Notice of Privacy Practices

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.

Your Rights

You have rights concerning the health information we maintain about you.

Access your medical record

You may ask to inspect or receive an electronic or paper copy of your medical record and other health information we maintain about you. We generally will provide a copy or summary within the time required by law and may charge a reasonable, cost-based fee.

Request a correction

You may ask us to correct information you believe is inaccurate or incomplete. We may deny the request in some circumstances, but we will explain the reason in writing as required by law.

Request confidential communications

You may ask us to contact you in a particular way or at a different address. We will accommodate reasonable requests.

Request limits on use or disclosure

You may ask us not to use or share certain information for treatment, payment, or healthcare operations. We are not always required to agree. If you pay in full out of pocket for a service, you may ask us not to disclose information about that service to your health plan for payment or healthcare operations unless disclosure is required by law.

Receive an accounting of disclosures

You may request a list of certain disclosures made during the six years before your request. The list generally does not include disclosures for treatment, payment, healthcare operations, or disclosures you authorized. One accounting in a 12-month period is provided without charge; a reasonable fee may apply to additional requests.

Obtain this notice and choose a representative

You may request a paper copy of this notice at any time. A person legally authorized to act for you may exercise your privacy rights after we verify that authority.

File a complaint

You may contact our Privacy Officer if you believe your privacy rights have been violated. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

Your Choices

In certain situations, you may tell us how you want your information shared, including disclosures to family members, close friends, others involved in your care or payment for care, and disaster-relief organizations. If you cannot communicate your preference, we may share information when we believe it is in your best interest or when necessary to prevent a serious and imminent threat.

We will obtain your written authorization before using or disclosing your information for most marketing, the sale of health information, or most disclosures of psychotherapy notes. You may revoke an authorization in writing, except to the extent that we already relied upon it.

How We May Use and Disclose Health Information

Treatment

We may use your health information and share it with physicians and other healthcare professionals involved in your treatment.

Healthcare operations

We may use and disclose health information to operate our practice, coordinate services, improve quality, train staff, conduct compliance activities, and contact you when necessary.

Payment

We may use and disclose information to bill and obtain payment from health plans or other responsible parties.

Other permitted or required uses

Subject to applicable legal requirements, we may use or disclose information for public-health and safety activities, health oversight, research, organ and tissue donation, workers’ compensation, law-enforcement or other government requests, judicial or administrative proceedings, and to coroners, medical examiners, or funeral directors. We may disclose information when federal or state law requires it.

Reproductive healthcare

We will not use or disclose health information to conduct an investigation into, impose liability on, or identify a person for the mere act of seeking, obtaining, providing, or facilitating lawful reproductive healthcare when the HIPAA Privacy Rule prohibits the use or disclosure. For certain requests involving health oversight, judicial or administrative proceedings, law enforcement, or coroners and medical examiners, we will obtain a signed attestation when required by law.

Substance use disorder records

To the extent we receive or maintain substance use disorder patient records protected by 42 CFR Part 2, those records—or testimony describing their contents—will not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless you provide written consent or a qualifying court order is issued after notice and an opportunity to be heard. A court order authorizing disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure. Information disclosed under HIPAA may be redisclosed by the recipient and may no longer be protected by HIPAA; additional federal or state confidentiality laws may still apply.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will notify affected individuals as required if a breach may have compromised the privacy or security of their information.
• We must follow the duties and privacy practices described in the notice currently in effect.
• We will not use or disclose information other than as described in this notice unless you authorize us in writing or the law otherwise permits or requires it.

We may revise this notice. A revised notice may apply to information we already maintain as well as information received in the future. The current notice will be available in our office, upon request, and on our website.

Website and Administrative Contact Requests

Questions or Complaints