Notice of Privacy Practices

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.

Your Rights

When it comes to your health information, you have certain rights. You can:

  • Get a 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 summary within 30 days of your request. A reasonable, cost-based fee may apply.

  • Ask us to correct your record – You can ask us to correct information you think is incorrect or incomplete. We may say “no,” 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, at your home or office phone, or to send mail to a different address). We will agree to all reasonable requests.

  • Ask us to limit what we use or share – You can ask us not to use or share certain information for treatment, payment, or operations. We may not be able to agree if it would affect your care.

  • Get a list of those with whom we’ve shared information – You can ask for a list (an “accounting”) of the times we’ve shared your health information, who we shared it with, and why.

  • Get a copy of this notice – You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically.

  • Choose someone to act for you – If you have given someone medical power of attorney or they are your legal guardian, that person can exercise your rights.

  • File a complaint – If you feel we have violated your rights, you can file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights at 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. 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.

We will never share your information for marketing, selling your information, or most sharing of psychotherapy notes unless you give us written permission.

Our Uses and Disclosures

We typically use or share your health information in the following ways:

  • 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 for your services – We can use and share your health information to bill and get payment from health plans or other entities.

We are also allowed or required to share your information in other ways, usually for public health or research purposes, when required by law, or to respond to legal actions. Examples include reporting public health concerns, complying with law enforcement requests, or responding to court orders.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.

  • We will notify you promptly if a breach occurs that may have compromised your information.

  • We must follow the duties and privacy practices described in this notice and provide you with a copy.

  • We will not use or share your information other than as described here unless you tell us we can in writing. If you give us permission, you may revoke it at any time in writing.

Changes to 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 in our office and on our website.