Your Rights as a Patient
(1) You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. (2) You can ask us to correct health information about you that you think is incorrect or complete. Ask us how to do this. We may say “no” to your request but we’ll tell you why in writing within 60 days. (3) 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. (4) You can ask us not to use or share certain health information for treatment, payments, or 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. (5) You can ask for a list (accounting) of the items we’ve share 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. (6) 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. (7) 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. (8) You can complain if we have violated your rights by contacting us using he information above. 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 Ave, S.W., Washington, D.C. 20201, calling 1 (877) 696-6775. We will not retaliate against you for filing a complaint.
Your Choices as a Patient
(1) To share information with your family, close friends, or others involved in your care. (2) To share information in a disaster relief situation. (3) To include your information in a hospital directory. (4) 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 we need to lessen serious an imminent threat to your health or your safety. (5) We will never share your information unless you give us written permission for marketing purposes, for the sale of your information, and for psychotherapy notes. (6) We may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures
(1) We can use your health information and share it with other professionals who are treating you. (2) We can use and share your health information to run our practice, improve your care, and contact you when necessary. (3) We can use and share your health information to bill and receive payment from health insurance plans or other third parties. (4) We can share health information about you for certain situations such as preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, ad preventing or reducing a serious threat to anyone’s health or safety. (5) We can use or share your information for health research. (6) We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy laws. (7) We can share health information about you with organ procurement organizations. (8) We can share health information with a coroner, medical examiner, or funeral director when an individual dies. (9) We can use or share health information about you for worker’s compensation claims, for law enforcement purposes or with a law enforcement official, when health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services. (10) We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities
(1) We are required by law to maintain the privacy and security of your protected health information. (2) We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. (3) We must follow the duties and privacy practices described in this notice and give you a copy of it. (4) We will not use or share your information other than as 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 can change your mind.
Change to the Terms and Conditions 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 notice will be available upon request, in our office, and on our website.