HIPAA Notice of Privacy Practices for Protected Health Information
HIPAA Notice of Privacy Practices for Protected Health Information
Effective February 16, 2026
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.
Our Legal Duty
We are required by law to maintain the privacy of protected health information and to provide you with notice of our legal duties and privacy practices with respect to your protected health information. We must abide to the terms of this Notice while it is in effect. However, we reserve the right to change the terms of this Notice and to make the new notice provisions effective for all of the protected health information that we maintain. If we make a change in the terms of this Notice, we will notify you in writing and provide you with a paper copy of the new Notice, upon request.
Uses and Disclosures
There are a number of situations in which we may use or disclose to other persons or entities your confidential health information. Certain use and disclosures will require you to sign an acknowledgement that you received this Notice of Privacy Practices. They include treatment, payment, and health care operations. Any use or disclosure of your protected information required for anything other than treatment, payment or health care operations requires you to sign an Authorization. Certain disclosures that are required by law, or under emergency circumstances, may be made without your Acknowledgement or Authorization. Under any circumstance, we will use or disclose only the minimum amount of information necessary from your medical records to accomplish the intended purpose of the disclosure.
We will attempt in good faith to obtain your signed Acknowledgement that you received this Notice to use and disclose your confidential medical information for the following purposes. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office once you have provided Consent.
TreatmenT
Example: We may use your health information within our office to provide health care services to you or we may disclose your health information to another provider if it is necessary to refer you to them for services.
Payment
Example: We can use and share your health information to bill and get payment from health plans or other entities. We give information about you to your health insurance plan so it will pay for your services.
Health Care Operations
Example: We may use your health information to conduct internal quality assessment and improvement activities and for business management and general administrative activities.
Run our Organization
Examples: We can use and share your health information to run our practice, improve your care, and contact you when necessary. This may include chiropractic interns.
Your name may be called upon when the provider is ready to see you.
We utilize open treatment and therapy areas. Private rooms are available; just ask.
We may share your health information with a third-party “business associate” that performs services such as billing or transcription. Our business associate agreements contain terms that protect your private health information.
We may use and disclose your protected health information for internal marketing. For example, your name and address may be used to send you a newsletter regarding our practice, services, or products that may benefit you.
Appointment Reminders
Example: Your name, address and phone number and health care records may be used to contact you regarding appointment reminders (such as voicemail messages, postcards or letters), information about alternatives to your present care, or other health related information that may be of interest to you.
Your Choices
In the following cases we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
In the case of fundraising: We may contact you for fundraising efforts, but you can tell us not to contact you again.
There are certain circumstances under which we may use or disclose your health information without first obtaining your Acknowledgement or Authorization:
Those circumstances generally involve public health and oversight activities, law-enforcement activities, judicial and administrative proceedings, and in the event of death.
Specifically, we may be required to report to certain agencies information concerning certain communicable diseases, sexually transmitted diseases or HIV/AIDS status. We may also be required to report instances of suspected or documented abuse, neglect or domestic violence. We are required to report to appropriate agencies and law-enforcement officials information that you or another person is in immediate threat of danger to health or safety as a result of violent activity. We must also provide health information when ordered by a court of law to do so.
We may contact you from time to time to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
You should be aware that we utilize an “open adjusting room” in which several people may be adjusted at the same time and in close proximity. We will try to speak quietly to you in a manner reasonably calculated to avoid disclosing your health information to others; however, complete privacy may not be possible in this setting. If you would prefer to be adjusted in a private room, please let us know and we will do our best to accommodate your wishes.
Others Involved in Your Healthcare
Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.
We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death.
Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your healthcare.
Communication Barriers and Emergencies
We may use and disclose your protected health information if we attempt to obtain consent from you but are unable to do so because of substantial communication barriers and we determine, using professional judgment, that you intend to consent to use or disclosure under the circumstances.
We may use or disclose your protected health information in an emergency treatment situation. If this happens, we will try to obtain your consent as soon as reasonably practical after the delivery of treatment. If we are required by law or as a matter of necessity to treat you, and we have attempted to obtain your consent but have been unable to obtain your consent, we may still use or disclose your protected health information to treat you.
