Notice of Privacy Practices

Your rights

When it comes to your health information, you have certain rights. These include the right to:

• Get an electronic or paper copy of your medical record and other health information we have about you.
• Ask us to correct health information that you think is incomplete or inaccurate.
• Request that we contact you in a specific way or at a different address or phone number.
• Ask us to limit how we use or share your information in some situations.
• Get a list of certain times we have shared your health information in the last six years.
• Get a paper copy of this notice at any time.
• Choose a person to act for you if you have given someone medical power of attorney or have a legal guardian.
• File a complaint if you feel your rights have been violated.

Your choices

For some health information you can tell us your choices about what we share. In these cases, you may tell us to:

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

In most cases we will ask for your written permission before using your information for marketing, selling your information or sharing most psychotherapy notes.

How we typically use and share your information

We usually use or share your health information in the following ways:

• Treat you. We use your information and share it with other professionals who are treating you.
• Run our practice. We use your information to manage your care, improve services and operate our clinic.
• Bill for services. We use and share your information to bill and receive payment from you, your health plan or other payers.

Other ways we may share information

We are allowed or required to share your information in other ways, usually to contribute to the public good, such as public health and research. We can share information about you:

• To help with public health and safety issues
• For health research
• To comply with state or federal law
• With organ and tissue donation organizations
• With a medical examiner, coroner or funeral director
• For workers’ compensation, law enforcement and other government requests
• To respond to lawsuits and legal actions

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 in ways not covered by this notice unless you tell us we can in writing.

For more information about your privacy rights, you can visit the U.S. Department of Health and Human Services website at hhs.gov/ocr/privacy/hipaa.