Notice of Privacy Practices


1. Bend Health Duties

Bend Health Psychiatric Services New England, P.A.  (“Bend Health”) is required by law to maintain the privacy of protected health information (PHI) private. Bend Health must also provide patients with notice of our legal duties and privacy practices with respect to protected health information and notify affected individuals following any breach of unsecured PHI. Bend Health is required to abide by the terms of our Notice of Privacy Practices currently in effect. Bend Health reserves the right to change our Notice of Privacy Practices.  Bend Health will provide you with a copy of any current Notice of Privacy Practices upon your written request, addressed to our Privacy Officer, at

2. Patient Complaints

You may submit a complaint to us and to the Secretary of the Department of Health and Human Services if you believe that your privacy rights have been violated. You may file a complaint with us by sending a written request addressed to our Privacy Officer at stating what protected health information you believe has been used or disclosed improperly. You will not be retaliated against for making a complaint. You can submit a complaint to the Department of Health and Human Services at  For further information contact our Privacy Officer, at

3. Uses and Disclosures of Protected Health Information

Bend Health will use your medical information for Treatment.  

For example: Information obtained by a physician, or other member of your Bend Health healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you.   

We may also provide your subsequent healthcare provider with copies of reports to assist him or her in treating you. 

We will use your medical information for Payment.  

For example: A bill may be sent to you or a third-party payer.  The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. 

We will use your medical information for Health Care Operations.  

For example: We may use information in your health record to assess the care and outcomes in your case and others like it.  This information will then be used in an effort to improve the quality and effectiveness of the healthcare and services we provide. 

Business Associates: There are some services provided in our organization through contracts with business associates, such as our management services arrangement with Bend Health Inc.   We may disclose your health information to our business associate so they can perform the job we’ve asked them to do.  However, we require the business associate to take precautions to protect your medical information.  

Notification of Family: We may use or disclose information to notify or assist in notifying a family member, personal representative, or other person responsible for your care of your location and general condition.  

Communication With Family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care.  

Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your medical information.    

Funeral Director, Coroner, and Medical Examiner: Consistent with applicable law we may disclose health information to funeral directors, coroners, and medical examiners to help them carry out their duties.  

Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.  

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events, product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.  

Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability, including child abuse and neglect.  

Victims of Abuse, Neglect or Domestic Violence: We may disclose to appropriate governmental agencies, such as adult protective or social services agencies, your health information, if we reasonably believe you are a victim of abuse, neglect, or domestic violence.  

Health Oversight: In order to oversee the health care system, government benefits programs, entities subject to governmental regulation and civil rights laws for which health information is necessary to determine compliance, we may disclose health information for oversight activities authorized by law, such as audits and civil, administrative, or criminal investigations.  

Court Proceeding: We may disclose health information in response to requests made during judicial and administrative proceedings, such as court orders or subpoenas.  

Law Enforcement: Under certain circumstances, we may disclose health information to law enforcement officials.  These circumstances include reporting required by certain laws (such as the reporting of certain types of wounds), pursuant to certain subpoenas or court orders, reporting limited information concerning identification and location at the request of a law enforcement official, reports regarding suspected victims of crimes at the request of a law enforcement official, and crimes in emergencies.  

Inmates:  If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official.  This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

Threats to Public Health or Safety: We may disclose or use health information when it is our good faith belief, consistent with ethical and legal standards, that it is necessary to prevent or lessen a serious and imminent threat or is necessary to identify or apprehend an individual.  

Specialized Government Functions: Subject to certain requirements, we may disclose or use health information for military personnel and veterans, for national security and intelligence activities, for protective services for the President and others, for medical suitability determinations for the Department of State, for correctional institutions and other law enforcement custodial situations, and for government programs providing public benefits.  

Workers Compensation: We may disclose health information when authorized and necessary to comply with laws relating to workers compensation or other similar programs.   

4. Other Uses and Disclosures We may also use and disclose your personal health information for the following purposes: 

to contact you to remind you of an appointment for treatment, 

to describe or recommend treatment alternatives to you, or

to furnish information about health-related benefits and services that may be of interest to you. 

Psychotherapy notes are given a higher degree of protection and cannot be disclosed without your express permission except to carry out certain treatment, payment, or health care operations including allowing the note taker to use them for treatment, using the notes for training programs, or using the notes in defense of a legal proceeding.   We will not sell your PHI in violation of the HIPAA regulations without your written authorization.  The HIPAA rules do not consider accepting payment for your treatment as a sale of PHI. All other uses and disclosures of your medical information will be made only with your written permission.  If you provide a written authorization, you may later revoke the authorization by sending a written request addressed to our Privacy Officer at  You understand that we are unable to take back any disclosure we have already made with your permission.   

5. Individual Rights

(i) You may request us to restrict the uses and disclosures of your medical information for treatment, payment, health care operations or for other permitted purposes, but Bend Health does not have to agree to such a request. You may make such a request in writing addressed to our Privacy Officer at 

(ii) You may request that we communicate with you in a specific manner, such as communicating to a specific phone number, or by sending mail to a specific address. Bend Health is required to accommodate all reasonable requests in this regard. You may make these requests in writing addressed to our Privacy Officer at    

(iii) You have the right to inspect and copy your medical information. You must submit your request in writing addressed to our Privacy Officer at   If you request a copy of your medical information we may charge you a fee for the cost of copying, mailing or other supplies.  In certain circumstances we may deny your request to inspect or copy your medical information.  If you are denied access to your medical information, you may request that the denial be reviewed.  Another licensed health care professional will then review your request and the denial.  The person conducting the review will not be the person who denied your request.  We will comply with the outcome of the review.

(iv)  You have the right to amend medical information.  If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information.  To request an amendment, you must send a written request addressed to our Privacy Officer at   You must also give us a reason to support your request.  We may deny your request to amend your medical information if it is not in writing or does not provide a reason to support your request.  We may also deny your request if:

- the information was not created by us, unless the person that created the information is no longer available to make the amendment,                       
- the information is not part of the medical information kept by or for us,                       
- is not part of the information you would be permitted to inspect or copy,or                       
- is accurate and complete

(v) You have the right to request and receive an accounting of our disclosures of your medical information up to six years before the date on which you request the accounting. Not all your medical information is subject to a request for an accounting of disclosures. Your request must state how you would like to receive the report (paper, electronically).  We may charge you the cost of providing the accounting of disclosures.  We will notify you of this cost and you may choose to withdraw or modify your request before charges are incurred.(vi)  You may request a paper copy of this Notice by submitting a request for a paper notice in writing to our Privacy Officer at 

9. Effective DateThe effective date of this Notice is October 1, 2021. 

10. Bend Health Contact, and our Privacy Officer at