- Get an electronic paper copy your medical record. We will provide a copy or summary, usually within 30 days; a reasonable fee may be charged.
- Ask us to correct your medical record. We may say "no" but we'll provide reasoning in writing within 60 days.
- Request confidential communications. You can tell us how to communicate with you (email, phone, different address, etc.)
- Ask us to limit what we use or share. We may say "no" if it would effect your care or conflict with law.
- Get a list of those with whom we've shared information with. This can be provided once per year for free, after that a fee will apply.
- Get a copy of this privacy notice.
- Choose someone to act for you. Someone with medical power of attorney or legal guardians can exercise your rights.
- File a complaint if you feel your rights are violated.
U.S. Dept. of Health and Human Services
Office of Civil Rights
200 Independence Avenue SW
Washington, D.C. 20201
You have the right and choice to tell us how we can share your information in following situations:
- 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, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious threat and imminent threat to health or society.
In the following situations, we will never share your information unless you have given written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
We may contact you for fundraising efforts, but you can tell us not to contact you again.
Our uses and disclosures.
- To treat you. We can use your health information and share it with other professionals who are treating you.
- Run our organization. We can use and share your health information to run our practice, improve your care, and contact you when necessary.
- Bill and receive payment for your services.
Other ways we can use your information:
- Help with public health and safety issues (preventing disease, product recalls, adverse reactions to medications, report suspected abuse, neglect or domestic violence, preventing or reducing serious threat to anyone's health or safety)
- Do research
- Comply with the law
- Respond to organ and tissue donation requests
- Work with a medical examiner or funeral director
- Address workers' compensation, law enforcement, and other government requests (special government functions such as military, national security, and presidential protective services.
- Respond to lawsuits and legal actions (court or administrative order, 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 privacy practices described in this notice and give you a copy or make one available on our website.
- We will not use or share your information other than 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/understandng/consumers/noticepp.html
We can change the terms of this notice, and the changes will apply to information we have about you. These changes will be available upon request.