EXCEPT AS INDICATED ABOVE, YOUR HEALTH INFORMATION WILL NOT BE USED OR DISCLOSED TO ANY OTHER PERSON OR ENTITY WITHOUT YOUR SPECIFIC AUTHORIZATION, WHICH MAY BE REVOKED AT ANY TIME.
In particular, except to the extent disclosure has been made to governmental entities required by law to maintain the confidentiality of the information, information will not be further disclosed to any other person or entity with respect to information concerning mental-health treatment, drug and alcohol abuse, HIV/AIDS or sexually transmitted diseases that may be contained in your health records.
We likewise will not disclose your health-record information to an employer for purposes of making employment decisions, to a liability insurer or attorney as a result of injuries sustained in an automobile accident, or to educational authorities, without your written authorization.
Patient Rights
Right to Request Restrictions
You may request that we restrict the uses and disclosures of your health record information for treatment, payment and operations, or restrictions involving your care or payment related to that care. We are not required to agree to the restriction; however, if we agree, we will comply with it, except with regard to emergencies, disclosure of the information to you, or if we are otherwise required by law to make a full disclosure without restriction.
Your request must be made in writing to our Privacy Official.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
All reproductive health information, including details related to contraception, fertility treatments, miscarriage care, and termination services, is subject to enhanced privacy protections. This information cannot be used or disclosed for legal investigations or proceedings without the explicit written consent of the patient.
Right to Receive Confidential Communications
You have a right to request receipt of confidential communications of your medical information by an alternative means or at an alternative location. If you require such an accommodation, you may be charged a fee for the accommodation and will be required to specify the alternative address or method of contact and how payment will be handled.
Your request to receive confidential communications must be made in writing to our Privacy Official.
Right to Inspect and/or Copy
You have the right to inspect, copy and request amendments to your health records including electronic health records.
Access to your health records will not include psychotherapy notes contained in them, or information compiled in anticipation of or for use in a civil, criminal or administrative action or proceeding to which your access is restricted by law.
We will charge a reasonable fee for providing a copy of your health records, or a summary of those records, at your request, which includes the cost of copying, postage, and preparation, or an explanation or summary of the information.
Your request to inspect and/or copy your health information must be made in writing to our Privacy Official.
We will provide a copy or a summary of your health information, usually within 15 days of your request. We may charge a reasonable, cost-based fee. Under particular circumstances, this may be extended to an additional 15 days.
Right to Amend
You have the right to request that we amend certain health information for as long as that information remains in your record.
Your request to amend your health information must be made in writing to our Privacy Official and you must provide a reason to support the requested amendment.
We may say “no” to your request, but we will tell you why in writing within 60 days.
Right to Receive an Accounting
Your request to receive an accounting must be made in writing to our Privacy Official.
Right to Receive Notice
You have the right to receive a paper copy of this Notice, upon request.
We are obligated to notify you if there is a breach of your PHI unless there is a low probability of PHI compromise.
Substance Use Disorder Records
Federal law provides additional privacy protections for records related to substance use disorder (SUD) treatment under 42 CFR Part 2.
Our clinic does not provide substance use disorder treatment services and does not maintain records for the purpose of diagnosing or treating substance use disorders.
If we ever receive substance use disorder records from another healthcare provider that is subject to these federal protections, we will maintain and use those records in accordance with applicable federal and state law, which may impose more stringent restrictions on their use and disclosure than HIPAA alone.
Certain wellness or neurological services provided by our clinic are not intended to diagnose or treat substance use disorders or serious mental health conditions.
Complaints
You may file a written complaint to us or to the Secretary of Health and Human Services if you believe that your privacy rights with respect to confidential information in your health records have been violated.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to:
200 Independence Avenue, S.W.
Washington D.C. 20201
1-877-696-6775
http://www.hhs.gov/ocr/privacy/hipaa/complaints/
You will not be retaliated against for filing such a complaint.
Changes to the Terms of This Notice
We can change the terms of this notice, which will apply to all information we have about you. The new notice will be available upon request in our office and on our website.
For more information, see:
http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
All questions concerning this Notice or requests made pursuant to it should be addressed to:
Privacy Officer
TPC
8283 SW Cirrus Drive
Beaverton, OR 97008