HIPAA NOTICE OF PRIVACY PRACTICES
Preserving Your Privacy. Upholding Your Rights. Our Responsibilities.
This notice provides an overview of how your medical information may be utilized and disclosed, as well as the steps you can take to access this information. We urge you to carefully review its contents.
You possess certain rights when it comes to your health information. This section outlines those rights and our corresponding responsibilities to assist you.
ACQUIRE A COPY OF YOUR MEDICAL RECORD
You have the right to request and receive an electronic or paper copy of your medical record and other relevant health information we possess. Feel free to inquire about the process. We strive to fulfill your request within 30 days and may charge a reasonable, cost-based fee.
REQUEST CORRECTIONS TO YOUR MEDICAL RECORD
If you believe that any health information regarding you is inaccurate or incomplete, you can request corrections. Please ask for guidance on how to proceed. While we retain the right to decline your request, we will provide a written explanation within 60 days.
OPT FOR CONFIDENTIAL COMMUNICATIONS
You can specify your preferred method of communication (e.g., home or office phone) or request mail delivery to an alternate address. Reasonable requests will be accommodated.
ASK FOR LIMITATIONS ON USE OR DISCLOSURE
You have the right to ask us not to use or share specific health information for treatment, payment, or operational purposes. While we are not obligated to comply, we may refuse if it would impact your care. If you have paid out-of-pocket in full for a service or healthcare item, you can also request that we do not share that information with your health insurer for payment or operational purposes. Unless prohibited by law, we will generally comply with this request.
RECEIVE A COPY OF THIS PRIVACY NOTICE
You can request a paper copy of this notice at any time, even if you have previously agreed to receive it electronically. We will promptly provide you with a physical copy upon request.
DESIGNATE A REPRESENTATIVE
If you have granted someone medical power of attorney or have a legal guardian, that person can act on your behalf regarding your health information. We will verify their authority before taking any action.
REPORT RIGHTS VIOLATIONS
If you believe that your rights have been violated, you have the right to file a complaint. Please use the contact information provided on the back page to reach us. Additionally, you can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. Contact them by mail at 200 Independence Avenue, S.W., Washington, D.C. 20201, by phone at 1-877-696-6775, or visit the Privacy Complaints Article. We assure you that there will be no retaliation for filing a complaint.
In certain situations, you have the authority to instruct us on how your health information is shared. If you have a clear preference regarding the disclosure of your information in the scenarios below, please communicate your instructions to us. We will adhere to your wishes.
YOU HAVE THE RIGHT AND CHOICE TO INSTRUCT US TO:
- Share information with your family, close friends, or others involved in your care.
- Disclose information in a disaster relief situation.
- Include your information in a hospital directory.
In the event that you are unable to express your preferences, such as during unconsciousness, we may share your information if we believe it is in your best interest or necessary to mitigate a serious and imminent threat to health or safety.
We will not share your information for marketing purposes, sale, or most sharing of psychotherapy notes without your written permission.
OUR USE AND DISCLOSURE PRACTICES
How do we typically use or share your health information? The following are common ways in which we utilize or disclose your health information:
TREATMENT: We may use your health information and share it with other healthcare professionals to provide you with appropriate medical treatment. For example, a doctor treating you for an injury may consult another healthcare provider regarding your overall health condition.
OPERATIONS: We may use and disclose your health information for the purpose of running our organization, which includes activities such as billing, payment collection, and quality improvement. For instance, we may share information about you with your health insurance plan to ensure proper payment for the services you receive.
BILLING: Your health information may be used and shared to facilitate the billing process, manage our practice, enhance your care, and communicate with you when necessary. This helps us to effectively handle your treatment and services.
OTHER USES AND DISCLOSURES: There are instances where we are permitted or required to use and disclose your information in ways that benefit the public, such as for public health purposes or research. Before sharing your information for these purposes, we must adhere to specific conditions outlined in the law. For more detailed information, please refer to the HIPAA Article.
By law, we are obligated to uphold the privacy and security of your protected health information. In the event of a breach that may compromise the privacy or security of your information, we will promptly notify you. We are committed to following the duties and privacy practices outlined in this notice and providing you with a copy of it.
CHANGES TO THE TERMS OF THIS NOTICE
We reserve the right to modify the terms of this notice, and any changes will apply to all the information we possess about you. Upon request, the updated notice will be made available in our office and on our website.
THIS NOTICE OF PRIVACY POLICIES APPLIES TO ALL ORGANIZATIONS LISTED ON THIS SITE. PLEASE REFER TO THE APPROPRIATE PAGE FOR CONTACT INFORMATION.
HIPAA Office Contact Information
HIPAA Entity: Civil Rights Coordinator: Civil Rights Coordinator Title: Address: Phone: Email: Fax:
Please note that the contact information above may be subject to revision.