Notice of Privacy Practices

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. You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. 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. You can ask to correct health information about you that you think is incorrect or incomplete. We may say no to your request, but we will tell you why in writing within 60 days. You can ask us to contact you in a specific way or send mail to a different address. We will say yes to all reasonable requests. 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 health care 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. You can complain if you feel we have violated your rights by contacting us. You can file a complaint with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint. 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 following situations, talk to us. Tell us what you want us to do, and we will follow your instructions.

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospital directory – 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.

We never share your information unless you give us written permission for:

• Marketing purposes
• Sale of your information

We typically use or share your health information:

• To treat you – We can use your health information and share it with other professionals who are treating you.
• 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.

We are allowed to 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 you information for these purposes. For more information see www.hhs.gov/ocr/privacy/hippa/understanding/consumers/index.html.

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
• For workers’ compensations claims
• Law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services.
• In response to a court or administrative order, or 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 in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

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.