Access: You have the right to look at or get copies of your health information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so.
You must make a request in writing to obtain access to your health information. You may obtain a form to request access by using the contact information listed at the end of this notice. I will charge you a reasonable cost-based fee for expenses such as copies and staff time. You may also request access by sending me a letter to the address at the end of this Notice. If you request copies, I will charge you $0.35 for each page, $15.00 per hour for staff time to locate and copy your health information, and postage if you want the copies mailed to you. If you request an alternative format, I will charge a cost-based fee for providing your health information in that format. If you prefer, I will prepare a summary or an explanation of your health information for a fee. Contact me using the information listed at the end of this notice for a full explanation of our fee structure.
Disclosure Accounting: You have the right to receive a list of instances in which I have disclosed your health information for purposes, other than treatment, payment, healthcare operations and certain other activities, for the last 6 years, but not before April 1, 2013. If you request this accounting more than once in a 12-month period, I may charge you a reasonable, cost-based fee for responding to these additional requests.
Restriction: You have the right to request that I place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency
Alternative Communication: You have the right to request that I communicate with you about your health information by alternative means or to alternative locations (you must make your request in writing Your request must specify the alternative means or location, and provide satisfactory explanation how payments will be handled under the alternative means or location you request.
Amendment: You have the right to request that I amend your health information (your request must be in writing, and it must explain why the information should be amended I may deny your request under certain circumstances.