HIPAA 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.
We care about your privacy
At Ardon Health, we respect the privacy of your protected health information and will maintain its confidentiality in a responsible and professional manner. Protected health information includes any information related to your healthcare that can identify you as the recipient of the healthcare services. We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information and to notify affected individuals following a breach of unsecured protected health information. This notice describes how health information about you may be used and disclosed and how you can get access to this information. We are required by law to provide you with this notice and abide by its terms.
How we collect and protect information
We collect information from enrollment forms. Examples of information gathered are: your name, address and Social Security number; general health status; employment details; and other information relevant to coverage. We also collect information from healthcare coverage transactions with your health plan. This information includes claims, service authorization requests, deductible status and copayments. While most information we collect is by telephone, we may also gather information electronically, in writing, or in person.
We ensure the security of your information through physical, technical, and procedural safeguards. All information collected is treated in a confidential and secure manner whether you are a prospective, current, or former client.
You have the right to:
- In most cases, inspect and obtain a paper or electronic copy of your medical record and other health information we have about you. We will provide a copy or summary of your health information, usually within 30 days of your request. Your request must be made in writing. We may charge a reasonable fee for copying and postage.
- Request that we amend the records, if you believe that the health information in your record is incorrect or if important information is missing. Your request must be in writing and include the basis for your request. We may deny your request if the information was not created by us, if it is not maintained by us, or if we determine that the record is accurate. We will respond to your request in writing within 60 days.
- Request that we communicate with you in a specific way (for example, home or office phone) or to send mail to an address other than your home. The request must be made in writing. We will accommodate reasonable requests.
- Request that we not use or disclose certain health information for treatment, payment, or healthcare operations, or to persons involved in your care except when specifically authorized by you, when required by law or in an emergency. The request must be made in writing. While we will consider your request for restrictions, we are not required to agree to these restrictions except in the following situation:
- The disclosure is to your health plan for the purpose of payment or healthcare operations, and is not otherwise required by law; and
- The protected health information pertains solely to a healthcare item or service for which you have paid in full out-of-pocket.
- Receive an accounting of certain disclosures of your information made by us during the six years prior to your request, who we shared it with, and why. The accounting will not include disclosures that were made:
- For treatment, payment, and healthcare operations purposes
- To you
- Incident to a use or disclosure otherwise permitted
- Pursuant to your authorization
- To persons involved in your care
- For national security or intelligence purposes
- To correctional institutions or law enforcement agencies
- As part of a limited data set for research, public health or healthcare operations purposes; and
- Prior to April 14, 2003
We will provide one accounting upon request every 12 months at no charge. We may charge a fee for an additional accounting within 12 months. We will inform you in advance of the fee and allow you to withdraw or modify your request.
- Choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
- Receive a paper copy of this notice upon request at any time. Contact us to access this notice.
Contact us at 855-425-4085 or firstname.lastname@example.org to exercise your rights or if you have questions.
Required disclosures of your health information
We are required by law to disclose your protected health information in two situations.
In the first situation, we must disclose your information to:
- You or your personal representative. When you (or a personal representative you have authorized in writing to represent you) specifically request access to or a summary of disclosures of your protected health information, we are required by law to provide that information to you or your representative.
In the second situation, we must disclose your information to:
- The U.S. Department of Health & Human Services (HHS). When HHS is investigating complaints or otherwise enforcing compliance with federal privacy laws, we are legally required to cooperate with HHS’s efforts. This cooperation could involve disclosing protected health information. Remember that all government agencies, including HHS, are required by law to protect the privacy of any protected health information they may receive.
Permitted uses and disclosures of your health information
Privacy laws permit uses or disclosures of your health information, as described below, for treatment, payment, healthcare operations, and other limited purposes without your authorization.
- Treatment. We can use and disclose health information about you to provide you with pharmacy care or other medical treatment or services. For example, information related to your treatment may be communicated with and obtained by a healthcare provider, such as a pharmacist, nurse or other person providing health services to you, and will be recorded in your medical record. The sharing of this information is necessary for healthcare providers to determine what treatment you should receive. Other examples include:
- Prescription reminders. We may use health information about you to provide you with prescription reminders.
- Alternative treatments. We may use health information about you to provide you with information about alternative treatments or other health-related benefits and services that may be of interest to you.
- Future communications. We may communicate with you via newsletters, mailings, the My Ardon app (if you opt-in) or other means regarding treatment options, health-related information, disease-management programs, wellness programs, or other community-based initiatives or activities in which we are participating.
