Notice of Privacy Practices

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an Electronic or Paper Copy of Your Medical Record

• You may ask to see or receive an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask Us to Correct Your Medical Record

• You may ask us to correct health information about you that you believe is incorrect or incomplete.
• We may deny your request, but we will explain our decision in writing within 60 days.

Request Confidential Communications

• You may ask us to contact you in a specific way (for example, home phone or office phone) or to send mail to a different address.
• We will agree to all reasonable requests.

Ask Us to Limit What We Use or Share

• You may ask us not to use or share certain health information for treatment, payment, or health care operations.
• We are not required to agree to your request and may deny it if it would affect your care.
• If you pay for a service or health care item out-of-pocket and in full, you may ask us not to share that information with your health insurer for payment or operations purposes. We will comply unless a law requires us to share the information.

Get a List of Those With Whom We’ve Shared Information

• You may ask for a list (accounting) of disclosures of your health information made during the six years prior to your request, including whom we shared it with and why.
• This list will not include disclosures for treatment, payment, or health care operations, or disclosures you authorized.
• One accounting per year is provided at no charge. We may charge a reasonable, cost-based fee for additional requests within a 12-month period.

Get a Copy of This Privacy Notice

• You may request a paper copy of this notice at any time, even if you have agreed to receive it electronically. We will provide one promptly.

Choose Someone to Act for You

• If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make decisions about your health information.
• We will verify that the person has the proper authority before taking any action.

File a Complaint if You Feel Your Rights Are Violated

• You may file a complaint if you believe we have violated your rights by contacting us using the information listed below.
• You may also 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 1-877-696-6775
  • Visiting: www.hhs.gov/ocr/privacy/hipaa/complaints/
• We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you may tell us your preferences about what we share. If you have a clear preference, tell us what you want us to do and we will follow your instructions.

You have the right and choice to tell us to:

• Share information with family members, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a facility directory

If you are unable to communicate your preference (for example, if you are unconscious), we may share your information if we believe it is in your best interest. We may also share information to reduce a serious and imminent threat to health or safety.

We will never share your information without written authorization for:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

Fundraising

We may contact you for fundraising purposes, but you may request not to be contacted again.

Our Uses and Disclosures

How We Typically Use or Share Your Health Information

Other Uses and Disclosures

We are allowed or required to share your health information in other ways, usually for public health and safety purposes, including:

• Preventing disease
• Reporting adverse reactions to medications
• Product recalls
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to health or safety
• Health research
• Compliance with state or federal law
• Organ and tissue donation
• Medical examiner or funeral director purposes
• Workers’ compensation, law enforcement, and health oversight activities
• Military, national security, or protective services
• Court orders, subpoenas, or legal proceedings

We will never disclose substance abuse treatment records, psychiatric, psychological, therapy, or mental health notes without your written authorization, except as permitted by law.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will notify you promptly if a breach occurs that may compromise the privacy or security of your information.
• We must follow the privacy practices described in this notice and provide you with a copy.
• We will not use or share your information other than as described here unless you authorize us in writing. You may revoke that authorization at any time in writing.

For more information, visit: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to This Notice

We may change the terms of this notice at any time. Changes will apply to all information we have about you. The updated notice will be available upon request, in our office, and on our website.