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!
With your consent, the practice is permitted by federal privacy laws to make uses and disclosures of
your health information for purposes of treatment, payment, and health care operations. Protected
health information is the information we create and obtain in providing our services to you. Such
information may include documenting your symptoms, examination and test results, diagnoses,
treatment, and applying for future care or treatment. It also includes billing documents for those
EXAMPLE OF USES OF Y OUR HEALTH INFORMATION ON FOR TREATMENT PURPOSES:
A nurse obtains treatment information about you and records it in a health record. During the course
of your treatment, the doctor determines a need to consult with another specialist in the area. The
doctor will share the information with such specialist and obtain input.
EXAMPLE OF USE OF YO UR HEALTH INFORMATION N FOR PAYMENT PURPOSES:
We submit a request for payment to your health insurance company. The health insurance company
requests information from us regarding medical care given. We will provide information to them
about you and the care given.
EXAMPLE OF USE OF YO UR INFORMATION FOR HEALTH CARE OPERATIONS:
We obtain services from our insurers or other business associates such as quality assessment,
quality improvement, outcome evaluation, protocol and clinical guidelines development, training
programs, credentialing, medical review, legal services, and insurance. We will share information
about you with such insurers or other business associates as necessary to obtain these services.
• File a statement of disagreement if your amendment is denied, and require that the request
for amendment and any denial be attached in all future disclosures of your protected health
• Obtain an accounting of disclosures of your health information (including electronic
disclosure for the preceding three years of electronic health record use) as required to be
maintained by law by delivering a written request to our office. An accounting will NOT
include internal uses of information for treatment, payment, or operations, disclosures made
to you or made at your request, or disclosures made to family members or friends in the
course of providing care;
• Request that communication of your health information be made by alternative means or at
an alternative location by delivering the request in writing to our office; and,
• Revoke authorizations that you made previously to use or disclose information except to the
extent information or action has already been taken by delivering a written revocation to our
• You may request that we not disclose PHI to a health plan for payment of healthcare
operations but in order for this to occur it would be necessary to pay in full out-of-pocket for
the item or service. If paid in full out-of-pocket, we must comply with this request.
If you want to exercise any of the above rights, please contact Westside OMS (503)547-8879 6125 NE Cornell Rd. Suite 320, Hillsboro OR 97124 in person or in writing, during normal hours.
The practice is required to:
• Maintain the privacy of your health information as required by law;
• Provide you with a notice of our duties and privacy practices as to the information we collect
and maintain about you;
• Abide by the terms of this Notice;
• Notify you if we cannot accommodate a requested restriction or request; and
• Accommodate your reasonable requests regarding methods to communicate health information
with you, and notify you if you are affected by a breach of unsecured PHI.
We reserve the right to amend, change, or eliminate provisions in our privacy practices and access
practices and to enact new provisions regarding the protected health information we maintain. If
our information practices change, we will amend our Notice. You are entitled to receive a revised
copy of the Notice by calling and requesting a copy of our “Notice” or by visiting our office and
picking up a copy.
TO REQUEST INFORMATION OR FILE A COMPLAINT
If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact Westside OMS (503)547-8879 6125 NE Cornell Rd. Suite 320, Hillsboro OR 97124. Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to Westside OMS (503)547-8879 6125 NE Cornell Rd. Suite 320, Hillsboro OR 97124. You may also file a complaint by mailing it or e-mailing it to the Secretary of Health and Human Services whose street address and e-mail address is 200 Independence Avenue, S.W., Washington, D.C. 20201, www.cms.hhs.gov/hipaa/hipaa2/default.asp.
• We cannot, and will not, require you to waive the right to file a complaint with the Secretary of
Health and Human Services (HHS) as a condition of receiving treatment from the practice.
• We cannot, and will not, retaliate against you for filing a complaint with the Secretary.
OTHER DISCLOSURES AND USES
Unless you object, we may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your death.
COMMUNICATION WITH FAMILY
Using our best judgment, we may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement in your care or in payment for such care if you do not object or in an emergency.
FOOD AND DRUG ADMINISTRATION (FDA)
We may disclose to the FDA your protected health information relating to adverse events with respect to products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
If you are seeking compensation through Workers Compensation, we may disclose your protected health
information to the extent necessary to comply with laws relating to Workers Compensation.
As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
ABUSE & NEGLECT
We may disclose your protected health information to public authorities as allowed by law to report abuse or neglect.
If you are an inmate of a correctional institution, we may disclose to the institution, or its agents, your
protected health information necessary for your health and the health and safety of other individuals.
We may disclose your protected health information for law enforcement purposes as required by law, such as when required by a court order, or in cases involving felony prosecutions, or to the extent an individual is in the custody of law enforcement.
Federal law allows us to release your protected health information to appropriate health oversight agencies or for health oversight activities.
We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, with your consent, or as directed by a proper court order.
This policy was last updated May 31, 2018
We collect “Non-Personal Information” and “Personal Information.” Non-Personal Information includes
information that cannot be used to personally identify you, such as anonymous usage data, general
demographic information we may collect, referring/exit pages and URLs, platform types, preferences you
submit and preferences that are generated based on the data you submit and number of clicks. Personal
Information includes only your email, which you submit to us through the registration process at the Site.
Information collected via Technology. To activate the Service you do not need to submit any personal
Information other than your email address. To use the Service thereafter, you do not need to submit further Personal Information. However, in an effort to improve the quality of the Service, we track information provided to us by your browser or by our software application when you view or use the Service, such as the website you came from (known as the “referring URL”), the type of browser you use, the device from which you connected to the Service, the time and date of access, and other information that does not personally identify you.
We track this information using cookies, or small text files which include an anonymous unique identifier.
Cookies are sent to a user’s browser from our servers and are stored on the user’s computer hard drive.
SHARING AND SELLING INFORMATION:
The Company never sells, trades, rents or otherwise share for marketing purposes your Personal Information with third parties without your consent. Said information is supplied by you to verify the validity of your credit card, designed to keep fraud from ever occurring. Additionally, Company does not store credit card information at any time.
LINKS TO OTHER WEBSITES
HOW WE PROTECT INFORMATION
We implement security measures designed to protect your information from unauthorized access. We protect your information from potential security breaches by implementing certain technological security measures including encryption, firewalls and secure socket layer technology. However, these measures do not guarantee that your information will not be accessed, disclosed, altered or destroyed by breach of such firewalls and secure server software. By using our Service, you acknowledge that you understand and agree to assume these risks.
This policy was last updated January 31, 2021
Refunds will be made on over-payments on an account or to any service not rendered after and expected service date has passed.