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HEALTH INSURANCE PORTABILITY ACCOUNTABILITY ACT (HIPAA)

YOUR INFORMATION. YOUR RIGHTS. YOUR RESPONSIBILITIES.

This notice describes how your medical information may be used and disclosed.  This notice also explains how you can get access to this information. Please take a moment to review.

YOUR RIGHTS

You have the right to:

  • Obtain a summary of your paper or electronic medical record
  • Make a request to correct your paper or electronic medical record
  • Request your confidential communication at designated contact numbers (example: you may have a landline, but you would prefer us to communicate with you about your health information on your cell phone)
  • Request that we limit the information we share
  • Request a listing of those with whom we’ve shared your information
  • Obtain a paper copy of this privacy notice for your records
  • Choose someone to act for you as legal guardian or power of attorney
  • File a complaint if you believe your privacy rights have been violated

YOUR CHOICES

You have some choices in the way that we use and/or share information:

  • Designate family and friends to discuss your condition
  • If needed to provide disaster relief
  • Provide mental health care

If you have a clear preference for how we share your information in any situation, please let us know. We do not share or sell your information in marketing or fundraising.

OUR USES AND DISCLOSURES

We may use and share your information as we:

  • Treat you in collaboration with other healthcare professionals
  • Run our organization, improve care, and to contact you
  • Bill for your services and receive payments
  • Help with public health and safety issues
  • Conduct health research
  • Compliance with the law
  • Work with a medical examiner or funeral director
  • Address workers’ compensation, law enforcement, and other government requests
  • Respond to lawsuits and legal actions
  • Report suspected abuse and neglect of minors or the elderly

OUR RESPONSIBILITIES

  • By law, we are required to maintain the privacy and security of your protected health information
  • By law, we are required to notify you, promptly, if a breach occurs that may have compromised the privacy or security of your information
  • By law, 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: Health and Human Services – Notice of Privacy Practices.  To file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by calling 1-877-696-6775 or by sending a letter to: 200 Independence Avenue, S.W., Washington, D.C. 20201 By filing a complaint, you are under no risk of retaliation from our office.

CHANGES TO THE TERMS OF 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.

Updated July 2022, Reviewed July 2022.