- Payment. We may disclose health information about you for payment-related purposes. For example, we may contact your insurer, payer or other entity for purposes of receiving payment for treatment and services that you receive or to determine whether the entity will pay for the particular product or service. The billing information may identify you, your diagnosis, and treatment or supplies used in the course of your treatment.
- Healthcare operations. We may use and disclose health information about you for administrative and operational purposes. For example, members of the risk management or quality improvement teams may use health information about you to assess the care and outcomes in your case and others like it. The results will be used internally to continually improve the quality of care for all patients.
Additional types of disclosures
We will not use or disclose your protected health information unless we are allowed or required by law to do so. We may make additional types of disclosures:
- To individuals involved in your care or payment for your care. We may disclose to a family member, other relative, close personal friend or any other person whom you designate, health information about you directly relevant to that person’s involvement in your care or payment related to your care. We will, to the extent possible, ensure that you have agreed to this.
- To business associates. We provide some services through contracts with business associates, such as accountants, consultants and attorneys, so they can perform the tasks we have assigned to them. To protect your health information, we require business associates to appropriately safeguard health information about you.
- As required by law. We may use and disclose health information about you as required by federal, state or local law. For example, we may disclose health information for the following purposes:
- To respond to judicial or administrative proceedings pursuant to legal authority
- To respond to appropriate authorities, if we believe you are a victim of abuse or neglect, domestic violence or other crimes
- To assist law enforcement officials in their law enforcement duties, under certain circumstances and specific conditions
- For public health activities. We may use or disclose health information about you for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury or disability, or for other health oversight activities.
- To public health authorities. We may use or disclose health information about you to authorized public health agencies. For instance, we may report concerns to the Food and Drug Administration regarding prescription drug or medical device problems.
- To military authorities and authorized federal officials for intelligence, counterintelligence, and other national security activities.
- To comply with laws relating to worker's compensation or other similar programs.
- To a public or private entity authorized by law to assist in disaster relief efforts.
- To coroners, medical examiners, and organ procurement entities, and for research in limited cases.
- For research. We may use or disclose health information about you to researchers if an institutional review board or privacy board has reviewed and approved the research proposal and established protocols to ensure the privacy of your health information.
- To reduce health or safety risk. We may use or disclose health information about you to appropriate agencies if we believe there is a serious health or safety threat to you or others.
- To health oversight agencies. We may use or disclose your health information as required by activities authorized by law, such as audits, criminal investigations, or licensure or disciplinary actions.
- To law enforcement agencies. We may use or disclose health information about you to law enforcement agencies attempting to identify or locate a suspect, fugitive, material witness, crime victim, or missing person.
- In communicating information not personally identifiable. We may use or disclose health information about you in ways that do not personally identify you or allow others to discover who you are.
Uses and disclosures that require your authorization
Your authorization is required for uses and disclosures other than those allowed or required by law. These uses and disclosures for which an authorization is required include but are not limited to:
- Most uses and disclosures of psychotherapy notes.
- Uses and disclosures of your protected health information for marketing purposes.
- Disclosures that would constitute the sale of your protected health information.
If you provide authorization for the use and disclosure of your information and later change your mind, you may revoke the authorization in writing. Contact us at 855-425-4085 or email@example.com if you have questions about how to revoke an authorization.
Exercising your rights
- Any uses or disclosures of your protected health information not described in this notice will be made only with your written authorization.
- If you have any questions about this notice or about how we use or disclose information, please contact the Ardon Health Privacy Office at 503-444-6503 or 855-425-4101, ext. 6503 Monday through Friday, from 8:30 a.m. to 5:00 p.m. Pacific time.
- If you believe your privacy rights have been violated, you may send a complaint to:
Attn: Privacy Office
11835 NE Glenn Widing Drive
Portland, OR 97220
- You may also file a written complaint with the Department of Health and Human Services (HHS), Office of Civil Rights. Visit www.hhs.gov/ocr to find the contact information. You may also contact our office for more specific information.
- We will not take any action against you for filing a complaint.
Changes to our notice
We reserve the right to change the terms of this notice and to make the new notice effective for all protected health information we maintain. If revised, we will provide notification to you by mail or electronically, if you have agreed to receive an electronic copy. We will also post an updated version of the notice to our website at ardonhealth.com.
This notice is effective on August 1, 2021. Ardon Health will abide by the terms of the notice that is then in effect.