HIPAA Compliance

01Notice of Privacy Practices

02Your 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.

Upon written request, you have the right to:

• Inspect and obtain copies of your health record, either electronically or on paper, as well as other health information we maintain about you. We may charge a reasonable, cost-based fee. We will respond as soon as possible, but no later than 30 days after your request.
• Request corrections to your health information if you believe it is incorrect or incomplete. We may deny your request, but we will explain the reason in writing within 60 days.
• Request confidential communications, such as contacting you at a specific phone number or mailing address. We will accommodate all reasonable requests.
• Request restrictions on certain uses or disclosures of your health information for treatment, payment, or health care operations. We are not required to agree to all requests and may deny a request if it would affect your care.
• Request restrictions for services paid out of pocket in full. If you pay for a service or health care item out of pocket in full and ask us not to share that information for payment or health care operations with your health insurer, we will agree unless we are required by law to share that information.
• Request an accounting of disclosures of your health information made in the six years prior to your request. One request per year is provided at no charge; additional requests may incur a reasonable, cost-based fee.
• Revoke an authorization to use or disclose your protected health information (PHI) at any time, except where action has already been taken in reliance on your authorization.

You may also:

• Choose someone to act on your behalf. If you have given someone medical power of attorney or they are your legal guardian, that person may exercise your rights and make choices about your health information. We will require proof of this relationship before taking action.
• Request a paper copy of this notice at any time, even if you have agreed to receive it electronically.
• File a complaint if you believe your privacy rights have been violated.

03Filing a Complaint

If you believe your rights have been violated, you may contact our designated Privacy Officer using the information below. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by:

• Sending a letter to: 200 Independence Avenue, S.W., Washington, D.C. 20201
• Calling: 1-877-696-6775
• Visiting: https://www.hhs.gov/ocr/privacy/hipaa/complaints

We will not retaliate against you for filing a complaint.

04Our Responsibilities

The law requires us to:

• Maintain the privacy and security of your protected health information.
• Notify you promptly if a breach occurs that may compromise the privacy or security of your information.
• Follow the duties and privacy practices described in this notice and provide you with a copy.
• Not use or disclose your health information other than as described in this notice unless you authorize us in writing. If you authorize us and later change your mind, you may revoke your authorization in writing.

05Your Choices

For certain health information, you can tell us your preferences about what we share. If you have a clear preference, please inform us.

In these situations, you have both the right and the 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.

If you are unable to communicate your preference (for example, if you are unconscious), we may share your information if we believe it is in your best interest. We may also share information when needed to lessen a serious and imminent threat to health or safety.

06Uses and Disclosures Requiring Written Authorization

In these cases, we will never share your information unless you give us written permission:

• Marketing purposes
• Sale of your health information
• Most sharing of psychotherapy notes

In the case of fundraising, we may contact you for fundraising efforts, but you may opt out of future communications at any time.

07Our Uses and Disclosures

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

Treatment

We may use your health information and share it with other professionals involved in providing or coordinating your care.

Payment

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

Health Care Operations

We may use and share your health information to operate our practice, improve care, and contact you when necessary.

08Other Ways We Can Use or Share Your Health Information

We may share your information in other ways permitted or required by law, typically for public health and safety purposes. We will meet all legal requirements before doing so.

• Public health and safety activities
• Compliance with the law
• Organ and tissue donation requests
• Work with medical examiners or funeral directors
• Workers’ compensation, law enforcement, and government requests
• Legal actions such as court or administrative orders

09Changes to This Notice

We reserve the right to change the terms of this notice. Any changes will apply to all health information we maintain. The updated notice will be available upon request and on our website.

10Privacy Officer Contact Information

If you have questions about this notice or your privacy rights, please contact: