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 Information. Your Rights. Our Responsibilities.

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.

You have the right to:

• Get an electronic or paper copy of your medical record. You can ask to see or get a copy of your health information. We will provide it within 30 days of your request. A reasonable fee may apply.
• Ask us to correct your medical record. If you believe your record is incorrect or incomplete, you can request a correction. We may say no, but we will explain why in writing within 60 days.
• Request confidential communications. You can ask us to contact you in a specific way or at a different address. We will say yes to reasonable requests.
• Ask us to limit what we use or share. You may request restrictions on how your information is used for treatment, payment, or operations. We are not required to agree, but if you pay out-of-pocket in full, we must honor your request not to share that information with your health insurer (unless required by law).
• Get a list of disclosures. You may request an accounting of when we’ve shared your health information (excluding certain routine uses) for the last six years. One free list per year; a fee may apply for additional requests.
• Get a copy of this notice. You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Choose someone to act for you. If you have given someone medical power of attorney or have a legal guardian, that person can act on your behalf.
• File a complaint. If you believe your privacy rights have been violated, you may contact us or file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights (www.hhs.gov/ocr/privacy/hipaa/complaints/). We will not retaliate against you for filing a complaint.

Your Choices

For certain information, you can decide how we share it.

You have the right and choice to:

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

You also control:

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

We may contact you for fundraising, but you can opt out at any time.

Our Uses and Disclosures

We typically use or share your health information in the following ways:

• Treatment. We can share your information with other providers involved in your care.
• Operations. We use your information to run our organization, improve care, and contact you.
• Billing. We share your information with health plans to bill and receive payment.

We may also use or share your information to:

• Help with public health and safety issues (report disease, recalls, adverse reactions, abuse/neglect, prevent serious threats).
• Conduct research.
• Comply with the law.
• Respond to organ and tissue donation requests.
• Work with coroners, medical examiners, or funeral directors.
• Address workers’ compensation, law enforcement, and government requests.
• Respond to lawsuits or legal actions.

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 your information.
• We must follow the duties described in this notice and provide you a copy.
• We will not use or share your information beyond what is described here unless you provide written permission. You may revoke that permission in writing at any time.
  

Changes to This Notice

We may change the terms of this notice. Updates will apply to all information we maintain and will be available upon request, in our office, and on our website