Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED ANDDISCLOSED AND HOW YOU CAN GET ACCESSTO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We respect our legal obligation to keep health information that identifies you private. We are obligated by law to give younotice of our privacy practices. This notice describes how we protect your health information and what rights you haveregarding it.
When it comes to your health information, you have certain rights. This section explains your rights and some of ourresponsibilities 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 yourmedical record and other health information we have about you. Ask us how to do this. We will provide a copy or asummary 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 isincorrect or incomplete. Ask us how to do this. We may say “no” to your request, but we’ll tell you why in writing within60 days.
Request confidential communications. You can ask us to contact you in a specific way (for example, home or officephone) 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 yourcare. 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 thepurpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share thatinformation.
Get a list of those with whom we’ve shared information. You can ask for a list (accounting) of the times we’ve sharedyour health information for six years prior to the date you ask, who we shared it with, and why. We will include all thedisclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such asany you asked us to make).
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 toreceive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you. If you have given someone medical power of attorney or if someone is your legalguardian, that person can exercise your rights and make choices about your health information.
File a complaint if you feel your rights are violated. You can complain if you feel we have violated your rights bycontacting us at the number listed above. You can file a complaint with the U.S. Department of Health and HumanServices 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 retaliate against you for filing acomplaint.
For certain health information, you can tell us your choices about what we share. If you have a clear preference forhow we share your information in the situations described below, talk to us. Tell us what you want us to do, and we willfollow your instructions. In these cases, you have both the right and choice to tell us to: 1) Share information with yourfamily, close friends, or others involved in your care. 2) Share information in a disaster relief situation. 3) Include yourinformation in a hospital directory.
If you are not able to tell us your preference, for example if you are unconscious, 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 aserious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission: 1) Marketing purposes. 2) Sale ofyour information. 3) Fundraising – We may contact you for fundraising efforts, but you can tell us not to contact youagain.
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. 1) Treat you. We can use your health information and share it with other professionals who are treating you. 2) Run our organization. We can use and shareyour health information to run our practice, improve your care, and contact you when necessary. 3) Bill for your services.We can use and share your health information to bill and get payment from health plans or other entities.
We are allowed or required to share your information in other ways – usually in ways that contribute to the publicgood, such as public health and research. We have to meet many conditions in the law before we can share yourinformation for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
Help with public health and safety issues. We can share health information about you for certain situations such as: 1)Preventing disease. 2) Helping with product recalls. 3) Reporting adverse reactions to medications. 4) Reporting suspectedabuse, neglect, or domestic violence. 5) 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 theDepartment 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 procurementorganizations.
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 healthinformation about you: 1) For workers’ compensation claims. 2) For law enforcement purposes or with a law enforcementofficial. 3) With health oversight agencies for activities authorized by law. 4) For special government functions such asmilitary, national security, and presidential protective services.
Respond to lawsuits and legal actions. We can share health information about you in response to a court oradministrative order, or in response to a subpoena.
1) We are required by law to maintain the privacy and security of your protected health information. 2) We will let youknow promptly if a breach occurs that may have compromised the privacy or security of your information. 3) We mustfollow the duties and privacy practices described in this notice and give you a copy of it. 4) We will not use or share yourinformation other than as described here unless you tell us we can in writing. If you tell us we can, you may change yourmind at any time. Let us know in writing if you change your mind. 5) For more information see:www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html. 6) 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 noticewill be available upon request, in our office.
We may call or write to remind you of scheduled appointments, or that it is time to make a routine appointment. We mayalso call or write to notify you of other treatments or services available at our office that might help you.
By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the rightto change this notice at any time as allowed by law. If we change this Notice, the new privacy practices will apply to yourhealth information that we already have as well as to such information that we may generate in the future. If we changeour Notice of Privacy Practices, we will post the new one in our office and have copies available in our office.
If you think that we have not properly respected the privacy of your health information, you are free to complain to us orthe U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you makea complaint. If you want to complain to us, send a written complaint to the office contact person at the address, fax, or Email shown at the beginning of this Notice. If you prefer, you can discuss your complaint in person or by phone.
FOR MORE INFORMATION
If you want more information about our privacy practices, call or visit the office contact person at the address or phonenumber shown at the beginning of this Notice.