Notice of Privacy Practices

A note from Coast to Coast

Your privacy matters. The information you share with your provider (about your health, your life, your history) is some of the most personal information you have. We take care of it the way we'd want ours taken care of.

This notice explains the rights you have over your health information and how we protect it. If anything in here is unclear, ask us. You can reach our Privacy Officer using the contact details at the end.

Who this notice applies to

This notice is issued by Coast to Coast Health Group, LLC ("Coast to Coast," "we," "us," "our"), a telehealth psychiatric practice licensed to provide care to patients located in Oregon. It applies to all health information we create, receive, or keep about you as our patient, whether you're paying out of pocket or using insurance.

"Your provider" in this notice means the licensed clinician at Coast to Coast who treats you. Coast to Coast is a professional practice, and one or more clinicians may practice under it over time. Your specific provider's name is shared with you at intake and appears in your chart.

Your rights

You are in control of your health information, and the law gives you specific rights over it.

Get a copy of your records

You can ask to see or get a copy of the health information we keep about you. We'll respond within 30 days. If we need a little longer, we'll tell you in writing and take no more than an additional 30 days. You can ask for an electronic copy if we keep your records electronically, which we do. We may charge a reasonable, cost-based fee for copies, and we'll tell you the fee before we start.

Ask us to correct your records

If you think something in your record is wrong or incomplete, you can ask us to correct it. We'll respond within 60 days. If we say no, we'll tell you why in writing and you have the right to file a written statement of disagreement that we'll keep with your record.

Ask us to limit what we use or share

You can ask us to limit how we use or share your health information. We'll consider your request but aren't always required to agree. One situation where we must agree: if you pay in full out of pocket for a specific service, you can tell us not to share that information with your health insurer for payment or operations, and we will honor that request unless a law requires otherwise.

Ask us to contact you a specific way

You can ask us to contact you at a specific phone number, address, or email, or only by one method. We'll accommodate reasonable requests without asking why.

Ask for a list of certain disclosures

You can ask for a list of the times we shared your health information, going back up to six years. The list won't include routine sharing for treatment, payment, operations, sharing we did with your permission, or sharing we gave to you. We'll respond within 60 days.

Choose someone to act for you

If you've given someone medical power of attorney, or someone is your legal guardian, that person can act for you and make choices about your health information. We'll confirm they have the authority before we act.

Get a paper copy of this notice

Even if you received this notice electronically, you can ask for a paper copy at any time. We'll give you one.

File a complaint

If you think your privacy rights have been violated, you can file a complaint with us (see contact details below) or with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

U.S. Department of Health and Human Services, Office for Civil Rights
200 Independence Avenue, SW, Washington, D.C. 20201
Phone: 1-877-696-6775
Online: hhs.gov/ocr/complaints

Your choices

For some information, you can tell us your preferences, and we'll follow them.

Sharing with family or others involved in your care

If you are present and able to agree, we may share information relevant to your care with a family member or friend you identify. If you're not able to agree because of an emergency, we use our professional judgment to share only what's needed to help you.

Where we always ask your written permission first

For any use or sharing of your health information that is not described in this notice, we ask your written permission first. You can change your mind and take back that permission at any time, in writing, for anything we haven't already done based on it. We will always ask your written permission before we:

• Use or share your information for marketing purposes beyond what the law allows without permission.
• Sell your health information. (We don't do this.)
• Share psychotherapy notes, with narrow exceptions the law specifically allows.

About psychotherapy notes

If your provider keeps separate, private session notes that go beyond the standard medical record, the law calls these "psychotherapy notes" and gives them extra protection. We do not share psychotherapy notes for treatment, payment, or operations without your specific written permission, except in the narrow situations the law requires (for example, the originating provider's own use, or certain legal proceedings). If you want to know whether your provider keeps psychotherapy notes, ask.

How we use your information to care for you

A few everyday parts of your care rely on your health information, the same as at any medical practice. Here is each one, with an example.

To treat you

We use your health information to provide your care, make treatment decisions, and coordinate with others involved in your treatment. Examples: sending a prescription to your pharmacy, reviewing your history before an appointment, sharing information with your primary care provider or therapist (with your knowledge), or checking the Oregon prescription drug monitoring program before we prescribe a controlled medication.

To bill for your care

We use your health information to prepare bills and, if you use insurance, to send a claim. Examples: giving your insurer the information it needs to pay for your visit, or preparing a superbill you can submit yourself.

To run our practice

We use your health information to run our practice well and improve the care we give. Examples: reviewing the quality of our care, training our team, or planning how we serve our patients.

Appointment reminders

We may send you reminders about upcoming appointments through the contact method you give us at intake.

Other times the law lets or requires us to share

Beyond your everyday care, the law allows or requires us to share your information in specific situations, usually to protect public health and safety. We share only what the situation calls for, and only when the law permits. These include:

• Public health and safety (such as reporting certain communicable diseases, reporting suspected abuse or neglect, or acting in good faith to prevent a serious and imminent threat to your safety or someone else's, following 45 CFR 164.512(j)).
• When a law, court order, or valid subpoena requires it.
• Health oversight, law enforcement (with limits), workers' compensation, coroners and medical examiners, and organ donation.
• Certain specialized government functions.
• Research conducted under strict legal safeguards.

Oregon adds extra protections

Oregon law may further limit how we use or share certain kinds of information, including HIV/AIDS information, mental health information, genetic information, and drug or alcohol treatment information. Genetic information has additional protections under Oregon law. Where Oregon law is stricter than federal law, we follow Oregon law.

Our responsibilities

• We are required by law to keep your health information private and secure.
• We are required to give you this notice and to follow the terms of the notice that is currently in effect.
• We must tell you if a breach happens that affects the privacy or security of your information.
• We cannot use or share your information in ways other than those described in this notice without your written permission. If you give us permission and then change your mind, you can take that permission back in writing at any time for anything we have not already acted on.

Changes to this notice

Coast to Coast reserves the right to change the terms of this notice and to make the new notice provisions effective for all protected health information we maintain, including information we had before the change. The current version is always posted on our website and available on request. The effective date at the top of this document tells you which version is current.

How to contact us about your privacy

If you have questions about this notice, want to exercise one of your rights, or want to file a complaint, contact our Privacy Officer:

Coast to Coast Health Group, LLC, Attention: Privacy Officer
Mail: 3000 NE Stucki Ave Ste 140B, Hillsboro OR 97124-7107
Phone: 503-461-4005
Email: meredith@c2chealthgroup.com

Acknowledgment of receipt

Patients are asked to acknowledge receipt of this notice at or before their first visit. Acknowledgment is collected through the intake workflow in our patient portal and kept with your record for at least six years. If you prefer not to sign the acknowledgment, we document that we offered it and your care proceeds either way.