Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
YOUR RIGHTS:
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibility to help you.
Get an electronic or paper copy of your medical records: You can ask to see or get 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 can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may say "no" to your request, but we'll tell you why in writing within 60 days.
Request confidential communications: You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say "yes" to all reasonable requests.
Ask us to limit what we use or share: You can ask us NOT to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say "no" if it would affect your care. 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.
Get a list of those with whom we've shared information: You can ask for a list (accounting) of the times we've shared your health information for six years before the date you ask, with whom we shared it, and why. We will include all the disclosures except those about treatment, payment, health care operations, and certain other disclosures (such as any you asked us to make). We'll provide one accounting a year for free but charge a reasonable, cost-based fee if you request another within 12 months.
Get a copy of this Privacy Notice: You can ask for a paper copy of this notice at any time, even if you have agreed to receive the information electronically. We will provide you with a paper copy promptly.
Get 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 health information. We will ensure the person has this authority and can act for you before we act.
File a complaint if you feel your rights are violated: You can complain if you feel we have violated your rights by contacting us using the information on the last page. You can 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.
YOUR CHOICES:
You can tell us your choices about what we share for specific health information. Talk to us if you have a clear preference for how we share your information in the situations described below. Please tell us what you want us to do, and we will follow your instructions. We can only share your information with your written permission.
In these cases, you have both the right and the choice to tell us: Marketing Purposes, Sale of your information, or Most sharing of psychotherapy notes.
Regarding fundraising, we may contact you for fundraising efforts, but you can tell us not to contact you again.
OUR USES AND DISCLOSURES:
How do we typically use or share your health information? We typically use or share your health information in the following ways:
Treat you: We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization: We can use and share your health information to bill and get payment from health plans or other entities. Example: We use your health information about you to manage your treatment and services.
Bill your services: We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information? We are allowed or required to share your information in other ways - usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before sharing your information for these purposes.
Help with public health and safety issues: We can share information about you for certain situations, such as: preventing disease, helping with
product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone's health or safety.
Do research: We can use or share your information for health research only with your written permission.
Comply with the law: We will share information about you if state or federal laws require it, including with the Department of Health and Human Services, if it wants to see that we comply with federal privacy law.
Respond to organ and tissue donation requests: We can share health information about you with organ procurement organizations upon your passing.
Work with a medical examiner or funeral director: We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers' compensation, law enforcement, and other government requests: We can use or share health information about you: For workers' compensation claims, For law enforcement purposes or with a law enforcement official, With health oversight agencies for activities authorized by law, For special government functions, such as military, national security, and presidential protective services.
Respond to lawsuits and legal actions: We can share health information about you in response to a court or administration order or in response to
a subpoena.
OUR RESPONSIBILITIES:
We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and give you a copy. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.