HIPAA POLICY

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

• 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.

Your Choices

You have some choices in the way 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 or sell your information.
• Raise funds.

Our Uses and Disclosures

We may use and share your information as we:

• Treat you.
• Bill for your services.
• Help with public health and safety issues.
• Conduct 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 our responsibilities to help you:

• Get a copy of your medical record: You can request a copy of your medical record or other health information, which we will provide within 30 days. A cost-based fee may apply.
• Correct your medical record: If information is incorrect or incomplete, you can request a correction. We may deny your request but will provide a written explanation within 60 days.
• Request confidential communication: You can ask us to contact you in a specific way or at a different address.
• Limit the information we use or share: You may request restrictions on certain uses or disclosures, though we may decline if it affects your care. If you pay for a service in full out-of-pocket, we will honor requests to limit sharing with your health insurer unless required by law.
• Get a list of disclosures: You may request a list of times your information was shared (excluding treatment, payment, and healthcare operations). One list per year is free; additional requests may incur a fee.
• Choose someone to act for you: If someone has medical power of attorney or is your legal guardian, they can exercise your rights.
• File a complaint: Complaints can be directed to the U.S. Department of Health and Human Services. Retaliation for filing a complaint is prohibited.

Your Choices

You may express preferences for how your information is shared. For example, you can:

• Share information with family, close friends, or others involved in your care.
• Share information in disaster relief situations.
• Include your information in a hospital directory.

If you are unable to communicate, we may act in your best interest. Written permission is required for marketing, selling information, or sharing psychotherapy notes. You may opt out of fundraising communications.

Our Uses and Disclosures

We typically use or share your information to:

• Treat you: Share information with other professionals involved in your care.
• Run our practice: Manage your treatment and services.
• Bill for services: Provide necessary information to your health insurer for payment.

We may also share information for public health purposes, research, legal obligations, and specific government functions.

Our Responsibilities

• We are required by law to maintain the privacy of your health information.
• You will be notified promptly of any breach affecting your information.
• We will not share your information beyond what is described without written permission.

For more details, visit www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.