Privacy Policy

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

Get an electronic or paper copy of your medical record

• 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 healthinformation, usually within30 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 writingwithin 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 timeswe’ve shared your health  information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for thoseabout treatment, payment, and 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 will charge a reasonable, cost-based fee if you ask for another one within  12 months.

Get a copy of this privacy notice

• You can askfor a papercopy of thisnotice at anytime, even if you have agreed to receive the notice electronically. We will provide you with a paper  copy promptly.

Choose someone to act for you

• If you havegiven someone medicalpower of attorney or if someoneis your legal guardian, that person can exercise your rights and make choices about your healthinformation.
• We will make sure the person has this authority and can act for you before we take any action.

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 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, calling1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliateagainst you for filing a complaint.

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both theright and choice to tell us to:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospitaldirectory
• Contact you for fundraising efforts

If youare not ableto tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in yourbest interest. We may alsoshare your information when needed to lessen a serious andimminent threat to health or safety.

In these caseswe never share your information unless you give us written permission:

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

In thecase of fundraising:

• We may contact you for fundraising efforts, but you can tell us not to contact you again.

How do we typically use or share your health information? We typicallyuse or share your health informationinthe following ways.

Treat you

• We can useyour 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 run our practice, improveyour care,

and contact you when necessary.

Example: We usehealth information about you to manage your treatment and services.

Bill for 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 canwe use or share yourhealth information? We areallowed or required to share your information in other ways– usually in ways thatcontribute to thepublic good, suchas public healthand

research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with publichealth and safety issues

• We can share health 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
  • Preventing or reducing a serious threat to anyone’s health or safety

Do research

• We can use or share your information for health research.

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’re complying with federal privacy law.

Respond to organ and tissue donation requests

• We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeraldirector

• We can sharehealth information witha 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 administrative order, or in response to a subpoena.

• 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 privacypractices described inthisnotice and give you a copy of it.
• 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.