You have the right to:
- 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
You can choose how we 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 and sell your information
- Raise funds
We may use and share your information as we:
- Treat you
- Run our organization
- Bill for your services
- Help with public health and safety issues
- Do 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
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
HEALTH INFORMATION CORRECTIONS
You can ask us to correct health information about you that you think is incorrect or incomplete.
Ask us how to do this.
We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications.
You can ask us to contact you in a specific way (home or office phone) or to send mail to a different address.
We will say “yes” to all reasonable requests.
Ask us to limit what we use or share.
- You can ask us not to use or share certain health information for treatment, payment, or our operations.
We are not required to agree to your request, and we may say “no” if it would affect your care.
- If you pay for a service or healthcare item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
- You can ask for a list of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and healthcare operations, and certain other disclosures (such as any you asked us to make). We’ll provide one list a year for free but will charge a reasonable, cost-based fee if you ask for another within 12 months.
- You have the right and choice to tell us how to share your information with your family, close friends, or others involved in your care, or in a disaster relief situation. If you are not able to tell us 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 your information to lessen a serious and imminent threat to health or safety.
- We will share information about you if state or federal laws require it, including state, federal, and local entities if they want to see that we’re complying with applicable laws, including HIPAA.
- We never share your information for Marketing Purposes, we never sell your information, and we never share psychotherapy notes, unless we have your written permission.
- We may contact you for fundraising efforts, but you can tell us not to contact you again.
- We can use and share your health information with other professionals who are treating you, to run our practice, improve your care, and contact you when necessary, to bill and get payment from health plans or other entities, to help with public health and safety issues, prevent disease, help with product recalls, and report adverse reactions to medications.
- We can use and share your health information to report suspected abuse, neglect, or domestic violence and to prevent or reduce a serious threat to anyone’s health or safety.
- We can use and share your health information to comply with the law and to work with a medical examiner or funeral director, to address workers’ compensation, with health oversight agencies for activities authorized by law, for special government functions such as military, national security, and presidential protective services, and in respond to lawsuits and legal actions, in response to a court or administrative order, and in response to a subpoena.
MEDICAL POWER OF ATTORNEY
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 the person has this authority and can act for you before we take any action.
VIOLATION OF RIGHTS
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights if you feel we have violated your rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, or call 1-877-696-6775. We will not retaliate against you for filing a complaint.
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.