Notice of Privacy Practices

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

• Get a copy of your record - 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 summary, usually within 30 days, and may charge a reasonable, cost-based fee.
• Ask us to correct your record - You can ask us to correct information you think is incorrect or incomplete. We may say no, but we will tell you why in writing within 60 days.
• Request confidential communications - You can ask us to contact you in a specific way or at 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 information. We are not required to agree. If you pay out-of-pocket in full for an item, you can ask us not to share that information with a health insurer, and we will say yes unless a law requires otherwise.
• Get a list of those we have shared with - You can ask for an accounting of disclosures for the six years prior to your request, with certain exceptions. One per year is free.
• Get a copy of this notice - You can ask for a paper copy at any time, and we will provide it promptly.
• Choose someone to act for you - A person with medical power of attorney or legal guardianship can exercise your rights and make choices about your information.
• File a complaint if you feel your rights are violated - You can complain by contacting us, or by contacting the U.S. Department of Health and Human Services Office for Civil Rights (200 Independence Avenue SW, Washington, D.C. 20201; 1-877-696-6775; www.hhs.gov/ocr/privacy/hipaa/complaints/). We will not retaliate against you for filing a complaint.

Your Choices

For certain information, you can tell us your choices about what we share. If you have a clear preference, talk to us and we will follow your instructions.

• You have both the right and choice to tell us to share information with family, friends, or others involved in your care; share information in a disaster relief situation; or contact you for fundraising efforts.
• If you are not able to tell us your preference, we may share information if we believe it is in your best interest, or when needed to lessen a serious and imminent threat to health or safety.
• We never share your information without your written permission for marketing purposes, the sale of your information, or most sharing of psychotherapy notes.

Our Uses and Disclosures

We typically use or share your health information in the following ways.

• To treat you - We can use your information and share it with other professionals who are treating you.
• To run our organization - We can use and share your information to operate our business, improve your care, and contact you when necessary.
• To bill for services - We can use and share your information to bill and obtain payment.
• We are also allowed or required to share your information in other ways that contribute to the public good - including public health and safety, research, complying with the law, organ and tissue donation, working with a medical examiner or funeral director, addressing workers' compensation and law enforcement requests, and responding to lawsuits and legal actions. We must meet conditions in the law before sharing for these purposes.

Our Responsibilities

What we are required to do.

• 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 - and you may change your mind at any time.

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.