The information provided on this Moda Wellness Clinic website is for general informational purposes only and does not constitute medical, legal, or professional advice. While we strive to ensure that the information on this site is accurate, current, and complete, Moda Wellness Clinic makes no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability, or availability of the information, services, or related graphics contained on the website for any purpose.
The content on this website, including but not limited to articles, blogs, and health-related information, is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website.
Moda Wellness Clinic, LLC, its affiliates, employees, or agents shall not be liable for any direct, indirect, incidental, special, consequential, or exemplary damages resulting from your use of this website or reliance on any information provided. This includes, but is not limited to, damages for loss of data, health complications, or any other intangible losses.
Moda Wellness Clinic complies with applicable federal civil rights laws. We do not discriminate on the basis of race, religion, color, national origin, age, disability, gender identity, sex or sexual orientation.
Moda Wellness Clinic provides free, timely aids and services to people with disabilities to help them communicate with us effectively. These accommodations include sign language interpreters and written information in other formats. If your primary language is not English, Moda Wellness Clinic also provides free, timely interpretation services and/or materials written in other languages.
If you need any of the services listed above contact our staff at 503-206-6200.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services Office for Civil Rights at:
https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf
or by mail or phone to:
U.S. Department of Health and Human Services
200 Independence Ave. SW, Room 509F
HHH Building, Washington, DC 20201
800-368-1019, 800-537-7697 (TDD).
Office for Civil Rights complaint forms are available at:
http://www.hhs.gov/ocr/filing-with-ocr/index.html
This notice describes how your health information may be used or shared and how you can get access to this information. Please review it carefully.
The Moda Wellness Clinic respects the privacy of your protected health information. We will keep it confidential in a responsible and professional manner. Protected health information includes any information about your healthcare that can identify you as the person who receives healthcare services. We are required by law to provide you with this notice and to abide by its terms.
We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law, and to make Notice provisions effective for all protected health information that we maintain. When we make a significant change in our privacy practices, we will change this Notice and post the new Notice clearly and prominently at our practice location, and we will provide copies of the new Notice upon request.
You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information at the end of this Notice.
We may use and disclose your health information for different purposes, including treatment, payment, and health care operations. For each of these categories, we have provided a description and an example. Some information, such as HIV-related information, genetic information, alcohol and/or substance abuse records, and mental health records may be entitled to special confidentiality protections under applicable state or federal law. We will abide by these special protections as they pertain to applicable cases involving these types of records.
Treatment. We may use and disclose your health information for your treatment. For example, we may disclose your health information to a specialist providing treatment to you.
Payment. We may use and disclose your health information to obtain reimbursement for the treatment and services you receive from us or another entity involved with your care. Payment activities include billing, collections, claims management, and determinations of eligibility and coverage to obtain payment from you, an insurance company, or another third party. For example, we may send claims to your health plan containing certain health information.
Healthcare Operations. We may use and disclose your health information in connection with our healthcare operations. For example, healthcare operations include quality assessment and improvement activities, conducting training program, and licensing activities.
Individuals Involved in Your Care or Payment for Your Care. We may use and disclose your health information to your family or friends or any other individual identified by you when they are involved in your care or in the payment for your care. Additionally, we may disclose information about you to a patient representative. If a person has the authority by law to make health care decisions for you, we will treat the patient representative the same way we would treat you with respect to your health information.
Disaster Relief. We may use and disclose your health information to assist in disaster relief efforts.
Required by Law. We may use and disclose your health information when we are required to do so by law.
Public Health Activities. We may use and disclose your health information for public health activities, including disclosures to:
National Security. We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institutions or law enforcement officials having lawful custody, the protected health information of an inmate or patient.
Secretary or HHS. We may use and disclose your health information to the Secretary of the U.S. Department of Health and Human Services when required to investigate or determine compliance with HIPAA.
Workers Compensation. We may disclose your protected health information to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.
Law Enforcement. We may disclose your protected health information for law enforcement purposes as permitted by HIPAA, as required by law, or in response to a subpoena or court order.
Judicial and Administrative Proceedings. If you are involved in a lawsuit or dispute, we may disclose your protected health information in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process instituted by someone else involved in the dispute, but only if efforts have been made, either by the requesting party or us, to tell you about the request or to obtain an order protecting the information request.
Research. We may disclose your protected health information to researchers when their research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your information.
Coroners, Medical Examiners, and Funeral Directors. We may release your protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose your protected health information to funeral directors consistent with applicable law to enable them to carry out their duties.
