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.
Your Rights
You have the right to:
· Get a copy of your electronic medical record (At your request, we will provide a copy or a summary of your health information within 30 days of your request. We may charge a reasonable, cost-based fee.)
· Correct your electronic medical record (You can ask us to correct health information about you that you think is incorrect or incomplete. We may decline the request, but will give you a written explanation within 60 days.)
· Request confidential communication (You can ask us to contact you in a specific way or different address.)
· Ask us to limit the information we share.
· 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 top share that information for the purpose of payment or our operations with your health provider. We will say ‘yes’ unless a law requires us to share that information.
· Get a list of those with whom we’ve shared your information.
· You can ask for a list (accounting) of the times we’ve shared your health information for 6 years prior to the date you ask, to who we shared it, 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). We will provide one accounting yearly at no charge, but may charge a fee for more than one yearly.
· Get a copy of this privacy notice (You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will promptly provide you with a paper copy.)
· 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 health information choices for you.
· We will ensure the person has legal authority to act for you before we take any action.
· File a complaint if you believe your privacy rights have been violated.
· If you feel we have violated your rights, contact us using the information on this letter head.
· You can file a complaint with the US Department of Health and Human Services Office for Civil Right by sending a letter to 200 Independence Avenue, S.W., Washington. D.C. 20201, calling 1-877-696-6775, or visiting their website at: www.hhs.gov/ocr/privacy/hipaa/complaints/
· We will not retaliate against you for filing a complaint.
Your Choices
You have some choices in the way that we use and share information as we:
· Tell family and friends about your condition
· Provide disaster relief
· Provide mental health care
· Market our services and sell your information
· Raise funds
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 situations described above, talk to us.
Tell us what you want us to do, and we will follow your instructions.
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.
· Include your information in a Premier database.
If you are not able to tell us your preferences, for example if you are unconscious, we may 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.
In these cases, we never share your information unless you give us written permission:
· Marketing purposes.
· Sale of your information.
· Most sharing of psychotherapy notes.
Our Uses and Disclosures
We may use and share your information as we:
· Treat you: We use your health information and share it with other professional who are treating you.
· Run our organization.
· Help with public health and safety issues: 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: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
· Preventing disease.
· Reporting adverse reactions to medications.
· Reporting suspected abuse, neglect, or domestic violence.
· Preventing or reducing serious threat to anyone’s health or safety.
· Do research: We can use or share your information for health research.
· Comply with the law: We will share information about you if state or federal laws require it, including the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
· Respond to organ and tissue donation requests: We can share health information about you with organ procurement organizations.
· 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 worker’s compensation, law enforcement, and other government requests: We can use or share health information about you for workers’ compensation 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.
· Bill for services.
· 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 other than as described here unless you tell us in writing that we can. 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: www.hhs.gove/ocr/privacy/hipaa/understanding/consumers/noticepp.html
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.
