Note: If you're a Washington State resident who lives outside the Vancouver/Longview area, learn about our privacy practices here.
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Kaiser Permanente — Northwest Region
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL AND DENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
In this notice we use the terms "we," "us," "our," and "Kaiser Permanente" to describe the Kaiser Permanente Northwest Region. For more details, please refer to section IV of this notice.
Your protected health information (PHI) is individually identifiable health information, including demographic information, about your past, present or future physical or mental health or condition, health care services you receive, and past, present or future payment for your health care. Demographic information means information such as your name, social security number, address, and date of birth.
PHI may be in oral, written or electronic form. Examples of PHI include your medical record, claims record, enrollment or disenrollment information, and communications between you and your health care provider about your care.
Your individually identifiable health information ceases to be PHI 50 years after your death.
If you are a Kaiser Foundation Health Plan of the Northwest member and also an employee of any Kaiser Permanente company, PHI does not include the health information in your employment records.
By law, we must
We take these responsibilities seriously and have put in place administrative safeguards (such as security awareness training and policies and procedures), technical safeguards (such as encryption and passwords), and physical safeguards (such as locked areas and requiring badges) to protect your PHI and, as in the past, we will continue to take appropriate steps to safeguard the privacy of your PHI.
This section tells you about your rights regarding your PHI, and describes how you can exercise these rights.
Subject to certain exceptions, you have the right to view or get a copy of your PHI that we maintain in records relating to your care or decisions about your care or payment for your care. Requests must be in writing.
After we receive your written request, we will let you know when and how you can see or obtain a copy of your record. If you agree, we will give you a summary or explanation of your PHI instead of providing copies. We may charge you a fee for the copies, summary or explanation.
If we do not have the record you asked for, but we know who does, we will tell you who to contact to request it. In limited situations, we may deny some or all of your request to see or receive copies of your records, but if we do, we will tell you why in writing and explain your right, if any, to have our denial reviewed.
If you believe there is a mistake in your PHI or that important information is missing, you may request that we correct or add to the record. Requests must be in writing, tell us what corrections or additions you are requesting, and why the corrections or additions should be made. We will respond in writing after receiving your written request. If we approve your request, we will make the correction or addition to your PHI. If we deny your request, we will tell you why and explain your right to file a written statement of disagreement.
Submit all written requests for access or amendments to us at Release of Information Department, 10220 SE Sunnyside Road, Clackamas, OR 97015 for medical records or to Dental Administration, North Interstate Dental Office, 7201 N Interstate Ave., Portland, OR 97217 for dental records.
You may ask us to send your PHI to you at a different address (for example, your work address) or by different means (for example, fax instead of regular mail).
Under Oregon law you have the right to submit a Request for Confidential Communications Form asking Kaiser Permanente to send any communications containing your personal health information to you alone, and not to the insurance subscriber that pays for your health insurance. For example, you can request that explanation of benefits (EOB), medical appointment information and the names and addresses of any doctors that you’ve seen, only be sent to you. The Confidential Communications Request Form is located on your kp.org “Forms” page. You can send the form to Privacy Officer, Compliance Department, Kaiser Permanente, 500 NE Multnomah St, Portland, OR 97232.
If your PHI is stored electronically, you may request a copy of the records in an electronic format offered by Kaiser Permanente. You may also make a specific written request to Kaiser Permanente to transmit the electronic copy to a designated third party.
If the cost of meeting your request involves more than a reasonable additional amount, we are permitted to charge you our costs that exceed that amount.
You may ask us for a list of our disclosures of your PHI. Write to us at Release of Information Department, 10220 SE Sunnyside Road, Clackamas, OR 97015 for medical or dental records. You are entitled to one disclosure accounting in any 12-month period at no charge. If you request any additional accountings less than 12 months later, we may charge a fee. An accounting does not include certain disclosures, for example, disclosures:
To carry out treatment, payment, and health care operations; For which Kaiser Permanente had a signed authorization;
Of your PHI to you;
From a Kaiser Permanente facility directory; For notifications for disaster relief purposes;
To persons involved in your care and persons acting on your behalf; or Not covered by the right to an accounting.
You may request that we limit our uses and disclosures of your PHI for treatment, payment, and health care operations purposes. We will review and consider your request. You may write to us at Release of Information Department, 10220 SE Sunnyside Road, Clackamas, OR 97015 for medical records or Dental Administration, North Interstate Dental Office, 7201 N Interstate Ave., Portland, OR 97217 for dental records, for consideration of your request.
We are not required to agree to your request, except to the extent that you request a restriction on disclosures to a health plan or insurer for payment or health care operations purposes and the items or services have been paid for out of pocket in full. However, we can still disclose the information to a health plan or insurer for the purpose of treating you. For requests to restrict your PHI for payment or health care operations purposes, please request the restriction prior to receiving services at the Kaiser Permanente facility or medical office where you receive your care.
