933 NW 25th Avenue
Portland, Oregon 97210
OREGON'S ONLY STATE AND FEDERALLY LICENSED ABORTION PROVIDER
Effective Date: 09/12/13
Lovejoy Surgicenter abortion clinic in Portland, Oregon
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE
USED OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION. PLEASE REVIEW CAREFULLY.
If you have any questions about this notice, please contact our Privacy Officer at (503) 221-1870.
WHO WILL FOLLOW THIS NOTICE
This notice describes Lovejoy Surgicenter’s practices and that of:
- Any healthcare professional authorized to enter information into your chart.
- All departments and units of Lovejoy Surgicenter.
- Any member of a volunteer group we allow to help you while you are at Lovejoy Surgicenter.
- All employees, staff and other surgicenter personnel.
- Any and all Business Associates, and/or their subcontractors, that we may contract with.
- All of these entities will follow the terms of this notice. In addition, these entities may share medical information with each other for treatment, payment or surgicenter operations purposes described in this notice.
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at Lovejoy Surgicenter. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by Lovejoy Surgicenter, whether made by surgicenter personnel or your personal doctor or other practitioners involved with your care. Any use or disclosure not described in this notice will be made only with your express authorization.
This notice will tell you about the ways in which we may use and disclose medical information about you. It will also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
- Make sure that medical information that could identify you is kept private.
- Give you this notice of our legal duties, privacy practices and patient rights with respect to medical information about you.
- Follow the terms of this notice that is currently in effect.
- Notify you of any breach of privacy involving your information.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we may use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
- For Treatment: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students or other personnel who are involved in your care. For example, your physician will need to know your past medical history in order to evaluate your condition and health care needs. Different departments of the surgicenter also may share information about you in order to coordinate your care. For example, prescriptions, lab work and ultrasounds. We may also disclose medical information about you to people outside Lovejoy Surgicenter who may be involved in your medical care after you leave the surgicenter, such as pharmacies.
- For Payment: We may use and disclose medical information about you so that the treatment and services you receive at Lovejoy Surgicenter may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health insurance information about surgery you received so your health plan will pay us or reimburse you for the surgery. We may also tell your health insurance about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
- For Health Care Operations: We may use and disclose medical information about you for Lovejoy Surgicenter operations. These uses and disclosures are necessary to run the surgicenter and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services, or to evaluate the performance of our staff in caring for you. We may also combine medical information about many surgicenter patients to decide what additional services the surgicenter should offer, what services are not needed and whether certain new services are effective. We may also disclose information to doctors, nurses, technicians, medical students and other personnel for review and learning purposes. We may also combine the medical information we have with medical information from other clinics to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who specific patients are.
- Research: All research is strictly on a volunteer basis at Lovejoy Surgicenter. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the results of all patients who receive one medication to those who received another for the same condition. All research projects, however, are subject to a special approval process. We will ask for your specific permission. In the case of any state or federally mandated statistics reporting, all identifying patient information is removed prior to reporting.
- Marketing/Fundraising: Any information used at Lovejoy Surgicenter for marketing or statistical purposes is non-identifiying information only. No identifying information will be used for these purposes. Lovejoy Surgicenter will never contact you for fundraising purposes.
- As Required By Law: We will disclose medical information about you when required to do so by federal, state or local law.
Military: If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
Business Associates: We may contract with business associates to perform activities on your behalf, such as payment and health care operations. These business associates, and any subcontractors they may employ, are also under contract to safeguard your medical information.
Public Health Risks (Health and Safety of You and Others): We may disclose medical information about you for public health activities. We may use and disclose medical information about you to agencies when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. These activities generally include the following:
- to prevent or control disease, injury or disability;
- to report child abuse or neglect;
- to report reactions to medications or problems with products;
- to notify people of recalls of products they may be using;
- to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
- to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure when required or authorized by law.
Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.
Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request or other lawful process by someon else involved in the dispute.
Law Enforcement: We may release medical information if asked to do so by a law enforcement official:
- in response to a court order, subpoena, warrant, summons or similar process;
- to identify or locate a suspect, fugitive, material witness or missing person.
- about the victim of a crime, if under certain limited circumstances, we are unable to obtain the person’s agreement.
- about a death we believe may be the result of criminal conduct.
- about criminal conduct at Lovejoy Surgicenter; and
- in emergency circumstances to report a crime; the location of a crime; or the identity, description or location of a person who committed the crime.
National Security and Intelligence Activities: We may release medical information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
Protective Services for the President and Others: We may disclose medical information about you to authorized federal officials sot they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary:
- for the institution to provide you with health care;
- to protect your health and safety or the health and safety of others;
- or, for the safety and security of the correctional institution.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information we maintain about you:
Right to Inspect and Copy:
You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
To inspect and copy medical information that may be used to make decisions about you, contact the Medical Records Department at (503) 221-1870. If you request a copy of the information, we may charge a fee for the cost of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by Lovejoy Surgicenter will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend:
If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for Lovejoy Surgicenter.To request and amendment, your request must be made in writing and submitted to the Medical Records Department. In addition, you must provide a reason that supports your request.We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to
- make the amendment;
- Is not part of the medical information kept by or for Lovejoy Surgicenter;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
Right to an Accounting of Disclosures:
You have the right to request an “accounting of disclosures.”This is a list of the disclosures we have made of medical information about you to others except for purposes of treatment, payment or operations identified above.
