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.
When it comes to your health information, you have certain rights. This section explains your rights and our responsibilities.
Get a copy of your medical record. You may ask to have a copy of the health information we have about you. We will provide a copy or a summary of your health information within 30 days of your request.
Ask us to correct your medical record. You may ask us to correct health information about you that you believe is incorrect or incomplete. We may say "no" to your request, but we'll tell you why in writing within 60 days.
Request confidential communications. You may ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
Ask us to limit what we use or share. You may 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 prefer to pay out-of-pocket in full, you may ask us not to share payment information with your health insurance provider.
Find out who has seen your information. You may ask for a list (accounting) of the times we've shared your health information for 5 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 health care operations, and certain other disclosures (such as any you asked us to make).
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.
File a complaint. You may file a complaint directly with us if you feel we have violated your rights. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by calling 1-877-696- 6775, or by visiting:
You may also send a letter of complaint to:
Office for Civil Rights, DHHS
200 Independence Avenue, S.W. Washington, D.C. 20201
We will not retaliate against you for filing a complaint.
For certain health information, you may give us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, please let us know.
In these cases, you have both the right and 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 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 will never share your information for marketing purposes.
How do we typically use or share your health information? We typically use or share your health information in the following ways:
Treat you. We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks us about your overall health condition.
Improve our services. We can use and share your health information to evaluate our operations and improve patient care.
Example: We use health information about you to manage your treatment and services.
Bill for your services. We can use and share your health information to bill and receive payment from your insurance provider.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information? We are allowed 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 your information for these purposes. For more information see:
Help with public health and safety issues. We can share health information about you for certain situations such as:
Work with a medical examiner or funeral director. We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers' compensation, law enforcement, and other government requests. We can use or share health information about you:
Comply with the law or respond to lawsuits and legal actions. We will share information about you if state or federal laws require it. We can share health information about you in response to a court or administrative order, or in response to a subpoena.
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. 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. For more information see:
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 website.
If you have any questions, if you wish to file a complaint or exercise any rights listed in this Notice, please contact Ed Kaufman, Privacy Officer (206) 451-2037.