Substance Use Disorder Provider or Programs Treatment Information. If we receive or maintain any information about you from a substance use disorder treatment provider or program that is covered by 42 CFR Part 2 (a “Part 2 Program’’) through a general consent you provide to the Part 2 Program to use and disclose the Part 2 Program record for purposes of treatment, payment or health care operations, we may use and disclose your Part 2 Program record for treatment, payment, and health care operations purposes as described in this Notice. If we receive or maintain your Part 2 Program record through specific consent you provide to us or to another third party, we will use and disclose your Part 2 Program record only as expressly permitted by you in your consent as provided to us.
In no event will we use or disclose your Part 2 Program record, or testimony that describes the information in your Part 2 Program record, in any civil, criminal, administrative, or legislative proceedings by any federal, state, or local authority, against you, unless authorized by your consent or the order of a court after it provides you notice of court order.
Fundraising. We may contact you to provide you with information about our sponsored activities, including fundraising programs, as permitted by applicable law. If you do not wish to receive such information from us, you may opt out of receiving these communications.
Your authorization is required, with a few exceptions, for disclosure of psychotherapy notes, use or disclosure of protected health information for marketing, and for the sale of protected health information. We will also obtain your written authorization before using or disclosing your protected health information for purposes other than those provided for in this Notice or as otherwise permitted or required by law. You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent that we have already taken action in reliance on the authorization.
Access. You have the right to look at or get copies of your health information, with limited exceptions. You must make the request in writing. You may obtain a form to request access by using the contact information listed at the end of this Notice. You may also request access by sending us a letter to the address at the end of this Notice. If you request information that we maintain on paper, we may provide photocopies. If you request information that we maintain electronically, you have the right to an electronic copy. We will use the form and format you request if readily producible. We may charge you a reasonable cost-based fee for the cost of supplies and labor of copying, and for postage if you want copies mailed to you. Contact us using the information listed at the end of this Notice for an explanation of our fee structure.
If you are denied a request for access, you have the right to have a denial reviewed in accordance with the requirement of applicable law.
Disclosure Accounting. Except for certain disclosures, you have the right to receive an accounting of disclosures of your health information in accordance with applicable laws and regulations. To request an accounting of disclosures of your health information, you must submit your request in writing to the Privacy contact listed at the end of this Notice. If you request the accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to the additional requests.
Right to Request a Restriction. You have the right to request additional restrictions on our use or disclosure of your protected health information by submitting a written request to the Privacy contact listed at the end of this notice. Your written request must include:
We are not required to agree to your request except in the case where the disclosure is to a health plan for purposes of carrying out payment or health care operations, and the information pertain solely to a health care item or service for which you, or a person on your behalf, other than the health plan, has paid our practice in full.
Alternative Communication. You have the right to request that we communicate with you about your health information by alternative means or at alternative locations. You must make your request in writing using the contact information listed at the end of this Notice. Your request must specify the alternative means or location and provide satisfactory explanation of how payments will be handled under the alternative means or location you request. We will accommodate all reasonable requests. However, if we are unable to contact you using the way or locations you have requested, we may contact you using the information we have.
Amendment. You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances. If we agree to your request, we will amend your record(s) and notify you of such. If we deny your request for an amendment, we will provide you with a written explanation of why we denied it and explain your rights.
Right to Notification of Breach. You will receive notifications of breaches of your unsecured protected health information as required by law.
Electronic Notice. You may receive a paper copy of this Notice upon request, even if you have agreed to receive this Notice electronically on our website or by electronic mail (email).
If you want more information about our privacy practices or have questions or concerns, please contact us.
If you are concerned that we may have violated your privacy rights, or if you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of this Notice. You may also submit a written compliant to 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 by visiting www.hhs.gov/hipaa/filing-a-complaint/index.html.
We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a compliant with us or with the U.S. Department of Health and Human Services.
Moda Wellness Clinic
5331 S. Macadam Ave. Suite 255
Portland, OR 97239
503-206-6200
info@modawellnessclinic.com
Moda Wellness Clinic: Attn: Privacy Office
5331 S. Macadam Ave. Suite 255
Portland, OR 97239
Email privacy@modawellnessclinic.com
©2025 Moda Wellness Clinic. All rights reserved.
All content on this website, including text, graphics, logos, images, videos, and other materials, is the property of Moda Wellness Clinic or its content providers and is protected by United States and international copyright laws. Unauthorized use, reproduction, distribution, or modification of any content from this website without prior written permission from Moda Wellness Clinic is strictly prohibited. You may not copy, reproduce, republish, upload, post, transmit, or distribute any part of this website without express written consent, except for personal, non-commercial use, provided that all copyright and proprietary notices are kept intact. Any other use of the content requires prior written permission from Moda Wellness Clinic.
For permission requests, questions, or concerns regarding this disclaimer or Copyright Notice, please contact: info@modawellnessclinic.com