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THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice, please contact Serenity Lane’s Compliance Officer at: 541-284-8605
Serenity Lane Coburg Campus and Administrative Offices
Physical Address: 1 Serenity Lane, Coburg, OR 97408
Mailing Address: PO Box 8549, Coburg, OR 97408
This notice describes the information privacy practices followed by Serenity Lane’s staff members, including contracted providers.
All Serenity Lane staff receive regular training on privacy and security practices, and our systems are audited to ensure ongoing compliance with HIPAA and 42 CFR Part 2 regulations.
This notice applies to the information and records we have about your health, health status, and the healthcare and services you receive at Serenity Lane. Your health information may include information created and received by Serenity Lane and may be in the form of written or electronic records or spoken words. It may include information about your health history, health status, symptoms, examinations, test results, diagnoses, treatments, procedures, prescriptions, and similar types of health-related information.
We are required by law to give you this notice. It will tell you about the ways in which we may use and disclose health information about you and describes your rights and our obligations regarding the use and disclosure of that information.
General Confidentiality: The confidentiality of our patients’ records is protected by federal law and regulations. Generally, we may not say to persons outside our facilities that a patient attends our facilities, or disclose any information identifying a patient as a person with a substance use disorder unless the patient agrees to the disclosure in writing, or the disclosure is allowed by subpoena and court order, or the disclosure is made to medical personnel in a medical emergency, or under certain circumstances, to qualified personnel for research, audit or program evaluation. In other words, we will not disclose substance use disorder (SUD) records in most circumstances without having your written authorization.
Minimum Necessary Standard: Serenity Lane will only use or disclose the minimum amount of health information necessary to accomplish the intended purpose of the use or disclosure, in accordance with HIPAA and 42 CFR Part 2.
Marketing and Sale of Your Health Information: We will not use or disclose your health information for marketing purposes without your written authorization.
Fundraising Activities and Opt-Out Rights: We may use certain information (name, address, telephone number, dates of service, age, and gender) to contact you for fundraising efforts. If you receive a fundraising communication, you will be provided with an opportunity to opt-out of receiving such communications in the future.
Limitations on use and Disclosure of Substance Use Disorder Treatment Records: Our patients’ substance use disorder treatment records or testimony relaying the content of such records will not be used or disclosed in civil, criminal, administrative, or legislative proceedings unless based on written consent, or a court order after notice and an opportunity to be heard is provided to the individual or the holder of the record, as provided in 42 CFR part 2. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested record is used or disclosed.
Serenity Lane will comply with the updated federal regulations under 42 CFR Part 2. These changes include:
We may use and disclose health information with your Authorization for the following purposes:
For Treatment: We may use health information about you to provide you with clinical treatment or services. We may disclose health information about you to Serenity Lane’s doctors, nurses, technicians, office staff, or other personnel who are involved in taking care of you and your health. For example, your doctor may be treating you for substance use disorder and may need to know if you have other health problems that could complicate your treatment. The doctor may use your clinical history to decide what treatment is best for you. With a written authorization, the doctor may also tell another doctor about your condition so that doctor can help determine the most appropriate care for you. Different personnel in our office may share information about you and disclose information to people who do not work in our office in order to coordinate your care, such as phoning in prescriptions to your pharmacy, scheduling lab work and ordering x-rays. Family members and other health care providers may be part of your clinical care outside Serenity Lane and may require information about you. This information may be shared with them only with your written authorization.
For payment: We may use and disclose health information about you so that the treatment and services you receive at Serenity Lane may be billed to and payment may be collected from your insurance company, a third party or from you. For example, we will need to contact your insurance company to determine your eligibility and estimated benefits. We may tell you your health plan about the treatment you are going to receive in order to obtain prior approval. Your insurance company may require treatment updates and clinical records to determine whether your plan will pay for treatment.
For Health Care Operations: We may use and disclose health information about you in order to perform business functions and provide quality care. For example, we may use your health information to evaluate the performance of our staff in caring for you. We may also use health information about you to help us decide what additional services we should offer, how we can become more efficient, or whether certain new treatments are effective. We may also disclose your health information to health plans that provide you insurance coverage for the purpose of helping these providers and plans provide improved quality of care and improve services, reduce cost, coordinate and manage health care and services, train staff and comply with the legal requirements and accrediting organizations. We may use your protected health information for purposes of treatment, payment and health care operations to communicate between or among our own staff, facilities, and certain organizations which have a need for the information in connection with their duties or functions related to diagnosing, treating, or referring you for treatment. In these instances, we do not need your written Authorization to make such communications. If, however, we disclose your protected health information for treatment, payment, or health care operations to other persons or organizations, we will first need your written Authorization to make such a disclosure.
Business Associate Agreements: Serenity Lane requires all vendors, contractors, and business associates who may have access to your protected health information to sign Business Associate Agreements (BAAs). These agreements ensure that all parties comply with HIPAA and 42 CFR Part 2 requirements for privacy and security.
Serenity Lane uses industry-standard safeguards to protect your electronic health information, including encryption at rest and in transit, multi-factor authentication for system access, network segmentation, and real-time monitoring. These measures comply with the latest HIPAA Security Rule requirements.
