Privacy Practices Notice
This notice describes how psychological and medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
If you have questions about this notice, you may contact the Privacy Officer:
6950 SW Hampton St Ste 207
Portland, OR 97223
I. Uses and Disclosures for Treatment, Payment, and Health Care Operations
Portland Psychological Services may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:
“PHI”
refers to information in your health record that could identify you.
“Treatment, Payment and Health Care Operations”
Treatment
is when we provide, coordinate or manage your health care and other services related to your health care. An example of treatment would be when we consult with another health care provider, such as your primary care provider (e.g., pediatrician).
Payment
is when we obtain reimbursement for your healthcare. Examples of payment are when we disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.
Health Care Operations
are activities that relate to the performance and operation of Portland Psychological Services. Examples of health care operations are supervision, quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.
“Use”
applies only to activities within Portland Psychological Services such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
“Disclosure”
applies to activities outside of Portland Psychological Services, such as releasing, transferring, or providing access to information about you to other parties.
II. Uses and Disclosures Requiring Authorization
Portland Psychological Services may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances when we are asked for information for purposes outside of treatment, payment and health care operations, we will obtain an authorization from you before releasing this information. We will also need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes that may have been made about conversations during a private, group, joint, or family therapy sessions, which have been kept separate from the rest of your health record. These notes are given a greater degree of protection than PHI. We will also obtain an authorization from you before using or disclosing PHI for marketing purposes (as defined by HIPAA) or in a way that is not described in this notice.
You may revoke all such authorizations (to disclose PHI or psychotherapy notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) we have already relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.
III. Uses and Disclosures with Neither Consent nor Authorization
Portland Psychological Services may use or disclose PHI without your consent or authorization in the following circumstances:
Abuse
If we have reasonable cause to believe that a child with whom we have had contact has been abused (or someone with whom we have had contact has abused a child), we may be required to report the abuse to the state abuse-prevention agency. The same applies to abuse of an elderly person or an adult with mental illness or developmental disability.
Health Oversight
The Oregon State Board of Psychology may subpoena relevant records from us should we be the subject of a complaint.
Judicial or Administrative Proceedings
If you are involved in a court proceeding and a request is made for information about your evaluation, diagnosis and treatment and the records thereof, such information is privileged under state law, and we must not release your information without written authorization by you or your personal or legally-appointed representative, or a court order. This privilege does not apply when you are being evaluated for a third party or where the evaluation is court-ordered. You will be informed in advance if this is the case.
Serious Threat to Health or Safety
We may disclose confidential information when we judge that disclosure is necessary to protect against a clear and substantial risk of imminent serious harm being inflicted by you on yourself or another person. We must limit disclosure of the otherwise confidential information to only those persons and only that content which would be consistent with the standards of the profession in addressing such problems.
Worker’s Compensation
If you file a worker’s compensation claim, this constitutes authorization for us to release your relevant mental health records to involved parties and officials. This would include a past history of complaints or treatment of a condition similar to that in the complaint.
When the use and disclosure without your consent or authorization is allowed under other sections of Section 164.512 of the Privacy Rule and the state’s confidentiality law
This includes certain narrowly-defined disclosures to law enforcement agencies, to a health oversight agency (such as HHS or a state department of health), to a coroner or medical examiner, for public health purposes relating to disease or FDA-regulated products, or for specialized government functions such as fitness for military duties, eligibility for VA benefits, and national security and intelligence.
Substance Use Disorder Treatment Records Received from a Substance Use Disorder Treatment Program
In all cases, including those listed above, if we have substance use disorder treatment records about you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.
There may be additional disclosures of PHI that we are required or permitted by law to make without your consent or authorization, however the disclosures listed above are the most common.
Mobile phone information will not be disclosed for marketing or promotional purposes.
IV. Your Rights and Our Duties
Your Rights
Right to Request Restrictions
You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, we are not required to agree to a restriction you request.
Right to Receive Confidential Communications by Alternative Means and at Alternative Locations
You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may request communications by phone, email, or postal mail and at another phone number or address.)
Right to Inspect and Copy
You have the right to inspect or obtain a copy (or both) of PHI in our mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. We may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. On your request, we will discuss with you the details of the request and denial process.
Right to Amend
You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. We may deny your request. On your request, we will discuss with you the details of the amendment process.
Right to an Accounting
You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in Section III of this notice). On your request, we will discuss with you the details of the accounting process.
Right to a Paper Copy
You have the right to obtain a paper copy of this notice from us upon request, even if you have agreed to receive the notice electronically.
Right to Restrict Disclosures When You Have Paid for Your Care Out-of-Pocket
You have the right to restrict certain disclosures of PHI to a health plan when you pay out-of-pocket in full for our services.
Right to Be Notified if There is a Breach of Your Unsecured PHI
You have a right to be notified if: (a) there is a breach (a use or disclosure of your PHI in violation of the HIPAA Privacy Rule) involving your PHI; (b) that PHI has not been encrypted to government standards; and (c) our risk assessment fails to determine that there is a low probability that your PHI has been compromised.
Right to Opt out of Fundraising Communications
You have a right to decide that you would not like to be included in fundraising communications that we may send out. If we have substance use disorder treatment records about you, subject to 42 CFR part 2, we will give you clear and obvious notice in advance and a choice about whether to receive fundraising communications that use your Part 2 information.
Our Duties
We are required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI.
We reserve the right to change the privacy policies and practices described in this notice. Unless we notify you of such changes, however, we are required to abide by the terms currently in effect.
If we revise our policies and procedures, we will provide you with a revised notice by posting it at PortlandPS.com/privacy
V. Questions and Complaints
If you believe that your privacy rights have been violated and wish to file a complaint, you may send your written complaint to the Privacy Officer at privacy@PortlandPS.com or 6950 SW Hampton St Ste 207, Portland, OR 97223.
If you have questions, you may contact the Privacy Officer at +15039284182.
VI. Effective Date, Restrictions and Changes to Privacy Policy
We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that we maintain. We will provide you with a revised notice by posting it at PortlandPS.com/privacy
This notice will go into effect on 15 February 2026.