Notice of Privacy Practices

Purpose

This Notice of Privacy Practices describes established privacy practices followed by our staff in relation to your protected health information (PHI). This notice explains how and when we may use and disclose your PHI, but may not include every possible situation. Please address any questions to the Compliance Officer as noted at the end of this notice.

Your Protected Health Information (PHI)

This notice addresses information and records we maintain regarding your health, health status, and the healthcare services provided at our office.

This information may include:

• Information collected and recorded at this office
• Information received from other healthcare providers
• Written, electronic, or spoken information

It may include:

• Health history
• Health status
• Symptoms
• Examinations
• Test results
• Diagnoses
• Treatments
• Procedures
• Prescriptions
• Billing information

We are required by law to give you this notice and follow the terms described.

How We May Use or Disclose Your PHI Without Your Written Consent

For Treatment

Mosaic may use or disclose your information to healthcare providers involved in your care. This includes doctors, nurses, technicians, office staff, and others.

Examples include:

• Coordinating care
• Calling in prescriptions
• Scheduling lab work
• Ordering X-rays

Family members or other providers involved in your care may also receive information as needed.

For Payment

Mosaic may use or disclose PHI to bill for services and receive payment from insurance companies or other third parties.

Insurance providers may require:

• Information about visits or procedures
• Pre-approval for services

For Healthcare Operations

Mosaic may use or disclose PHI to operate and improve services, including:

• Quality review
• Staff training
• Program improvement

Health Information Exchange (HIE)

Mosaic participates in the Central Oregon Health Information Exchange (COHIE).

HIE is a secure, electronic system used to share patient information for treatment, payment, and operations.

Benefits include:

• Better coordination of care
• Fewer duplicate tests
• Improved safety and quality
• Enhanced data security through encryption and access controls

OCHIN Participation

Mosaic participates in a Health Information Exchange that includes OCHIN Inc.

OCHIN provides:

• Information technology services
• Quality improvement support
• Clinical review coordination
• Referral management support

Your information may be shared with OCHIN participants when necessary for healthcare operations.

Specially Protected Information

Certain information may require additional authorization, including:

• Mental health treatment information
• Substance use treatment information

Mosaic may request your authorization or “opt-in” before sharing this information.

Other Uses and Disclosures

Mosaic may also use or disclose PHI for:

• Appointment reminders
• Insurance verification
• Treatment alternatives
• Health-related products and services
• Research (with your consent)
• Organ and tissue donation
• Business associates performing services on our behalf

Other Situations Where PHI May Be Disclosed Without Consent

Mosaic may disclose PHI:

• As required by law
• For abuse reporting or to prevent serious threats
• For public health purposes
• For health oversight activities
• In legal proceedings or court orders
• For law enforcement purposes
• To coroners, medical examiners, or funeral directors
• For workers’ compensation
• For military, national security, or intelligence purposes
• In de-identified form that does not identify you

Family and Friends

Mosaic may share PHI with family members or friends:

• If you agree
• If you are given the opportunity to object and do not
• If we determine, using professional judgment, that you would not object

In emergencies, Mosaic may share information if it is in your best interest.

Marketing

Mosaic will not use your information for marketing without your written authorization and will not sell your PHI to another organization.

Your PHI Privacy Rights

You have the following rights:

Right to Inspect and Copy

You may request access to your records, including electronic copies. Requests must be in writing. Fees may apply. Access may be denied in certain cases, with the right to review.

Right to Amend

You may request corrections to your record in writing with a reason. Mosaic may deny requests under certain conditions.

Right to a List of Disclosures

You may request a list of disclosures of your PHI (excluding treatment, payment, and operations).

Requirements:

• Request must be in writing
• Covers up to six years
• Cannot include dates before April 14, 2003
• Fees may apply after the first request

Right to Request Restrictions

You may request limits on how your PHI is used or shared. Requests must be in writing. Mosaic may deny requests.

Right to Restrict Disclosure to Health Plans

You may request that information about services you pay for out-of-pocket is not shared with your health plan.

Right to Request Confidential Communications

You may request to be contacted in a specific way or location. Requests must be in writing.

Right to Breach Notification

If your PHI is compromised, Mosaic will notify you in writing with details and next steps.

Right to File a Complaint

You may file a complaint if you believe your privacy rights have been violated. You will not be penalized.

Contact:
Compliance Officer
600 SW Columbia Street
Bend, OR 97702
Phone: 541-383-3005
Fax: 541-647-2921

You may also contact:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue SW
Washington, DC 20201
Phone: 877-696-6775
TTY: 886-788-4989
Website: www.hhs.gov/ocr

Right to a Paper Copy

You may request a paper copy of this notice at any time.