Privacy Policy
Your Information. Your Rights. Our responsibilities.
The Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can receive access to this information.
Your Rights
When It comes to your health information, you have certain rights.
- Receive 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.
- We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable 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.
- We may say “no” to your request, but we will explain to you in writing within 6 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 us a list of those with whom we’ve shared information.
- You can ask for a list of times we’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 of the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures. We’ll provide one accounting a year for free will 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 notice electronically. We will provide you with a paper copy promptly.
- Choose someone to act for you.
- If you have given someone healthcare 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 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, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/HIPAA/complaints/.
- We will not retaliate against you for filling a complaint.
Your Choices
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 the right and choice to 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 hospital directory
- Contact you for fundraising efforts
- If you are unable to tell us your preference, for example if you are unconscious, we may go ahead and share information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
- In these cases, we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
- In the case of fundraising:
- We may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures
We typically use or share your health information in the following ways:
- To share with other professionals who are treating you.
- To run our practice, improve your care, and contact you when necessary.
- To bill and get payment from health plans or other entities.
- Top share in 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.
- Health research.
- To share information if state or federal laws require it, including with the Department of Health and Human Services to ensure we are complying with the federal privacy law.
- To share information with organ procurement organizations, coroner, medical examiner, or funeral director when a resident passes away.
- To share information for worker’s compensation claims, law enforcement purposes, health oversight agencies, special government functions, and any administrative orders that are administered.
We are required to share your information in other ways that contribute to the country’s public health and research.
For more information see www.hhs.gov/ocr/privacy/HIPAA/understanding/consumers/index.html
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 user 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.
For more information see: www.hhs/gov/ocr/privacy/HIPAA/understanding/consumers/noticed.html.
Changes to the Terms of this Notice: We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.