HIPAA Notice of Privacy Practices

How we may use and share your information

We typically use or share your health information in the following ways, without your written authorization:

• Treatment. We use and share your health information to provide, coordinate, and manage your care. For example, your provider may share information with another clinician, a specialist, or a lab involved in your treatment.
• Payment. We use and share your health information to bill and collect payment from you, an insurance company, or another payer. For example, we may share information with your health plan to obtain prior authorization or to confirm coverage and benefits.
• Health care operations. We use and share your health information to run our practice, improve your care, and contact you when necessary. For example, we may use information to evaluate the quality of care, train staff, or coordinate appointments and follow-up.

Uses and disclosures that require your authorization

Most uses and sharing of psychotherapy notes, uses for marketing purposes, and any sale of your health information require your written authorization. We will also obtain your authorization for any use or disclosure not described in this notice. If you give us authorization, you may revoke it in writing at any time, and we will stop, except to the extent we have already acted in reliance on it.

Other ways we may use or share information

We are permitted or required to use or share your health information in other ways — usually to contribute to the public good, such as public health and safety. We must meet the conditions in the law before we can share information for these purposes, including:

• As required by federal, state, or local law;
• For public health activities, such as preventing disease or reporting reactions to medications;
• To report suspected abuse, neglect, or domestic violence to authorities permitted by law to receive it;
• For health oversight activities, such as audits, investigations, and licensure;
• In response to a court or administrative order, subpoena, or other lawful process;
• For specific law enforcement purposes permitted by law;
• To coroners, medical examiners, and funeral directors as necessary;
• To address serious threats to your health and safety or that of the public;
• For workers’ compensation claims as authorized by law;
• For specialized government functions, such as military and veterans’ activities or national security; and
• For research, under strict conditions that protect your privacy.

Your rights regarding your health information

When it comes to your health information, you have certain rights. This section explains those rights and how to exercise them:

• Get a copy of your records. You can ask to see or get an electronic or paper copy of your medical record. We will provide it, usually within 30 days, and may charge a reasonable, cost-based fee.
• Ask us to correct your records. If you believe information in your record is incorrect or incomplete, you can ask us to amend it. We may say no, but we will tell you why in writing.
• Request confidential communications. You can ask us to contact you in a specific way (for example, by cell phone only) 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 information for treatment, payment, or operations. We are not required to agree. If you pay for a service or item out of pocket in full, you can ask us not to share that information with your health plan, and we will say yes unless a law requires us to share it.
• Get a list of those with whom we've shared information. You can request an accounting of certain disclosures we made in the six years before your request. We will provide one accounting per year for free.
• Get a paper copy of this notice. You can ask for 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 someone is your legal guardian, that person can exercise your rights and make choices about your information. We will verify the authority before taking action.
• File a complaint. If you feel your privacy rights have been violated, you can file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

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 — and if you tell us we can, you may change your mind at any time in writing.

Changes to 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. We reserve the right to make the revised notice effective for health information we already have as well as any information we receive in the future.

How to file a complaint

If you believe your privacy rights have been violated, you may file a complaint with us using the contact information below. You may also 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 hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.