Your Rights
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 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 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 (e.g., 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 with your health insurer. 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 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 disclosures except those about treatment, payment, health care operations, and certain other disclosures. We’ll provide one accounting a year for free and may charge a fee for additional requests.
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 it electronically. We will provide it 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 verify the authority of that person before taking action.
File a complaint if you feel your rights are violated
- You can complain if you believe we have violated your rights by contacting us (see page 1 for contact info).
- You may also file a complaint with the U.S. Department of Health and Human Services:
200 Independence Avenue, S.W., Washington, D.C. 20201
Phone: 1-877-696-6775
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 choices about what we share. If you have a clear preference, let us know and we will follow your instructions.
You can choose to let us:
- 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’re unable to tell us your preference (e.g., unconscious), we may share information if it’s in your best interest or to reduce a serious and imminent threat.
We will never share your information without written permission for:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
In the case of fundraising:
- We may contact you, but you can opt out at any time.
Our Uses and Disclosures
How do we typically use or share your health information?
- Treat you: We can use and share your health info with other professionals treating you.
Example: A doctor treating you for an injury asks another doctor about your health condition. - Run our organization: We use/share info to improve care and manage operations.
Example: We use your info to manage treatment and services. - Bill for your services: We share your info to bill and get payment.
Example: We send info to your insurance for payment.
How else can we use or share your information?
We are allowed or required to share your info in other ways that serve the public good, provided legal conditions are met. For more info, see this page.
- Public health and safety: Preventing disease, recalls, adverse reactions, abuse reporting, threats
- Research: For health research purposes
- Law compliance: Required sharing with government agencies
- Organ/tissue donation: With procurement organizations
- Medical examiner/funeral director: When needed after death
- Government functions: Workers’ comp, law enforcement, oversight, military, national security
- Legal actions: In response to court orders or subpoenas
Our Responsibilities
- We must 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 duties and practices described here and give you a copy of this notice.
- We will not share your information beyond what’s described unless you authorize it in writing. You can revoke this at any time.
More info: hhs.gov/ocr/privacy/hipaa
Changes to the Terms of This Notice
We may change this notice and the changes will apply to all your information. The new notice will be available in our office and online.
Applies To
This Notice of Privacy Practices applies to the following organizations: