LAST UPDATED ON 08.21.2020.
Your information. Your rights. Our responsibilities:
Full Potential Men’s Clinic LLC, an Oregon limited liability company, and Full Potential Men’s Clinic LLC, a Washington limited liability company, are collectively referred to herein as “FPMC”, “we”, or “us”.
Your information: The information subject to this policy includes your “personal identifying information,” as well as your “protected health information” that you share with us during the course of your treatment with our clinics. Personal identifying information means information that can be used to identify you as an individual. Protected health information is personal identifying information specifically related to your health.
Your rights: You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. You can also choose how we contact you and how we share certain information. You have the right to file a complaint according the process outlined below.
Our responsibilities: We are required by law to maintain the privacy and security of your personal and protected health information. We will let you know promptly if we determine that a breach has occurred that may have compromised the privacy or security of your physically or electronically stored information. We must follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us you want us to do so in writing.
We do not sell or share your information with others:
Unless you provide us with permission (for instance, by authorizing the release of your medical records to a third party) we will not release or share your personal identifying information or your protected health information with anyone or any entity, unless the law requires us to do so.
You can ask to see or get an electronic or paper copy of your medical record and other health information at any reasonable time:
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee when appropriate.
You can also ask us not to use or share certain health information. We are not required to agree to your request. We will say “yes” unless a law requires us to share that information.
You can ask us to correct health information about you that you think is incorrect or incomplete.
For certain health information, you can tell us your choices about what we share:
Let us know if you have a clear preference for how we share your information. You can tell us how to (i) share information with your family, close friends, or others involved in your care, (ii) share information in a disaster relief situation, (iii) share information through communication instructions that you provide to us (text, email, etc.). If you are not able to tell us your preferences, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
If you have given someone medical power of attorney (not a durable power of attorney or a general power of attorney) or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
You can ask us to contact you in a specific way:
Let us know if you have a clear preference for how we contact you to coordinate your care or to provide you with information about the services we provide, whether it’s via your home, office, or mobile phone, or via a certain email address, or whether you’d like us to contact you via text messages.
As a service to our patients, we provide courtesy appointment reminder calls, emails, and / or texts to your mobile phone. If you use voicemail, we may leave you a voicemail message. The information transmitted may include protected health information. You have the right to opt out of these programs if you do not consent to receiving such communication. Let us know in writing and we will remove you from these programs.
How we use your information:
We only use your information for a few different reasons:
1 – We can share your health information with other medical professionals who are treating you – at your request via a medical records release authorization.
2 – We can use your information to provide you with customer service from our administrative team and medical care from our medical team. For example, we will use your name and phone number and your service and payment information and history to call you to collect payment if you’re making a purchase for a product or service, or to coordinate other logistics for your medical care. In other words, we can use your information within our office in order to operate our business in order to serve you.
3 – We can use your information such as your name and your phone number or your email address to text and / or email you and / or call you to remind you of your appointments, or to contact you in order to schedule an appointment for you, or to contact you to provide you with information about our products and services that may be of interest to you, or to provide you with a monthly newsletter, or other important updates about our business.
4 – We are sometimes obligated to share your information by state or federal law: (1) preventing disease, (2) helping with product recalls, (3) reporting adverse reactions to medications, (4) reporting suspected abuse, neglect, or domestic violence, or (5) preventing or reducing a serious threat to anyone’s health or safety. In these cases, we would take steps to protect your personal information to the fullest extent possible.
5 – We will sometimes need to share your information for other reasons: (1) We may share your health information to respond to requests from a medical examiner, coroner, or funeral director. We may share your health information in response to a proper request, for instance, we can use or share your health information about you for: (2) Workers’ compensation claims, (3) Law enforcement purposes, (4) Health oversight agencies to perform activities authorized by law, (5) Special government functions such as military, national security, or presidential protective services, (6) Responses to lawsuits or legal actions, or (7) Responses to a subpoena or court or administrative order.
To file a complaint if you have one:
You can complain if you feel that we have violated your privacy rights by calling 971-319-4636 and asking to speak with Jessika D. regarding privacy enforcement.
You can also 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, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.
We can change the terms of this notice: