HIPAA Privacy Policy

Effective Date: May 2025

Your Information. Your Rights. Our Responsibilities.

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

When it comes to your health information, you have certain rights.

You have the right to:

  • Get a copy of your paper or electronic medical record

  • Correct your paper or electronic medical record

  • Request confidential communications

  • Ask us to limit the information we share

  • Get a list of those with whom we’ve shared your information

  • Get a copy of this privacy notice

  • Choose someone to act for you

  • File a complaint if you believe your privacy rights have been violated

Get an Electronic or Paper Copy of Your Medical 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 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.

  • We may say “no” to your request, but we will explain 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 agree 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 operations.

  • We are not required to agree to your request, and we may say “no” if it would affect your care.

  • If you pay out-of-pocket in full for a service or health care item, you can ask us not to share that information with your health insurer. We will agree unless a law requires us to share that information.

Get a List of Disclosures

  • You can request a list (accounting) of the times we have shared your health information for six years prior to the date you ask.

  • This list will not include disclosures for treatment, payment, and healthcare operations, or certain other disclosures (such as those you requested).

  • We will provide one accounting per year at no charge. Additional requests within 12 months may incur a reasonable fee.

Get a Copy of This Privacy Notice

You may request a paper copy of this notice at any time, even if you agreed to receive it electronically.

Choose Someone to Act for You

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights.

  • We will verify their authority before taking action.

File a Complaint

If you believe your privacy rights have been violated:

  • You may contact our office directly.

  • You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at:

U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/ocr/privacy/hipaa/complaints/

We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your preferences about what we share.

You have the right to tell us to:

  • Share information with family, close friends, or others involved in your care

  • Share information in a disaster relief situation

  • Include your information in a hospital directory

If you are unable to tell us your preference (for example, if unconscious), we may share information if we believe it is in your best interest or necessary to reduce a serious and imminent threat.

We will never share your information without your written permission for:

  • Marketing purposes

  • Sale of your information

  • Most sharing of psychotherapy notes

Fundraising:

  • We may contact you for fundraising efforts.

  • You may opt out at any time.

Our Uses and Disclosures

How We Typically Use or Share Your Health Information

Treatment

We may use and share your health information with other professionals who are treating you.
Example: A doctor treating you for an injury may consult another provider about your overall health.

Healthcare Operations

We may use and share your information to run our practice, improve care, and contact you when necessary.
Example: We use health information to manage your treatment and services.

Billing and Payment

We may use and share your information to bill and receive payment from health plans or other entities.
Example: We provide necessary information to your insurance company for payment.

Other Permitted Uses and Disclosures

We may share your information for purposes that contribute to public good and safety, including:

Public Health and Safety

  • Preventing disease

  • Assisting with product recalls

  • Reporting adverse medication reactions

  • Reporting suspected abuse, neglect, or domestic violence

  • Preventing or reducing serious threats to health or safety

Research

We may use or share your information for health research when legally permitted.

Legal Compliance

We will share information if required by state or federal law.

Organ and Tissue Donation

We may share information with organ procurement organizations.

Medical Examiner or Funeral Director

We may share information when an individual has died.

Workers’ Compensation and Government Requests

We may use or share information:

  • For workers’ compensation claims

  • For law enforcement purposes

  • With health oversight agencies

  • For national security or protective services

Lawsuits and Legal Actions

We may disclose information in response to court orders or subpoenas.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.

  • We will notify you promptly if a breach occurs that may compromise your information.

  • We must follow the privacy practices described in this notice.

  • We will not use or share your information other than as described here unless you provide written permission.

  • You may revoke your permission at any time in writing.

For more information, visit:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to This Notice

We may change the terms of this notice. Any changes will apply to all information we maintain. The updated notice will be available:

  • Upon request

  • In our office

  • On our website