NOTICE OF PRIVACY PRACTICES
Updated 07/01/2024
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
PRIVACY PRACTICES AND POLICIES
Your medical record contains protected health information about your health. Your health information may identify you and relate to your past, present or future physical or mental health condition and related healthcare services. This notice of privacy practices (Notice) describes how we may use and disclose your health information in accordance with applicable law. It also describes your rights regarding how you may gain access to and control your health information. We are required by law to maintain the privacy of your health information and provide you with and abide by the terms of this Notice.
Except as described in this Notice, we may not use or disclose health information which identifies you without your written authorization. If you do authorize us to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time. The revocation will not affect health information that we used or disclosed prior to your revocation.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
We most commonly use or disclose your health information for care and treatment, payment for services rendered, or for our healthcare operations.
Care or Treatment: We use your health information to provide you with care or treatment of your health condition. We disclose health information to our employees and others who are involved in providing the care you need. For example, we may share your medical information with other health care providers who are involved in your care or that provide services that we do not provide. Or we may share this information with a pharmacist who needs it to dispense a prescription to you, or a laboratory that performs a test. We may also disclose medical information to members of your family or others who can help you when you are sick or injured, or after you die.
Payment: We use and disclose medical information about you to obtain payment for the services we provide. For example, we give your health plan the information it requires before it will pay us. We may also disclose information to other health care providers to assist them in obtaining payment for services they have provided to you.
Health Care Operations:
We may use and disclose medical information about you to operate this medical practice. For example, we may use and disclose this information to review and improve the quality of care we provide, or the competence and qualifications of our professional staff. Or we may use and disclose this information to get your health plan to authorize services or referrals. We may use and disclose medical information to contact and remind you about appointments, leave messages on your phone or at your home concerning questions you asked or test results. We may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your name when your provider is ready to see you. We may also use and disclose this information as necessary for medical reviews, legal services, and audits, including fraud and abuse detection and compliance programs and business planning and management. We may also share your medical information with certain "business associates" that perform administrative or technical services for us (for example, maintenance of our electronic medical record system). We have a written contract with each of these business associates that contains terms requiring them and their subcontractors to protect the confidentiality and security of your protected health information.
We are also allowed and sometimes required by law, to share your health information in other ways, usually in ways that contribute to the public good.
When Required by Law:
As required by law, we will use and disclose your health information, but we will limit our use or disclosure to the relevant requirements of the law. When the law requires us to report abuse, neglect, or domestic violence, or respond to judicial or administrative proceedings, or to law enforcement officials, we will further comply with the requirement set forth below concerning those activities.
Judicial and Administrative Proceedings: We may, and are sometimes required by law, to disclose your health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order. Except in the case of mental health records or substance abuse records (see below), we may also disclose information about you in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order. Unlike other medical records, in order for us to release mental health records or substance abuse records under a subpoena, the subpoena must be accompanied by a court order authorizing the issuance of the subpoena.
Law Enforcement Activities:
We may, and are sometimes required by law, to disclose your health information to law enforcement officials for purposes such as identifying or locating a suspect, fugitive, material witness, or missing person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes.
Public Health and Safety:
We may, and are sometimes required by law, to disclose your health information to public health authorities for such reasons as preventing or controlling diseases, infections, or responding to a public emergency; helping with product recalls; reporting adverse reactions to medications; and to prevent or lessen serious and imminent threat to the health or safety of the general public or a particular person, including when we suspect abuse, neglect, or domestic violence. When we report suspected abuse, neglect, or domestic violence, we will inform you or your personal representative promptly unless in our best professional judgment, we believe the notification would place you at risk of serious harm or would require informing a personal representative we believe is responsible for the abuse or harm. We may disclose your health information to prevent or reduce a threat to anyone’s health or safety.
Oversight Activities, Government Functions and Workers’ Compensation:
We may disclose your health information to certain government agencies during the course of audits, investigations, inspections, licensure and other proceedings, subject to compliance with the law. We may disclose your health information for military or national security purposes or to correctional institutions or law enforcement officers that have you in their lawful custody. We may disclose your health information as necessary to comply with workers’ compensation laws, including reporting cases of occupational injury or illness to your employer, as required by law.
Medical Examiner and Organ Donation:
We may, and are often required by law, to disclose your health information to coroners in connection with their investigations of deaths. We may also share your health information with organ and tissue procurement organizations.
Notification and Communication with Family Members:
We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or, unless you had instructed us otherwise, in the event of your death. In the event of a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts. We may also disclose information to someone who is involved with your care or helps pay for your care (please note we have specific policies regarding disclosure of health information to the parents of a patient who is a minor). If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures, although we may disclose this information in a disaster even over your objection if we believe it is necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.
