Monterey Health Center Privacy Practices

What is the "Health Information Authorization" notice?


Your health care provider and health plan must give you a notice that tells you how they may use and share your health information and how you can exercise your health privacy rights. In most cases, you should get this notice on your first visit to a provider or in the mail from your health insurer, and you can ask for a copy at any time.  The provider or health plan cannot use or disclose information in a way that is not consistent with their notice. 

Why are you asked to sign the form?


The law requires your doctor, hospital, or other health care provider you see in person to ask you to state in writing that you received the notice.  Often, that means the doctor's office will ask you to sign a form stating that you received the notice of privacy practices.

Notice of Privacy Practice - Brief Version




Our commitment to your privacy:


Our practice is dedicated to maintaining the privacy of your personal health information as part of providing professional care.  We also are required by law to keep your information private.  These laws are complicated, but we must give you this important information.  This document is a shorter version of the full, legally required NPP that is available for you to refer to for more information.  However, we can’t cover all possible situations so please talk to our Privacy Officer (see the end of this pamphlet) about any questions or concerns you may have about our privacy practices.

We will use the information about your health, which we get from you or from others, mainly to provide you with treatment, to arrange payment for our services, and for other additional business activities which are called, in the law, health care operations.  You will be asked to sign a consent form to let us use and share your information.  If you do not consent to our privacy practices and sign our Health Information Authorization Form, we cannot treat you.

If we, you or any other party wants to use or disclose (send, share, release) your information for any other purposes not covered by our long version NPP we will discuss this with you and ask you to sign an authorization form to allow this.

Of course we will keep your health information private but there are some times when the laws require us to use or share it.  For example:

When there is a serious threat to your health and safety or the health and safety of another individual or the public.  We will only share information with a person or organization who is able to help prevent or reduce the threat.

  • Some lawsuits and legal or court proceedings.

  • If a law enforcement official requires us to do so.

  • For Workers Compensation and similar benefit programs.

There are some other situations like these which don’t happen very often.  They are described in the longer version of the NPP.

  • You can ask us to communicate with you about your health and related issues in a particular way or at a certain place, which is more private for you.  For example, you can ask us to call you at home, and not at work to schedule or cancel an appointment.  We will try our best to do as you ask.

  • You have the right to ask us to limit what we tell people involved in your care or the payment for your care, such as family members and friends.  While we don’t have to agree to your request, if we do agree, we will keep our agreement except if it is against the law, or in an emergency when you are incapacitated, or when the information is necessary in order to treat you.

  • You have the right to look at the health information we have about you such as your medical and billing records.  You are allowed to get copies of these records but we may charge you for that service.  Contact our Privacy Officer to arrange how to see your records.  See below.

  • If you believe the information in your records is incorrect or missing important information, you can ask us to make changes (called amendments) to your health information.  You have to make this request in writing and send it to our Privacy Officer.  You must tell us the reasons you want to make the changes.

  • You have the right to take a copy of this notice with you.  IF we change this NPP we will post the new version in our waiting area and you can always get a copy of the NPP from the Privacy Officer.

  • You have the right to file a complaint if you believe your privacy rights have been violated.  You can file a complaint with our Privacy Officer and with the Secretary of the Department of Health and Human Services.  All complaints must be in writing.  Filing a complaint will not change the health care we provide to you in any way.

  • If you have questions regarding this notice or our health information privacy policies, please make your inquiry to (503) 905-2526 and you will be directed to the appropriate party.

Learn more at the U.S. Department of Health and Human services website at

Please contact our office at 503.905.2526 to schedule an appointment.

Monterey Health Center ~ 6975 SE Lake Rd ~ Milwaukie, OR  97267