To request this list or “accounting of disclosures”, you must submit your request in writing to the Medical Record Department. Your request must state a time period which may not be longer than six (6) years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list, for example, electronically or paper. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions:
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care of the payment for your care, such as a family member or friend. For example, you can ask that we not use or disclose information about a surgery you had.
Please note that it is NOT the practice of Lovejoy Surgicenter to disclose information to friends or family members without your prior consent. But we must, by law, let you know how you can request restrictions. We automatically assume that your healthcare information is confidential unless you inform us otherwise.
We are not required to agree to your request. If we do agree, we will comply with your request unless information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing to the Privacy Officer. In your request, you must tell us:
- What information you want to limit;
- whether you want to limit our use, disclosure or both; and
- to whom you want the limits to apply. For example, disclosures to your spouse about medical matters in a certain way or at a certain location. Another example would be if you asked that we only contact you at work.
To request confidential communications you can let us know verbally. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice:
You have the right to a paper copy of this privacy notice. You may ask us to give you a copy of this privacy notice at any time by requesting a copy from any member of our staff.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you, as well as any information we may receive in the future. We will post a copy of the current notice at Lovejoy Surgicenter. The notice will contain, on the first page, the effective date. In addition, each time you are admitted to Lovejoy Surgicenter for treatment or health care services, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may contact or submit your complaint in writing to the Privacy Officer in the Medical Records Department at Lovejoy Surgicenter. If we cannot resolve your concern, you also have the right to file a written complaint with the Secretary of the Department of Health and Human Services.The quality of your care will not be jeopardized, nor will you be penalized for filling a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this notice of the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we have provided you.
You have the right to:
- Considerate and respectful care, and to be made comfortable. You have the right to respect for your cultural, psychosocial, spiritual and personal values, beliefs and preferences.
- Have a family member, or other representative of your choosing, and your own physician notified promptly upon your admission to Lovejoy Surgicenter.
- If a patient is adjudged incompetent under applicable State Health and Safety Laws by a court of proper jurisdiction, the rights of the patient are exercised by the person appointed under State Law to act on the patient’s behalf.
- If a State Court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with State Law may exercise the patient’s rights to the extent allowed by State Law.
- Know the name of the physician and/or CRNA who has primary responsibility for coordinating your care.
- Receive information about your health status, diagnosis, prognosis, course of treatment, prospects for recovery and outcome of care in terms that you can understand.
- Make decisions regarding medical care, and receive as much information about any proposed treatment or procedure you may need in order to give informed consent or refuse a course of treatment. This information shall include a description of the procedure or treatment, the medically significant risks involved, alternate courses of treatment and the name of the person who will perform the procedure.
- Exercise his or her rights without being subjected to discrimination or reprisal.
- Execute an advanced directive in accordance with Oregon State Health and Safety Laws. The advance directive should be discussed with your physician during your initial appointment. Official State Advance Directive forms are available if requested.
- Request or refuse treatment, to the extent permitted by law. However, you do not have the right to demand inappropriate or medically unnecessary treatment.
- Reasonable responses to any reasonable requests made for services.
- Appropriate assessment and management of your pain, information about your pain, pain relief measures and to participate in pain management decisions.
- Have personal privacy respected. Case discussion, consultation, examination and treatment are confidential and should be discussed as discreetly as possible. You have the right to be told the reason for the presence of any individual. Privacy curtains will be used in semi-private rooms.
- Confidential treatment of all communications and records pertaining to your care and stay at Lovejoy Surgicenter free of charge. You will receive a “Notice of Privacy Policies” that explains your privacy rights in detail.
- Receive care in a safe setting; free from mental, physical, sexual or verbal abuse and neglect, exploitation or harassment.
- Reasonable continuity of care, and to know in advance the time and location of appointments as soon as they are scheduled.
- Be informed by the physician, or a delegate of the physician, of continuing health care requirements and options following discharge from Lovejoy Surgicenter.
- Designate visitors of your choosing unless:
- No visitors are allowed. Lovejoy Surgicenter can reasonably determine that the presence of a particular visitor would endanger the health or safety of a patient, a member of the staff or would significantly disrupt the operations of the facility.
- You have told Lovejoy Surgicenter that you no longer want a particular person to be in the facility.
- Examine and receive an explanation of any bill from Lovejoy Surgicenter, regardless of the source of payment.
- Exercise these rights without regard to sex, race, color, religion, ancestry, national origin, age, disability, medical condition, economic status, sexual orientation, educational background, economic status or source of payment for care.
- File a grievance. If you want to file a grievance with Lovejoy Surgicenter, you may do so by calling or writing:
933 NW 25th Ave
Portland, Oregon 97210
(503) 221-1870 or (800) 752-6189
The grievance will be reviewed and you will be provided with a written response within 30 days. The written response will contain the name of the person to contact at Lovejoy Surgicenter, steps taken to investigate the grievance, the results of the grievance process and the date of completion of the grievance process. Concerns regarding the quality of care will also be referred to appropriate committee.
- File a complaint with the State Department of Health Services regardless of whether you use the grievance process. You can contact the State Department of Health Services at:
Oregon Department of Healthcare Licensure and Certification
800 NE Oregon St, Suite 305
Portland, Oregon 97323
Office of the Medicare Beneficiary Ombudsman