If the services are not paid for in full and out of pocket by you or by someone on your behalf, we do not have to agree to your request to restrict uses or disclosures of PHI for health care operations, payment or treatment purposes. We will consider all submitted requests and, if we deny your request, we will notify you in writing.
You have a right to receive a paper copy of this notice upon request.
This notice applies to the Kaiser Permanente Northwest Region, which includes:
Northwest Permanente, P.C., Physicians & Surgeons (NWP); Permanente Dental Associates, P.C. (PDA);
Kaiser Foundation Health Plan of the Northwest Inc. (KFHPNW), including health plan and provider operations;
Kaiser Foundation Hospitals (KFH);
Kaiser Foundation Health Plan, Inc. (KFHP, Inc.), as discussed below.
Our health care delivery sites include medical and dental offices, KFH hospitals, ambulatory surgery centers, and other licensed facilities of Kaiser Permanente in the region, member call advice, appointment centers, and our member Web site and mobile applications.
To provide you with the health care you expect, to treat you, to pay for your care, and to conduct our operations, such as quality assurance, accreditation, licensing, and compliance, these Kaiser Permanente companies share your PHI with each other.
Our personnel may have access to your PHI either as employees, professional staff members of Kaiser Permanente facilities, and others authorized to enter information in a Kaiser Permanente medical or dental record, volunteers or persons working with us in other capacities. Our region may share your PHI with KFH and KFHP, Inc., in connection with shared services and other national Kaiser Permanente activities for treatment, payment, or health care operations purposes. For example, if you are being considered for a transplant, we will share your PHI with our Kaiser Permanente National Transplant Network.
Your confidentiality is important to us. Our physicians and employees are required to maintain the confidentiality of the PHI of our members and patients, and we have policies and procedures and other safeguards to help protect your PHI from improper use and disclosure. Sometimes we are allowed by law to use and disclose certain PHI without your written permission. We briefly describe these uses and disclosures below and give you some examples.
How much PHI is used or disclosed without your written permission will vary depending, for example, on the intended purpose of the use or disclosure. Sometimes we may only need to use or disclose a limited amount of PHI, such as to send you an appointment reminder or to confirm that you are a health plan member. At other times, we may need to use or disclose more PHI such as when we are providing medical treatment.
Except for those uses and disclosures described above, we will not use or disclose your PHI without your written authorization. Some instances in which we may request your authorization for use or disclosure of PHI are:
Marketing: We may ask for your authorization in order to provide information about products and services that you may be interested in purchasing or using. Note that marketing communications do not include our contacting you with information about treatment alternatives, prescription drugs you are taking or health-related products or services that we offer or that are available only to our health plan enrollees. Marketing also does not include any face-to-face discussions you may have with your providers about products or services.
Sale of PHI: We may only sell your PHI if we received your prior written authorization to do so.
Psychotherapy Notes: On rare occasions, we may ask for your authorization to use and disclose “psychotherapy notes”. Federal privacy law defines “psychotherapy notes” very specifically to mean notes made by a mental health professional recording conversations during private or group counseling sessions that are maintained separately from the rest of your medical record. Generally, we do not maintain psychotherapy notes, as defined by federal privacy law.
When your authorization is required and you authorize us to use or disclose your PHI for some purpose, you may revoke that authorization by notifying us in writing at any time. Please note that the revocation will not apply to any authorized use or disclosure of your PHI that took place before we received your revocation. Also, if you gave your authorization to secure a policy of insurance, including health care coverage from us, you may not be permitted to revoke it until the insurer can no longer contest the policy issued to you or a claim under the policy.
If you have any questions about this notice, or want to lodge a complaint about our privacy practices, please let us know by calling Membership Services at 503-813-2000 in the Portland metropolitan area and 1-800-813-2000 from all other areas. For TTY, call 1-800-735-1232. For language interpretation services, call 1-800-880-2753. You also may notify the Secretary of the Department of Health and Human Services (HHS).
We will not take retaliatory action against you if you file a complaint about our privacy practices.
We may change this notice and our privacy practices at any time, as long as the change is consistent with state and federal law. Any revised notice will apply both to the PHI we already have about you at the time of the change, and any PHI created or received after the change takes effect. If we make an important change to our privacy practices, we will promptly change this notice and make the new notice available in our hospitals, medical and dental offices and at www.kp.org/privacy. Except for changes required by law, we will not implement an important change to our privacy practices before we revise this notice.
This notice is effective on September 23, 2016.
Kaiser Foundation Health Plan of the Northwest (Kaiser Health Plan) complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Kaiser Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. We also:
If you need these services, call the number provided below.
If you believe that Kaiser Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
the Kaiser Civil Rights Coordinator,
500 NE Multnomah St., Ste 100,
Portland OR 97232,
telephone number: 1-800-813-2000.
