Your Information. Your Rights. Our Responsibilities.

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. 

Click here for a downloadable copy of this information. 

• Your Rights

  You have the right to:
  

  • Get a copy of your paper or electronic medical record
  • Correct your paper or electronic medical record
  • Request confidential communication
  • Ask us to limit the information we share
  • Get a list of those with whom we've shared your information
  • Get a copy of this privacy notice
  • Choose someone to act for you
  • File a complaint if you believe your privacy rights have been violated

  Read more details about your rights.

• Your Choices

  You have some choices in the way that we use and share information as we:
  

  • Tell family and friends about your condition
  • Provide disaster relief
  • Include you in a hospital directory
  • Provide mental health care
  • Market our services and sell your information
  • Raise funds

• Our Uses and Disclosures

  We may use and share your information as we:
  

  • Treat you
  • Run our organization
  • Bill for your services
  • Help with public health and safety issues
  • 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
  • Respond to lawsuits and legal actions

   

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.

• Get 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. Ask us how to do this.

  • We will provide a copy or a summary 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 is incorrect or incomplete. Ask us how to do this. 

  • We may say "no" to your request, but we'll tell you why in writing within 60 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 a list of those with whom we've shared information

  

  • You can ask for a list (accounting) of the 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 the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We'll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for 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 medical 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 make sure 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 provided in the Patient Bill of Rights page.

  • 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, SW, 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 filing 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 you 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 tell 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

  
  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 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

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

• To treat you

  • We can use your health information and share it with other professionals who are treating you.
  • Example: A doctor treating you for an injury asks another doctor about your overall health condition.

• To run our organization

  • We can use and share your health informationion to run our practice, improve your care, and contact you when necessary.
  • Example: We use health information about you to manage your treatment and services.

• To bill for your services

  • We can use and share your health information to bill and get payment from health plans or other entities.
  • Example: We give information about you to your health insurance plan so it will pay for your services.

Other Uses

How else can we use or share your health information? We are allowed or required to share your information in other ways -- usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more details visit www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

• Help with public health & safety issues

  • We can use your health information and share it with other professionals who are treating you.
  • Example: A doctor treating you for an injury asks another doctor about your overall health condition.

• Do research

  • We can use and share your health informationion to run our practice, improve your care, and contact you when necessary.
  • Example: We use health information about you to manage your treatment and services.

• Comply with the law

  • We can use and share your health information to bill and get payment from health plans or other entities.
  • Example: We give information about you to your health insurance plan so it will pay for your services.

• Respond to organ and tissue donation requests

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• Work with a medical examiner or funeral director

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• Address workers' compensation, law enforcement, and other government requests

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• Respond to lawsuits and legal actions

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