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Also see: HIV
Alliance Privacy Notice to Clients (Oregon Department of Human
Services page in PDF format) If you don't have the Adobe Acrobat
Reader needed to view this file, here's the link to the free
plugin.
NOTICE OF PRIVACY PRACTICES
HIV ALLIANCE CLIENT SERVICES, COUNSELING AND TESTING PROGRAM
______________________________________________________________
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.
______________________________________________________________
Effective Date: April 14, 2003
THIS PRIVACY NOTICE IS PROVIDED BY HIV ALLIANCE INC.
The Health Insurance Portability and Accountability Act (HIPAA)
is a federal law. We are required by HIPAA to provide you with this
notice. This notice describes privacy practices, legal duties, and
your rights concerning Protected Health Information (PHI). We must
adhere to privacy practices described in this notice, and will respect
your confidentiality to the highest degree of Oregon law as well.
This notice takes effect April 14, 2003, and will remain in effect
until we publish and issue further notice.
1. Our Commitment to Your Privacy
At HIV Alliance, we are responsible for the information that we
collect about you. Your privacy is of the utmost importance to us.
We are committed to protecting the confidential nature of your medical
information to the fullest extent of the law. In addition to various
laws governing your privacy, we have our own stringent privacy policies
and procedures in place. HIPAA was designed to protect your privacy.
HIV Alliance makes your right to privacy our priority.
2. Our Legal Duties
We are required by applicable state and federal laws to keep certain
information about you private. We treat medical and demographic
information collected about you as part of provision of services
as "Protected Health Information". It is HIV Alliance's
policy to maintain PHI confidentiality in accordance with HIPAA,
except when applicable state law provides greater protection for
you. This Notice of Privacy Practices was drafted to be consistent
with HIPAA Privacy Regulation. Any terms not defined in this notice
will have the same meaning as they have in the HIPAA Privacy Regulation.
HIPAA Privacy Regulations do not generally take precedence over
state privacy or other applicable laws that provide you with greater
privacy protections. Where such laws are in place, we will follow
more stringent state privacy laws.
We reserve the right to change the terms of this notice. We may
make new notice provisions effective for all PHI, including PHI
created or received prior to changing the terms of this notice.
Any revisions made will be posted at our agency and accessible by
mail. Anyone can request a copy of our notice at any time. To request
this or related information, contact information is listed at the
end of this notice.
3. Primary Uses and Disclosures of Protected Information
HIPAA dictates that your PHI may be disclosed without your specific
authorization for the purposes of treatment, payment, and health
care operations. HIV Alliance's Counseling and Testing Program does
not provide medical treatment, and does not bill for services rendered;
therefore, your PHI would not be released for these reasons, with
or without your specific authorization. It is our policy to release
information about you in accordance with more stringent state privacy
laws.
4. Your Health Information Rights
Access:. You have the right to look at or obtain copies
of your PHI for as long as that information is maintained in our
designated record set. You may request this information in writing
by using the contact information listed at the end of this notice.
We will respond to your request within 30 days. If your request
is denied, our response will detail any appeal rights you may have
with respect to that decision.
Amendment: You have the right to request that we amend the
PHI we have in our record set if you believe it is inaccurate. A
request for amendment must be made in writing, using the contact
information listed at the end of this notice. We will respond to
your request for amendment within 60 days of receiving your request.
We will notify you if your request is accepted.
Account of Disclosures: You have the right to request a list
of disclosures not specifically authorized by you of your PHI. This
applies to disclosures made after April 14, 2003.
Limit of Disclosures: You may ask that we limit use or disclosure
of PHI, including what PHI is shared, and with whom it is shared.
A request may be made verbally or in writing.
Revoking Permission: If you choose to sign an authorization
of release of PHI, you may cancel that authorization at any time.
Your request to revoke permission must be made in writing, and does
not apply to information disclosed prior to written revoke of authorization.
Mode of Communication: You may ask that we communicate with
you in a certain place or by certain means. If you feel that standard
process of communication may compromise your confidentiality, we
will make a reasonable effort to accommodate you in an alternate
way.
Right to Make a Complaint: You have the right to file a complaint
if you do not agree with how we have used or disclosed your PHI.
Contact information is listed at the end of this notice.
How to Request Copies of Your PHI, Request to Amend Your PHI,
File a Complaint, or Report a Problem: You may contact any of
the people listed below if you want to request copies of your PHI,
request that we amend your PHI in our record set, file a complaint
about how your PHI has been used or disclosed, or to report a problem.
HIV Alliance may not retaliate against you for filing a complaint.
Michael
Eaves
Prevention Department Director
HIV Alliance
1966 Garden Avenue
Eugene, Oregon 97403
541.342.5088, ext. 35
Diane
Lang
Executive Director
HIV Alliance
1966 Garden Avenue
Eugene, Oregon 97403
541.342.5088, ext. 21
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