Welcome to Divergent Therapy Pdx! I, Owen Wardrop, am a Licensed Clinical Social Worker. I have had a master’s degree in social work since 2021 and am fully licensed to practice clinical social work in the state of Oregon. I adhere to the National Association of Social Workers NASW Code of Ethics and the laws of the state of Oregon and the United States. The following is intended to provide you with the necessary information to understand the privacy practices of this organization. 

Your information. Your rights. My responsibility. 

This notice describes how protected health information (PHI) about you may be used and disclosed and how you can access this information. Please review it carefully. 

Your Rights: 

You have the right to: 

• Get a copy of your electronic health record

• Correct your electronic health record

• Request confidential communication

• Ask me to limit the information I share

• Get a list of whom I’ve shared your information

• Get a copy of this privacy notice 

• Choose someone to act for you

• File a complaint if you believe your privacy rights have been violated

Your Choices: 

You have some choices in the way I use and share information as I: 

• Collaborate and consult with other professionals on your behalf

• Tell family and friends about your condition

• Provide you mental health care

• Provide disaster relief or emergency mental health treatment

Our Uses and Disclosures: 

I may use and share your information as I: 

• Treat you

• Run my practice

• Coordinate treatment and comply with health plan requirements

• Bill you for services and/or collect overdue payments

• Comply with mandatory reporting laws

• Respond to lawsuits and legal actions

Your Rights: 

When it comes to your health information, you have certain rights. This section explains your rights and my responsibility to help you. 

Get an electronic copy of your health record: 

• You can ask to see or get a copy of your health record and any information I have about you. 

• I can send you a physical copy of your health record within 14 days of your request. 

Ask me to correct your health record: 

• You can ask me to make changes to your health record. 

• I can decline to make changes and will respond to your request within 60 days of the request with the reasoning for the decline in writing. 

Request confidential communication: 

• I will communicate with you in the way that you prefer.

• I will provide information about the security of each means of communication. 

Ask me to limit the information that I share: 

• You can revoke my ability to communicate about your care at any time. 

• The limitations of confidentiality still apply. 

Get a list of those who I have shared your information with: 

• I will include all communications except those communicated with billers or insurance companies. 

Get a copy of this privacy notice: 

• You can request a paper copy of this document at any time, even if you have agreed to receive it electronically. You will have access to this and all documents on your client portal. 

Choose someone to act for you: 

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your medical information. 

• It’s my job to make sure that this person has this authority and can act for you before I take any action. 

File a complaint if you feel your rights are violated: 

• You can complain if you feel I have violated your rights by contacting me using the contact information on page 1. 

• You can file a complaint with 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 1-877-696-6779, or https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf

• I will not retaliate against you for filing a complaint. 

Your Choices 

I never share your information unless you give me written permission in the cases of: 

• Requests from family, friends, or others

• Requests for copies of your records (unless accompanied by a subpoena) 

• Most sharing of psychotherapy notes

Other Uses and Disclosures 

How do I typically use your health information? 

To treat you: 

• Although I keep PHI private in these situations, I may consult with other professionals about your case to support me in providing quality care.

• After receiving an ROI, I may talk to other providers such as a psychiatrist or primary care physician to collaborate about your care. 

To run the practice: 

• I can use and share your health information to tun my practice, improve your care, and contact you when necessary. 

• I have to disclose certain things to insurance providers to bill for services. Diagnosis will always be disclosed if billing insurance or if you are using a superbill. Progress notes may be audited and viewed by the insurance company if I bill your insurance or you use a superbill to receive out of network benefits. 

How else can I use or share your health information?

• I am legally required to act to prevent clients from attempts to end their life by suicide or any situation where there is clear and imminent risk of irreversible and substantial bodily harm to you or another identified person.

• I am legally required to report cases of abuse or neglect of a minor or a dependent/elder adult. 

• I may have to release your records if ordered to do so by court subpoena or by order of a judge. It is my intention to engage with the court system as little as possible. If you are entering therapy with needs that would involve this clinician engaging with the court system, please inform me before our intake session. 

My responsibilities

• I am required by law to maintain the privacy and security of your protected health information. 

• I will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. 

• I must follow the duties and privacy practices described in this notice and give you a copy of it. 

• I will not use or share your information other than as described here unless you tell me I can in writing. If you tell me so, you can change your mind at any time. 

Changes to the Terms of this Notice: 

•  I can change the terms of this notice and the changes will apply to all information I have about you. The new notice will be available by request and on my website. 

This notice was last updated on 04/01/2025. 

This form was adapted using the available example from hhs.gov.