You can file a grievance by mail or phone. If you need help filing a grievance, the Kaiser Civil Rights Coordinator is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at:
U.S. Department of Health and Human Services,
200 Independence Avenue SW.,
Room 509F, HHH Building,
Washington, DC 20201,
Complaint forms are available at https://www.hhs.gov/civil-rights/filing-a-complaint/
English: You have the right to get help in your language at no cost. If you have questions about your application or coverage through Kaiser Permanente, or if this is a notice that requires you to take action by a specific date, call the number provided for your state or region to talk to an interpreter.
አማርኛ (Amharic): ያለምንም ክፍያ በራስዎ ቋንቋ እገዛ የማግኘት መብት አለዎት። ስለ ማመልከቻዎ ወይም ከኬሰር ፐርማነንቴ Kaiser Permanente ስለሚያገኙት ሽፋን ማንኛውም ጥያቄዎች ካሉዎት፣ ወይም ይህ ማሳወቂያ በግልፅ በተጠቀሰ ቀን ማድረግ ያለብዎ ነገር እንዳለ የሚያስገድድዎ ከሆነ፣ በተጠቀሰው የስልክ ቁጥር ለስቴትዎ ወይም ለክልልዎ ደውለው ከአስተርጓሚ ጋር ይነጋገሩ።
العربية (Arabic): لك الحق في الحصول على المساعدة بلغتك دون تحمل أي تكاليف. إذا كانت لديك استفسارات بشأن طلبك أو تغطيتك التي تقدمها Kaiser Permanentee، أو إذا كان هذا الإشعار الذي يتطلب منك اتخاذ إجراء خلال تاريخ محدد، يُرجى الاتصال بالرقم المخصص لولايتك أو منطقتك للتحدث إلى مترجم فوري.
Հայերեն (Armenian): Դուք ունեք Ձեր լեզվով անվճար օգնություն ստանալու իրավունք: Եթե Դուք հարցեր ունեք Ձեր դիմումի կամ Kaiser Permanente-ի միջոցով Ձեր ծածկույթի վերաբերյալ, կամ եթե սա ծանուցում է, որը պարտադրում է Ձեզ, որպեսզի գործուղություններ ձեռնարկեք մինչև որոշակի ամսաթիվ, ապա զանգահարե՛ք Ձեր նահանգի կամ շրջանի համար տրամադրված հեռախոսահամարով` թարգմանչի հետ խոսելու համար:
Ɓǎsɔ́ɔ̀ Wùɖù (Bassa): Ɔ mɔ̀ nì kpé ɓɛ́ m̀ ké gbo-kpá-kpá dyé ɖé nì mìɔùn nììn ɓíɖí-wùɖù mú pídyi. Ɔ jǔ ké m̀ dyi dyi-diè-ɖɛ̀ ɓě ɓéɖé ɓá nì céè-ɖɛ̀ m̀ tò ɓó ɖɛ zɔ̀ jè dyíɛ ní, mɔɔ jǔ ɓá nì kũùn kpɔ̃ jè dyí dyììn ɖé Kaiser Permanente múɛ ní, mɔɔ ɔ dyi bɔ̃̌ ɖò jǔ ɓɛ́ m̀ ké ɖɛ ɖò nyu ɓó wé jɛ́ɛ́ ɖò kɔ̃ nì, nìí, ɖá nɔ̀ɓà ɓɛ́ wa tòà ɓó nì ɓóɖóɔ̀ mɔɔ nì gbɛ̌ɛ̀ɔ̀ bììɛ, ké nì mu nyɔ-wuɖuún-zà-nyɔ̀ ɖò gbo wùɖùùn.
বাংলা (Bengali): বিনা খরচে আপনার নিজের ভাষায় সাহায্য পাওয়ার অধিকার আপনার আছে। আপনার যদি আপনার আবেদন বা Kaiser Permanente-এর মাধ্যমে পাওয়া কভারেজ নিয়ে কোনো প্রশ্ন থাকে বা এটি যদি কোনো নোটিস হয় যার ফলে আপনার একটি নির্ধারিত দিনের মধ্যে কোনো পদক্ষেপ গ্রহণ করার প্রয়োজন হয়, তাহলে দোভাষীর সাথে কথা বলতে আপনার রাজ্য বা অঞ্চলের জন্য প্রদত্ত নম্বরটিতে ফোন করুন।
California ................ 1-800-464-4000
Colorado ................ 1-800-632-9700
District of Columbia ................ 1-800-777-7902
Georgia ................ 1-888-865-5813
Hawaii ................ 1-800-966-5955
Maryland ................ 1-800-777-7902
Oregon ................ 1-800-813-2000
Virginia ................ 1-800-777-7902
Washington ................ 1-800-813-2000
TTY ................ 711
Kaiser Foundation Health Plan, Inc., in Northern and Southern California and Hawaii • Kaiser Foundation Health Plan of Colorado • Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000 • Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., in Maryland, Virginia, and Washington, D.C., 2101 E. Jefferson St., Rockville, MD 20852 • Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232