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.
Inspect and Copy Your Health Information:
You may inspect and copy your health information, with limited exceptions. To access your health information, you must submit a written request detailing what information you want access to, whether you want to inspect it or obtain a copy of it, and if you want a copy, your preferred form and format. We will provide a copy of your health information within the time period required by law, and in your requested form and format if it is readily producible, or we will provide you with an alternative format you find acceptable, or if we can’t agree and we maintain the record in an electronic format, your choice of a readable electronic or hardcopy format. We will also send a copy to any other person you designate in writing. We will charge a reasonable fee which covers our costs for labor, supplies, postage, and if requested and agreed to in advance, the cost of preparing an explanation or summary. We may deny your request under limited circumstances. If we deny your request to access your child's records or the records of an incapacitated adult you are representing because we believe allowing access would be reasonably likely to cause substantial harm to the patient, you will have a right to appeal our decision. If we deny your request to access your psychotherapy notes, you will have the right to have them transferred to another mental health professional.
Correct Your Health Information:
You may request that we amend your health information that you believe is incorrect or incomplete. You must make a request to amend in writing and include the reasons you believe the information is inaccurate or incomplete. We are not required to change your health information and will provide you with information about our policy and how you can disagree with the denial. We may deny your request if we do not have the information, if we did not create the information (unless the person or entity that created the information is no longer available to make the amendment), if you would not be permitted to inspect or copy the information at issue, or if the information is accurate and complete as is. If we deny your request, you may submit a written statement of your disagreement with that decision, and we may, in turn, prepare a written response. All information related to any request to amend will be maintained and disclosed in conjunction with any subsequent disclosure of the disputed information.
Request Confidential Communication:
You may request in writing that we provide you with your health information in a specific way or at a specific location. For example, you may request that we contact you at a home or office phone number, or to send the health information to a different address. We will comply with all reasonable, written requests.
Limit What We Use or Share:
You may request in writing that we not use or share your health information for treatment, payment, or our healthcare operations. However, we are not required to agree to and may deny your request if it would affect your care. If you pay for a service or item out-of-pocket in full, you may request in writing that we not share that information for the purpose of payment or our healthcare operations with your insurer. We will comply with reasonable, written requests unless we must disclose the information for treatment or legal reasons. We will notify you in writing of our decision.
Obtain a List of Those Persons or Entities with Whom We Have Shared Your Health Information
You may request in writing a list (accounting) of the times we’ve shared your health information, with whom we shared your health information and why. The accounting will identify such information for 6 years prior to the date you ask. We will include all disclosures except for those about treatment, payment or our healthcare operations, disclosures provided to you or pursuant to your written authorization, and certain other disclosures. We will provide you with one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another accounting within 12 months.
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 and make choices about your health information. We will make sure the person has the authority and can act for you before we take any action.
YOUR CHOICES
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your health information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
When You Have the Right and Choice to Tell Us How We Share Your Health Information
In these cases, you have both the right and choice to tell us to: share your health information with family, close friends, or others involved in your care; share your information in a disaster relief situation; include your information in a hospital directory. If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your health information if we believe it is in your best interest. We may also share your health information when needed to lessen a serious and imminent threat to health or safety.
Only With Your Written Authorization:
We will never share your health information unless you give us written authorization, for the following purposes: marketing purposes; the sale of your health information to a third party; substance abuse treatment records (unless required by law); most sharing of psychotherapy notes (see below). We may contact you for fundraising efforts, but you can tell us not to contact you again and will we honor your request.
PSYCHOTHERAPY NOTES:
We will not use or disclose your psychotherapy notes without your prior written authorization except for the following: 1) use by the originator of the notes for your treatment, 2) for training our staff, students and other trainees, 3) to defend ourselves if you sue us or bring some other legal proceeding, 4) if the law requires us to disclose the information to you or the Secretary of Health and Human Services or for some other reason, 5) in response to health oversight activities concerning your psychotherapist, 6) to avert a serious and imminent threat to health or safety, or 7) to the coroner or medical examiner after you die. To the extent you revoke an authorization to use or disclose your psychotherapy notes, we will stop using or disclosing these notes.
CHANGES TO THIS NOTICE
We may update this Notice at any time and updates will be effective for all health information that we maintain about you. We will post on our website any revisions made to this Notice. You may also choose to request an updated copy in person or via mail.
COMPLAINTS
Complaints about this Notice or how we have handled your health information should be directed to our Privacy Officer. If you are not satisfied with the manner in which we handle a complaint, you may submit a formal complaint to the Department of Health and Human Services Office of Civil Rights. Further information about how and where to file a complaint may be found at:
https://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html