Notice of Privacy Practices

When it comes to your health information, you have certain rights. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Also, this notice explains some of our responsibilities to help you. Please review it carefully. You can ask for a paper copy of this notice at any time, even if you agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Obtaining an electronic or paper copy of your medical record - You can ask to get an electronic or paper copy of your medical records and other health information we have about you. We will provide a copy or a summary of your health information within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record- You can ask us to correct health information about you that you think is incorrect or incomplete. We may say “no” to your request.

Request confidential communications- 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.

Get a list of those with whom we’ve shared information- You can ask for a list of the times we’ve shared your health information, for up to six years prior to that date you ask, who we've shared it with and why.

Choose someone to act for you- 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 that person has this authority and can act for you before we take any action.

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.

In these cases, you have both the right and choice to tell us, with written permission, to:

• Share information with your family, close friends, or others involved in your care.

If you are unable 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.

Written Consent- You can tell us at any time, with a written consent form, if you want your information to be shared with others (for example, a spouse, primary care physician, friend, etc.). Also, if you change your mind at any time, you can let us know in writing if you would like to withdraw a consent form and we will follow your instructions.

Our Uses and Disclosures- We typically use or share your health information in the following ways:

To Treat you- We can use your health information and share it with other professionals who are treating you, with a written consent. The only exception would be in the case of an emergency where there is an imminent threat to health or safety and a written consent can not be obtained.

Run our organization- We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Bill for your services- We can use and share your health information to bill and get payment from health plans or other entities.

How else can we use or share your health information?- We are allowed or required to share your information in other ways, however we have to meet many conditions in the law before we can share your information for these purposes.

• Help with public health and safety issues- We can share health information about you for certain situations such as: reporting suspected abuse, neglect, or domestic violence and preventing or reducing a serious threat to anyone's health or safety

• 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 they want to see that we’re complying with federal privacy law.

• Work with a medical examiner or funeral director- We can share health information with a coroner or medical examiner when a patient is deceased.

• Address workers’ compensation, law enforcement, and other government requests- We can use or share health information about you: for workers’ compensation claims, for law enforcement purposes or with a law enforcement officials, with health oversight agencies for activities authorized by law, and for special government functions such as military, nation security, and presidential protective services

• 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.

Our Responsibilities- We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described here.

File a complaint if you feel your rights are violated- You can file a complaint if you feel we have violated your rights by contacting the Office Manager. You can 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, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/ . We will not retaliate against you for filing a complaint

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, on our website, and we will mail a copy to you.