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 an electronic or paper 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. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually
within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
• You can ask us to correct health information about you that you think is
incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within
60 days.
Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office
phone) or to send mail to 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 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 to share that information for the purpose of payment or our
operations with your health insurer.
• We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health
information for six 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). We’ll provide one accounting a year for free but
will charge a reasonable, cost-based fee if you ask for another one within
12 months.
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 provide you with a paper
copy promptly.
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.
• We will make sure the person has this authority and can act for you before
we take any action.
File a complaint if you feel your rights are violated
• You can complain if you feel we have violated your rights by contacting us
using the information on page 1.
• You can file a complaint with the U.S. Department of Health and Human
Services Office for Civil Rights by sending a letter to 200 Independence
Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting
www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.
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 below, 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 hospital directory
• Contact you for fundraising efforts
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.
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
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 another doctor
about your overall health condition.
Run our organization
• We can use and share your health information
to run our practice, improve your care,
and contact you when necessary.
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 get payment from health plans or
other entities.
Example: We give information
about you to your health insurance
plan so it will pay for your services.
Help with public health and safety issues
• We can share health information about you for certain situations such as:
• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
Comply with the law
• We will share information about you if state or federal laws require it,
including with the Department of Health and Human Services if it wants to
see that we’re complying with federal privacy law.
Respond to lawsuits and legal actions
• We can share health information about you in response to a court or
administrative order, or in response to a subpoena.
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 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: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html