E. YOUR RIGHTS REGARDING YOUR PHI:
1. Confidential Communications. You have the right to request that our practice communicates with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask us that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to: Privacy Officer, The Children's Clinic of Klamath, 2580 Daggett Ave, Klamath Falls, OR 97601, 541-884-1224, specifying the requested method of contact or the location where you wish to be contacted. Our practice will accommodate a reasonable request. You do not need to give a reason for your request.
2. Requesting restrictions. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when information is necessary to treat you. In order to request a restriction in our use or disclosure of your health information, you must make your request in writing to: Privacy Officer, The Children's Clinic of Klamath, 2580 Daggett Ave, Klamath Falls, OR 97601. Your request must describe in a clear and concise fashion:
- the information you wish restricted;
- whether you are requesting to limit our practice’s use, disclosure or both; and
- to whom you want the limits to apply.
3. Inspection and Copies. You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. In care of teenagers, certain confidential information may not be released to parents. This includes information about sexual activity, contraception, sexually transmitted diseases, and other information gathered in a setting where the physician/provider has agreed to confidentiality with the patient. You must submit your request in writing to Privacy Officer, The Children's Clinic of Klamath of the Northwest, 2580 Daggett Avenue, Klamath Falls, OR 97601 in order to inspect and/or obtain a copy of your PHI. Our practice may charge a fee for the cost of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct the reviews.
4. Amendment. You may ask us to amend your PHI if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to Privacy Officer, The Children's Clinic of Klamath of the Northwest, 2580 Daggett Avenue, Klamath Falls, OR 97601. You must provide us with a reason that supports your request for amendment. Our practice may deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the PHI kept by or for the practice; (c) not part of the PHI which you would be permitted to inspect and copy; or (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.
5. Accounting of Disclosures. All of our patients have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your PHI for non-treatment, non-payment or non-operations purposes. Use of your PHI as part of the routine patient care in our practice is not required to be documented. For example, the doctor sharing information with the nurse; or the billing department using your information to file your insurance claim. In order to obtain and “accounting of disclosures”, you must submit your request in writing to Privacy Officer, The Children's Clinic of Klamath of the Northwest, 2580 Daggett Avenue, Klamath Falls, OR 97601. All requests for an “accounting of disclosures” must state a time period, which may not be longer that six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period if free of charge, but our practice may charge you for additional list within the same 12-month period. Our practice will notify you of the cost involved with additional request, and you may withdraw your request before you incur any cost.
6. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our Notice of Privacy Practices. You may ask us to give you a copy of this Notice at anytime. To obtain a paper copy of this Notice, contact Front Office Staff/Office Assistant, The Children's Clinic of Klamath of the Northwest, 2580 Daggett Avenue, Klamath Falls, OR 97601.
7. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact the Privacy Officer, The Children's Clinic of Klamath of the Northwest, 2580 Daggett Avenue, Klamath Falls, OR 97601. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
8. Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your health information for the reason described in the authorization. Please note, we are required to retain records of your care.