Privacy Policy


This notice describes how clinical information about clients may be used and disclosed, and how to get access to this information.

We are committed to maintaining the privacy of client health information.  We are required by law (HIPAA) to give clients this notice, and to abide by its terms.   We may change this notice, and make the revised or changed notice effective for medical information we already have about clients, as well as any information we receive in the future.  We have posted this summary of the current notice in our offices (where applicable) with its effective date in the top right hand corner.  Clients are entitled to a copy of the notice currently in effect.   


In 1996 Congress passed the Health Insurance Portability and Accountability Act (HIPAA), which was intended to:

1.         Improve communication of health information between providers and health plans;

2.         Reduce overhead and administrative expenses;

3.         Mandate the use of industry-wide standard codes for financial transactions: and

4.         Provide a uniform set of federal rules for protecting clients health information.

HIPAA requires that all health care providers post and make available a Notice of Privacy Practices, that is in compliance with HIPAA, which we have done below.  These are minimal standards of privacy that apply to all health care providers.  MUCH STRICTER PRIVACY RULES APPLY TO MENTAL HEALTH AND ALCOHOL AND DRUG TREATMENT. These rules have not changed and we continue to follow them.  (Where applicable) For more information about the limits of confidentiality, please refer to the Permission To Treat Form that all new clients sign and our Guide to Services that all new clients receive.  Please address your questions to your therapist.


We may use and disclose health information about clients, only with signed written authorization, except in those situations listed below.  We must obtain written authorization to use and disclose mental health, HIV, alcohol and other drug treatment records, and genetic testing information.  The authorization includes who is to receive the information, limitations on the information released, and the time period covered by the authorization.  If we are given authorization to use or disclose health information about clients, they may cancel this authorization in writing at any time.  However, we cannot take back any use or disclosure already made with their permission.

How we may use and disclose health information about clients, without their written authorization:

  • For treatment. We may share information about clients with other Looking Glass staff to better provide them with coordinated clinical treatment. For example, information may be shared with our clinical supervisors or other treatment staff to review treatment plans or treatment progress. Sharing of information about clients outside of Looking Glass will only be done with written authorization.

  • For payment. For example, we may provide an insurance company or health plan with information about a service clients receive so the service can be authorized or so the health plan will reimburse us for the service.

  • For health care operations to run our business office. For example, we may use health information to evaluate the effectiveness of the services we provide.

  • For appointment reminders. For example, a phone call the day before an appointment.

  • For a serious threat to the health and safety of yourself or others. For example, a suicide threat or threat to hurt others.

  • To family members who are involved in a child’s treatment. For example, a parent or spouse, unless directed otherwise.

  • To law enforcement only as required by federal, state, or local law. For example, in response to a court order.

  • To report suspected child or elder abuse as required by law. For example, physical or sexual abuse of a child.

  • For health oversight activities. For example, audits, investigations, inspections or licensing.

  • For public health reasons. For example, collecting vital statistics.

Clients have the following rights regarding health information:

  • To inspect and copy their health information such as clinical and billing records, in most cases. The request must be made in writing, and they may be charged a fee for copying costs. We may deny the request, and the client may appeal such denial.

  • To amend health information that they believe is incomplete or incorrect. Clients must make the request in writing, and provide reason for the request. We may deny this request for specific reasons.

  • To get a list of disclosures made after April 14, 2003. Clients must make the request in writing. The list will exclude disclosures for treatment, payment, health care operations, information provided to the client, and information disclosed with authorization. We may charge a fee to cover costs.

  • To request restrictions or limitations on the health information we use or disclose. Clients must make the request in writing. We are not required to agree to the requested restrictions except under the following conditions: The request is to restrict disclosure of protected health information about an individual to a health plan if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law and the protected health information pertains solely to a health care item or service for which the individual, or person other than the health plan on behalf of the individual, has paid us in full.

  • To choose how we communicate with clients, including requesting confidential communications. They must make the request in writing, and do not need to specify a reason. We will attempt to accommodate all reasonable requests.

  • To receive a paper copy of this notice, at any time.

  • To be notified if there is a breach of their unsecured protected health information

  • To file a complaint if they believe their privacy rights have been violated. They will not be penalized for filing a complaint. Clients may contact the Secretary of the Department of Health and Human Services, Office for Civil Rights. They may also contact by phone or in writing:

Quality Assurance Coordinator

 Looking Glass Administrative Office

 1790 W. 11th, Suite 200

 Eugene, OR 975402

 (541) 686-2688. 

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  • Our agency enters personal and demographic information about you into a computerized record-keeping system.

  • The information is used to plan delivery of services & to provide statistical information for setting goals.

  • Information you provide will be used for functions related to payment or reimbursement for services, monitor program effectiveness, and to prepare reports and statistical information without personally identifying information.

  • If you have safety concerns, you may not want personal information entered into the system, you should discuss this with a staff member.

  • Personally identifying information may be seen by staff members who provide you with services, select community service providers when appropriate, and a small number of people (ie: system administrators or program funders) who maintain the computerized record-keeping system, except where required by law.

  • You will not be denied services, if you refuse to consent to share data.

  • You have the right to see your record and to ask that it be corrected.

  • You have the right to file a grievance if you feel that you have been harmed in some way by the use of the computerized data system.

THIS IS NOT A COMPLETE STATEMENT OF YOUR INFORMATION RIGHTS. For a complete statement of your information rights, please ask a staff person for a copy of our Privacy Policy. If you have any questions about our computerized record-keeping system and how it might affect you, feel free to talk about your concerns with a staff member.