Your Information. Your Rights. Our Dedication to You.

 

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.

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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.

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•  Get an electronic or paper copy of your medical record 

• Ask us to correct your medical record

• Request confidential communications

• Ask us to limit what we use or share

• Get a list of those with whom we’ve shared information

• Get a copy of this privacy notice

• Choose someone to act for you

• File a complaint if you feel your rights are violated

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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. 

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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 your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
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.

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OUR USES AND DISCLOSURES.

How do we typically use or share your health information? 
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.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization
We can use and share your health information 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. 

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. 

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 information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues

We can share health information about you for certain situations such as: 

For health research.
Comply with the law
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 law.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests

Respond to lawsuits and legal actions - we can share health information about you in response to a court or administrative order, or in response to a subpoena.

 

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
 

Changes to the Terms 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 web site.