Notice of Privacy Practices for Protected Health Information
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!
Dr. MacLean is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information he creates and obtains in providing services to you. Such information may include documenting your symptoms, examination, and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.
Examples of Uses of Your Health Information for Treatment Purposes are:
•Dr. MacLean obtains treatment information about you and records it in your health record.
•During the course of your treatment, the Dr MacLean determines he will need to consult with another specialist, or a supervisor. He will share the information with such specialist and obtain his or her input.
Example of Use of Your Health Information for Payment Purposes:
Dr. MacLean submits claims (requests for payment) to your health insurance company. The health insurance company (or other business associate helping Dr. MacLean obtain payment) requests information from him regarding medical care given. He will provide information to them about you and the care given.
Examples of Use of Your Information for Health Care Operations:
1) Dr. MacLean files a claim with your insurance company to be paid by them for the services he provides. He generally provides your name, insurance information, address, phone number, as well as a procedure code, like medication management or psychotherapy, and a diagnosis code, for example major depression.
2) The information needed to submit the claim is communicated to your insurance company by Office Ally a claim submission company that Dr. MacLean enters on their secure website.
3) Your insurance company may request to audit Dr. MacLean’s records, in which case they might ask to look at your entire medical record.
Your Health Information Rights
The health and billing records Dr. MacLean maintains are his physical property. The information in it, however, belongs to you. You have a right to:
•Request a restriction on certain uses and disclosures of your health information by delivering the request to his office — he is not required to grant the request, unless the requested restriction is for the disclosure to a health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment) and the PHI pertains solely to a health care item or service for which Dr. MacLean has been paid out of pocket in full;
•Obtain a paper copy of the current Notice of Privacy Practices for Protected Health Information (“Notice”) by making a request at Dr. MacLean’s office.
•Request that you be allowed to inspect and copy your health record and billing record – you may exercise this right by delivering the request to Dr. MacLean;
•Appeal a denial of access to your protected health information, except in certain circumstances;
•Request that your health care record be amended to correct incomplete or incorrect information by delivering a request to Dr. MacLean. He may deny your request if you ask him to amend information that:
Was not created by Dr. MacLean, unless the person or entity that created the information is no longer available to make the amendment;
Is not part of the health information kept by Dr. MacLean
Is not part of the information that you would be permitted to inspect and copy
Is accurate and complete.
If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your records;
You also have the right to:
•Request that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to Dr. MacLean;
•Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a request to Dr. MacLean. An accounting will not include uses and disclosures of information for treatment, payment, or operations; disclosures or uses made to you or made at your request; uses or disclosures made pursuant to an authorization signed by you; uses or disclosures made to family members or friends relevant to that person’s involvement in your care or in payment for such care; or, uses or disclosures to notify family or others responsible for your care of your location, condition, or your death.
•Revoke authorizations that you made previously to use or disclose information by delivering a written revocation to Dr. MacLean except to the extent information or action has already been taken.
If you want to exercise any of the above rights, please contact Scot MacLean, M.D., 2250 NW Flanders St #101, Portland, OR 97210, work phone 503-816-5836, in person or in writing, during regular, business hours. He will inform you of the steps that need to be taken to exercise your rights.
Dr. MacLean is required to:
•Maintain the privacy of your health information as required by law;
•Provide you with a notice as to his duties and privacy practices as to the information he collects and maintains about you;
•Abide by the terms of this Notice;
•Notify you if he cannot accommodate a requested restriction or request; and,
•Accommodate your reasonable requests regarding methods to communicate health information with you.
He reserves the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information he maintains. If his information practices change, he will amend his Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our “Notice” or by visiting his office and picking up a copy.
To Request Information or File a Complaint
If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact Scot MacLean, M.D. 2250 NW Flanders St #101, Portland, OR 97210, work phone 503-816-5836.
Additionally, if you believe your privacy rights have been violated, you may file a written complaint at his office by delivering the written complaint to Scot MacLean, M.D. 2250 NW Flanders St #101, Portland, OR 97210. You may also file a complaint by mailing it or e-mailing it to the United States Secretary of Health and Human Services.
•Dr. MacLean cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from him.
•He cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services.
Other Disclosures and Uses
Communication with Family
•Using his best judgment, Dr. MacLean may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement in your care or in payment for such care if you do not object or in an emergency.
•Unless you object, Dr. MacLean may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your death.
•Dr. MacLean may use and disclose your protected health information to assist in disaster relief efforts.
Food and Drug Administration (FDA)
•Dr. MacLean may disclose to the FDA your protected health information relating to adverse events with respect to food, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
•As authorized by law, Dr. MacLean may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability; to report reactions to medications or problems with products; to notify people of recalls; to notify a person who may have been exposed to a disease or who is at risk for contracting or spreading a disease or condition.
Abuse & Neglect
•Dr. MacLean may disclose your protected health information to public authorities as allowed by law to report abuse or neglect.
•Dr. MacLean may release health information about you to your employer if he provides health care services to you at the request of your employer, and the health care services are provided either to conduct an evaluation relating to medical surveillance of the workplace or to evaluate whether you have a work-related illness or injury. In such circumstances, he will give you written notice of such release of information to your employer. Any other disclosures to your employer will be made only if you execute a specific authorization for the release of that information to your employer.
•Federal law allows Dr. MacLean to release your protected health information to appropriate health oversight agencies or for health oversight activities.
•Dr. MacLean may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, with your authorization, or as directed by a proper court order.
•To avert a serious threat to health or safety, Dr. MacLean may disclose your protected health information consistent with applicable law to prevent or lessen a serious, imminent threat to the health or safety of a person or the public.
For Specialized Governmental Functions
•Dr. MacLean may disclose your protected health information for specialized government functions as authorized by law such as to Armed Forces personnel, for national security purposes, or to public assistance program personnel.
Coroners, Medical Examiners, and Funeral Directors.
•Dr. MacLean may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. He may also release health information about patients of Covered Entities to funeral directors as necessary for them to carry out their duties.
•Other uses and disclosures, besides those identified in this Notice, will be made only as otherwise required by law or with your written authorization and you may revoke the authorization as previously provided in this Notice under “Your Health Information Rights.”
•Dr. MacLean maintains websites (http://macleanmd.com and psychiatrypdx.com) that provide information about his practice, this Notice will be on the website.
Effective Date: January 2nd, 2013, updated February 6, 2017.