HIPAA Notice of Privacy Practices

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.

Obtain 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 medical information we have about you. Ask us how to do this.
  • We will provide you with a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable fee based on cost.

Ask us to correct your medical record

  • You can ask us to correct medical information about you that you believe is incorrect or incomplete. Ask us how to do this.
  • We may not be able to grant your request, but we will inform you of the reason in writing within 60 days.

Request confidential communications.

  • You can ask us to contact you in a specific way (for example, your home or office phone) or to send an email 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 medical information for treatment, payment or our operations.
  • We are not required to accept your request, and we can say "no" if that would affect your care.
  • If you pay for a health care service or item in full, you can ask us not to share that information in order to pay 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 share information

  • You can request a list (accountant) of the times we have shared your health information during the six years prior to the date you requested it, with whom we share it and why.
  • We will include all disclosures, except those related to treatment, payment and health care operations, and some other disclosures (such as those you requested). We will provide you with one-year accounting for free, but we will charge you a reasonable cost-based fee if you request another one within 12 months.

Get a copy of this privacy notice

  • You may request a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.

Choose someone to act for you

  • If you have given someone medical power or if you are your legal guardian, that person can exercise your rights and make decisions about your health information.
  • We will ensure that the person has this authority and can act for you before taking any action..

File a complaint if you believe your rights are violated

  • You can complain if you think we have violated your rights if you contact us through the information found at the top of the page.
  • You can file a complaint with the Office of Civil Rights of the US Department of Health and Human Services by sending a letter to 200 Independence Avenue, SW, Washington, DC 20201, calling 1-877-696-6775, or visiting www .hhs.gov/ocr/privacy / hipaa / complaints /.
  • We will not retaliate against you for filing a complaint.

Your options

For certain medical 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, contact us. Tell us what you want us to do and we will follow your instructions.

 In these cases, you have the right and the option to tell us that:

  • Share information with your family, close friends or other people involved in your care
  • Share information in a disaster relief situation
  • Include your information in a hospital directory If you cannot tell us your preference, for example, if you are unconscious, We can go ahead and share your information if we believe it is best for you. We may also share your information when necessary 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
  • Greater exchange of psychotherapy notes

Our uses and disclosures

How do we usually use or share your health information? We normally use or share your health information in the following ways.

Treat you

  • We may use your health information and share it with other professionals who are treating you.

Example: a doctor who is treating you for an injury asks another doctor about your general health

Run our organization

  • We can use and share your health information to execute our practice, improve your care and contact you when necessary.

Example: We use your medical information to manage your treatment and services.

Invoice for your services

  • We may use and share your health information to bill and receive payments from health plans or other entities.

Example: We give information about you to your health insurance plan to pay for your services.

How do you know your child is healthy?

We are authorized or obligated to share your information in other ways, generally in a way that contributes to the public good, such as public health and research. We have to meet many conditions in the law. For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

  • We may share medical information about certain situations, such as:
  • Prevent diseases
  • Help with product recalls
  • Report counterfeit drug reactions
  • Report suspected abuse, neglect or domestic violence

The investigation

  • You cannot share your information for health research

Complying with the law

We will share information about you if state or federal laws require it, even with the Department of Health and Human Services if they want to see that we are complying with the federal privacy law.

Work with a coroner or funeral director

  • When a person dies, we may share medical information with a coroner, a coroner or a funeral director.

Address workers' compensation, law enforcement and other government requests

  • We may use or share medical information about you:
  • For workers compensation claims
  • For law enforcement purposes or with a law enforcement officer
  • With health oversight agencies for activities authorized by law and presidential protection services

Respond to lawsuits and legal actions

  • We may share medical information about you in response to a court or administrative order, or in response to a subpoena.

Our responsibilities

  • The law requires us to maintain the privacy and security of your protected health information.
  • We will inform you immediately if a violation occurs that may have compromised the privacy or security of your information.
  • We must comply with the duties and privacy practices described in this notice and give you a copy.
  • We will not use or share your information differently than described here, unless you tell us we can do so in writing. If you tell us that we can, you can 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/noticepp.html.

Changes to the terms of this notice

We may 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