Confluence Clinic, LLC
Notice of Privacy Practices
Effective Date: 1/1/2026
This Notice of Privacy Practices (“Notice”) describes how medical information about you may be used and disclosed, and how you can access this information. Please review it carefully.
Confluence Clinic is committed to protecting the privacy and security of your Protected Health Information (PHI) in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and applicable federal and state laws.


1. Our Legal Duty
Confluence Clinic is required by law to:

• Maintain the privacy and security of your Protected Health Information (PHI).
• Provide you with this Notice of our legal duties and privacy practices.
• Follow the terms of this Notice currently in effect.
• Notify you if a breach occurs that may have compromised the privacy or security of your information.

2. How We Use and Disclose Your Health Information
We may use and disclose your PHI for the following purposes:
A. Treatment
We may use your information to provide, coordinate, or manage your healthcare and related services.
B. Payment
We may use and disclose your information to bill and receive payment from health plans or other entities.
C. Healthcare Operations
We may use your information for clinic operations, quality assessment, staff training, licensing, and administrative activities.


3. Use of Contact Information
Confluence Clinic collects and maintains contact information, including:

• Phone number(s)
• Email address(es)
• Mailing address

Purpose of Contact Information
We use contact information solely for direct patient communication, including:

• Appointment scheduling and reminders
• Care coordination
• Follow-up communication
• Billing-related inquiries
• Administrative notices related to your care

We do not sell, rent, or share your contact information for marketing purposes.
We do not use patient contact information for third-party advertising.


4. Text and Email Communications
Confluence Clinic may communicate with you via:

• Text message (SMS)
• Email
• Phone call

These communications may include limited health-related information necessary for care coordination or scheduling.
While we implement safeguards to protect your information, standard email and text messaging may carry some security risks.
Your Right to Opt Out
You have the right to opt out of receiving communications via text message or email at any time.
To opt out, you may:

• Notify our office verbally
• Submit a written request
• Reply “STOP” to text messages (if applicable)
• Email us at: [email protected]

Opting out of text or email communications will not affect your ability to receive care. We will continue to communicate with you via alternative methods as needed (e.g., phone or mail).


5. Other Permitted or Required Uses and Disclosures
We may also disclose your PHI when required or permitted by law, including:

• Public health reporting
• Health oversight activities
• Judicial or administrative proceedings
• Law enforcement requests
• To prevent a serious threat to health or safety

We may also disclose information to Business Associates who perform services on our behalf. All Business Associates are required to safeguard your information under HIPAA-compliant agreements.


6. Uses and Disclosures Requiring Your Authorization
We will obtain your written authorization before:

• Using or disclosing psychotherapy notes (if applicable)
• Using your information for marketing purposes
• Selling your PHI
• Any other use not described in this Notice

You may revoke your authorization at any time in writing.


7. Your Rights Regarding Your Health Information
You have the right to:

• Access and obtain a copy of your medical records
• Request corrections to your health information
• Request confidential communications at a specific location or via a specific method
• Request restrictions on certain uses and disclosures
• Receive an accounting of disclosures
• Receive a paper copy of this Notice

To exercise any of these rights, contact us at the information listed below.


8. Changes to This Notice
Confluence Clinic reserves the right to change this Notice. Any revised Notice will apply to all information we maintain and will be made available upon request and posted in our office and/or on our website.


9. Complaints
If you believe your privacy rights have been violated, you may file a complaint with:
Confluence Clinic
Confluence Clinic
PO Box 370, Jacksonville, OR 97530
541-200-4988
[email protected]
Kjell Moline, Privacy Officer
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.
We will not retaliate against you for filing a complaint.


10. Contact Information
If you have questions about this Notice or your privacy rights, please contact:
Kjell Moline, Privacy Officer
Confluence Clinic
PO Box 370, Jacksonville, OR 97530
541-200-4988
[email protected]