Electronic Communication: Serenity Lane may communicate with you via electronic means such as text messages and email. While we use reasonable safeguards to protect your information, electronic communication may not always be secure. You have the right to request that we communicate with you only in certain ways or at certain locations. You may also opt-in or opt-out of electronic communications at any time by replying to the message requesting to opt-out or by notifying Serenity Lane’s Privacy Officer via email at compliance@serenitylane.org, via mail at ATTN: Compliance Officer, PO BOX 8549, Coburg, OR 97408, or via phone at 541-284-8605.
Recording for Clinical Documentation and AI: To improve the accuracy and quality of our clinical documentation, Serenity Lane may use audio or video recording during certain clinical encounters. These recordings may be processed using artificial intelligence (AI) tools to assist with documentation and care coordination. Recording will only be made with your knowledge and consent and will be protected in accordance with HIPAA and 42 CFR Part 2 requirements.
Psychotherapy notes are given special protection under HIPAA and require your explicit authorization for most uses and disclosures. Psychotherapy notes are maintained separately from your medical record and cannot be accessed or used without your specific written permission, except in limited circumstances such as to defend a legal action, mandatory reporting (abuse, duty to warn), health oversight/training, coroner use, or preventing serious imminent harm.
In the event of a breach of your protected health information, Serenity Lane will notify you in accordance with the HIPAA Breach Notification Rule.
You have the following rights regarding health information we maintain about you:
Right to Inspect and Copy: You have the right to inspect and copy your treatment information, such as clinical and billing records, that we keep and use to make decisions about your care. You must submit a written request to the Serenity Lane’s Health Information Department in Coburg. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other associated supplies. We may deny your request to inspect and/or copy in certain limited circumstances. If you are denied copies of or access to health information that we keep about you, you may ask that our denial be reviewed. If the law gives you a right to have our denial reviewed, we will select a licensed health care professional to review your request and our denial. The person conducting the review will not be the person who denied your request, and we will comply with the outcome of the review.
We will respond to requests for access within 15 business days, as required by law.
Right to Amend: If you believe treatment information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment as long as the information is kept by or for Serenity Lane. To request an amendment, complete and submit written request to the Serenity Lane’s Compliance Officer via email at compliance@serenitylane.org, via mail at ATTN: Compliance Officer, PO BOX 8549, Coburg, OR 97408, or via phone at 541-284-8605. We may deny your request for an amendment if your request is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that we did not create, the information is not part of the treatment information that Serenity Lane keeps; if it is information that you would not be permitted to inspect and copy; or if it is determined that the information is accurate and complete.
Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of clinical information about you for purposes other than treatment, payment, health care operations, and a limited number of special circumstances involving national security, correctional institutions, and law enforcement. The list will also exclude any disclosures we have made to you based on your written authorization. To obtain this list, you must submit your request in writing to Serenity Lane’s Privacy Officer via email at compliance@serenitylane.org, via mail at ATTN: Compliance Officer, PO BOX 8549, Coburg, OR 97408, or via phone at 541-284-8605. It must state a time period, which may not be longer than six years and may not include dates more than 10 years in the past. Your request should indicate your mailing address. This first list you request within a 12-month period will be free. For additional lists, we may charge you the normal copy fee of $25.00 per request.
Right to Request Restrictions: You have the right to request a restriction or limitation on the treatment information we use or disclose about you for treatment, payment, or health care operations by making selective choices on the written authorization to release such information. You also have the right to request a limit on the treatment information we disclose about you to someone who is involved in your care or the payment for it, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you had. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. To request restrictions, you may complete and submit a request to Serenity Lane’s Privacy Officer via email at compliance@serenitylane.org, via mail at ATTN: Compliance Officer, PO BOX 8549, Coburg, OR 97408, or via phone at 541-284-8605. Also, if you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say 'yes' unless a law requires us to share that information.
Right to Request Confidential Communications: You have the right to request that we communicate with you about clinical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you may complete and submit a written request to the Serenity Lane’s Privacy Officer via email at compliance@serenitylane.org, via mail at ATTN: Compliance Officer, PO BOX 8549, Coburg, OR 97408, or via phone at 541-284-8605. We will not ask you for the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive it electronically, you are still entitled to a paper copy. To obtain such a copy, contact Reception at any Serenity Lane location or Serenity Lane’s Privacy Officer via email at compliance@serenitylane.org, via mail at ATTN: Compliance Officer, PO BOX 8549, Coburg, OR 97408, or via phone at 541-284-8605.
If you believe your privacy rights have been violated, you may file a complaint with Serenity Lane’s Privacy Officer, at the address located at the beginning of this form. You may file a complaint with the Secretary of The Department of Health and Human Services, Office of Civil Rights, Hubert H. Humphrey Building, Room 425A, 200 Independence Avenue, SW, Washington, DC 20201.
You will not be penalized for filing a complaint.
See 42 U.S.C. 290dd-3 and 42 U.S.C. 290ee-3 for federal laws and 42 CFR part 2 for federal regulations protecting the confidentiality of substance use disorder information. Violation of these federal laws and regulations by a covered program is a crime. Suspected violations may be reported to appropriate authorities in accordance with federal regulations. Other applicable regulations are found at 45 CFR parts 160 and 164.
We reserve the right to change this notice, and to make the revised or changed notice effective for clinical information we already have about you, as well as any information we receive in the future. We will post a summary of the current notice in the office with its effective date. You are entitled to a copy of the notice currently in effect.
This Notice has been updated to reflect the new requirements under 42 CFR Part 2, effective February 2026.
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