certain way or at a certain place. For example, you may ask us to send information to your work address instead of your home address. Or you may ask us to call you at a different phone number. Generally, you must make this request in writing. You do not have to explain why. Right to File a Complaint. You have the right to file a complaint if you do not agree with how the Health Department has used or shared your health information or if you disagree with our privacy practices in general. Right to Get a Paper Copy of This Notice. You have the right to ask for a paper copy of this notice at any time. For More Information and How To Contact Us You may contact your Service Provider or the Health Department Privacy Officer at any time if you have a question about this notice or need more information on how to use your rights. Please use the address and phone number below. Marion County Health Department Privacy Officer 3180 Center St. NE Salem, Oregon 97301 Phone number: 503-588-5357 How to File a Complaint or Report a Suspected Problem You may contact us as listed above if you want to file a complaint or to report a problem with how the Health Department has used or shared information about you. You may also file written complaints with the Director, Office for Civil Rights of the US Department of Health and Human Services. When you ask, your Service Provider will provide you with the correct address for the Office of Civil Rights. Your benefits will not be affected by any complaints you make. The Health Department cannot retaliate against you for filing a complaint, cooperating in an investigation, or refusing to agree to something that you believe to be unlawful. Duration of This Notice We may change the terms of this notice at any time. Any changes will apply to information we already have, as well as any information we may receive in the future. A copy of the new notice will be posted at each Health Department Service Provider site and provided as required by law. You may ask for a copy of the current notice anytime you visit a Health Department site, or you may get a copy on-line at: www.co.marion.or.us/mhealth Marion County Health Department 1