Tuality Health Alliance
Notice of Privacy Practices

Effective Date: March 31, 2003
Revised Date: July 25, 2006

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.

This letter is available in other languages and alternate formats that meet the guidelines for the Americans with Disabilities Act (ADA).

Contact THA at: Phone 503-844-8104, 1-866-575-8104, TTY 1-800-735-2900 or fax 503-681-1927.
Tuality Health Alliance (THA) provides many types of services, such as health and case management services. THA staff must collect information about you to provide these services. THA knows that information we collect about you and your health is private. THA is required to protect this information by Federal and State law. We call this information “protected health information (PHI).”

The Notice of Privacy Practices will tell you how THA may use or disclose information about you. Not all situations will be described. THA is required to give you a notice of our privacy practices for the information we collect and keep about you. THA is required to follow the terms of the notice currently in effect.

THA May Use and Disclose Information Without Your Authorization For Treatment. THA may use or disclose 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. THA may use or disclose information to get payment or to pay for the health care services you receive. For example, THA may request PHI to pay for health care provided to you.

For Health Care Operations. THA may use or disclose information in order to manage its programs and activities. For example, THA may use PHI to review the quality of services you receive.

Appointments and Other Health Information. THA may send you reminders for medical care or checkups. THA may send you information about health services that may be of interest to you.

For Public Health Activities. DHS is the public health agency that keeps and updates vital records, such as births and deaths, and tracks some diseases.

For Health Oversight Activities. THA may use or disclose information to inspect or investigate health care providers.

As Required by Law and For Law Enforcement. THA will use and disclose information when required or permitted by federal or state law or by a court order.

For Abuse Reports and Investigations. THA is required by law to receive and investigate reports of abuse.

For Government Programs. THA may use and disclose information for public benefits under other government programs. For example, THA may disclose information for the determination of Supplemental Security Income (SSI) benefits.

To Avoid Harm. THA may disclose PHI to law enforcement in order to avoid a serious threat to the health and safety of a person or the public.

For Research. THA uses information for studies and to develop reports. These reports do not identify specific people.

Disclosures to Family, Friends, and Others. THA may disclose information to your family or other persons who are involved in your medical care. You have the right to object to the sharing of this information.

Other Uses and Disclosures Require Your Written Authorization. For other situations, THA will ask for your written authorization before using or disclosing information. You may cancel this authorization at any time in writing. THA cannot take back any uses or disclosures already made with your authorization.

Other Laws Protect PHI. Many THA programs have other laws for the use and disclosure of information about you. For example, you must give your written authorization for THA to use and disclose your mental health and chemical dependency treatment records.

Your PHI Privacy Rights. When information is maintained by THA as a public health agency, the public health records are governed by other State and Federal laws and is not subject to the rights described below.

Right to See and Get Copies of Your Records. In most cases, you have the right to look at 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.

Right to Request a Correction or Update of Your Records. You may ask THA 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.

Right to Get a List of Disclosures. You have the right to ask THA 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 disclosed 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.

Right to Request Limits on Uses or Disclosures of PHI. You have the right to ask that THA limit how your information is used or disclosed. You must make the request in writing and tell THA what information you want to limit and to whom you want the limits to apply. THA is not required to agree to the restriction. You can request that the restrictions be terminated in writing or verbally.

Right to Revoke Permission. If you are asked to sign an authorization to use or disclose 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 THA share information with you in a certain way or in a certain place. For example, you may ask THA to send information to your work address instead of your home address. You must make this request in writing. You do not have to explain the basis for your request.

Right to File a Complaint. You have the right to file a complaint if you do not agree with how THA has used or disclosed information about you.

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.

How to contact THA to Review, Correct, or Limit Your Protected Health Information (PHI). You may contact THA at the address listed at the end of this notice to:

• Ask to look at or copy your records
• Ask to correct or change your records
• Ask to limit how information about you
• Ask for a list of the times THA disclosed information about you
• Ask to cancel your authorization

THA may deny your request to look at, copy or change your records. If THA denies your request, THA will send you a letter that tells you why your request is being denied and how you can ask for a review of the denial. You will also receive information about how to file a complaint with THA or with the Department of Human Services (DHS), or the U.S. Department of Health and Human Services, Office for Civil Rights.

How to File a Complaint or Report a Problem. You may contact any of the people listed below if you want to file a complaint or to report a problem with how THA has used or disclosed information about you. Your benefits will not be affected by any complaints you make. THA cannot retaliate against you for filing a complaint, cooperating in an investigation, or refusing to agree to something that you believe to be unlawful.

Tuality Health Alliance
P.O. Box 925
Hillsboro, OR. 97123
Phone: 503-844-8104
1-866-575-8104

State of Oregon Department of Human Services
Governor’s Advocacy Office
500 Summer St. NE, E17
Salem, Oregon 97301-1097
Phone: 1-800-442-5238
Fax: 503-378-6532
Email: GAO.info@state.or.us

State of Oregon Department of Human Services
Privacy Officer
500 Summer Street NE
Salem, Oregon 97301
1-800-699-9075
Advocacy Line: 1-800-273-0557

Office for Civil Rights
Medical Privacy, Complaint Division
U.S. Department of Health and Human Services
200 Independence Avenue, SW, HHH Building, Room 509H
Washington, D.C. 20201
Phone: 866-627-7748 TTY: 886-788-4989
Email: www.hhs.gov/ocr

State of Oregon Department of Human Services
Privacy Officer
500 Summer Street NE
Salem, Oregon 97301
Phone: 503-945-5780
Email: www.hr.state.or.us/hipaa

For More Information. If you have any questions about this notice or need more information, please contact THA at the above address or phone at 503-844-81048 or 1-866-575-8104.

In the future, THA may change its Notice of Privacy Practices. Any changes will apply to information THA already has, as well as any information THA receives in the future. A copy of the new notice will be posted at each THA site and facility and provided as required by law. You may ask for a copy of the current notice anytime you visit a THA facility.