This notice describes how medical information about you may be used and disclosed, and how you can gain access to this information. Please review it carefully.

Protected health information (PHI), about you, is maintained as a written and/or electronic record of your contacts or visits for healthcare services with our practice. Specifically, PHI is information about you, including demographic information (i.e., name, address, phone, etc.), that may identify you and relates to your past, present or future physical or mental health condition and related healthcare services.

Our practice is required to follow specific rules on maintaining the confidentiality of your PHI, using your information, and disclosing or sharing this information with other healthcare professionals involved in your care and treatment. This Notice describes your rights to access and control your PHI. It also describes how we follow applicable rules and use and disclose your PHI to provide your treatment, obtain payment for services you receive, manage our healthcare operations and for other purposes that are permitted or required by law.

Your Rights Under The Privacy Rule

Following is a statement of your rights, under the Privacy Rule, in reference to your PHI. Please feel free to discuss any questions with our staff.

Right to Receive Notice of Privacy Practices You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices. We reserve the right to change the terms of our notice, at any time. Upon your request, we will provide you with a revised Notice. The Notice will also be posted in a conspicuous location within the practice, and if maintained by the practice, on its website.
Right to Authorize Other Use and Disclosure You have the right to authorize any use or disclosure of PHI that is not specified within this notice. For example, we would need your written authorization to use or disclose your PHI for marketing purposes, for most uses or disclosures of psychotherapy notes, or if we intended to sell your PHI. You may revoke an authorization, at any time, in writing.
Right to Request Alternative Means of Confidential Communication You have the right to ask us to contact you about medical matters using an alternative method (i.e., email, telephone), and to a destination (i.e., cell phone number, alternative address, etc.) designated by you. You must inform us in writing, using a form provided by our practice, how you wish to be contacted if other than the address/phone number that we have on file. We will follow all reasonable requests.
Right to Inspect and Copy Your PHI You may inspect, and obtain a copy of your complete health record. If your health record is maintained electronically, you will also have the right to request a copy in electronic format. We have the right to charge a reasonable fee for paper or electronic copies as established by professional, state, or federal guidelines.
Right to Request a Restriction of Your PHI You may ask us, in writing, not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. We are not permitted to deny a request, in writing, that we restrict communication to your health plan regarding a specific treatment or service that you, or someone on your behalf, has paid for in full, out-of-pocket.
Right to Request an Amendment to Your PHI You may request an amendment of your PHI for as long as we maintain this information. In certain cases, we may deny your request.
Right to Request a Disclosure Accountability You may request a listing of disclosures that we have made, of your PHI, to entities or persons outside of our office.
Right to Receive a Privacy Breach Notice You have the right to receive written notification if the practice discovers a breach of your unsecured PHI, and determines through a risk assessment that notification is required.

How We May Use or Disclose Protected Health Information

Following are examples of uses and disclosures of your protected health information that we are permitted to make. These examples are not meant to be exhaustive, but to describe possible types of uses and disclosures.

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes disclosure to a pharmacy that would fill your prescriptions or to other Healthcare Providers who may be involved in your care and treatment.

Special Notices

We may use or disclose your PHI to contact you to remind you of your appointment, provide results from exams or tests, recommend treatment alternatives, provide information about health-related benefits and services, or for fund-raising activities. **You will have the right to opt out of such special notices, and each such notice will include instructions for opting out.**

Payment

Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include activities that your health insurance plan may undertake before it approves or pays for the healthcare services, such as determining eligibility or coverage for insurance benefits.

Healthcare Operations

We may use or disclose your PHI in order to support the business activities of our practice. This includes, but is not limited to business planning and development, quality assessment and improvement, medical review, legal services, auditing functions and patient safety activities.

Health Information Organization

The practice may elect to use a health information organization, or other such organization to facilitate the electronic exchange of information for the purposes of treatment, payment, or healthcare operations.

To Others Involved in Your Healthcare

Unless you object, we may disclose your PHI that directly relates to that person’s involvement in your healthcare to a member of your family, a relative, a close friend or any other person that you identify. We may also use or disclose PHI to notify or assist in notifying a family member, personal representative, or any other person responsible for your care, of your general condition or death.

Other Permitted and Required Uses and Disclosures

We are also permitted to use or disclose your PHI without your written authorization for purposes including:

As required by law
Public health activities
Health oversight activities
Cases of abuse or neglect
To comply with Food and Drug Administration requirements
Research purposes
Legal proceedings
Law enforcement purposes
Coroners, funeral directors, and organ donation
Criminal activity
Military activity and national security
Worker’s compensation
When an inmate in a correctional facility
If requested by the Department of Health and Human Services to investigate our compliance with the Privacy Rule.

Privacy Complaints

You have the right to complain to us, or directly to the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying the Privacy Manager at the address below. We will not retaliate against you for filing a complaint.