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Notice of Privacy Practices



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. The examples provided do not include every possible us or disclosure please visit https://www.hhs.gov/hipaa/for-individuals/index.html for more  information.



Get a 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.  We will provide a copy or a summary of your records  within 30days. There maybe 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 or to send mail to a different address. 

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. 

ONLY if  you pay for a service or health care item out-of-pocket, in full, at the time of service, can we comply with your request not to share that information for the purpose of payment or our operations with your health insurer. Otherwise, we will say “yes” unless a   law requires us to share that information.

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

You may 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 the disclosures except for   those about treatment, payment, and health care operations, and certain other  disclosures (such as any you asked us to make). We’ll provide one accounting  a year for free but will charge a reasonable, cost-based fee if you ask for   another one within 12 months.

Get a copy of this privacy notice 

You can ask for a paper copy of this notice at any time.

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 make sure the person has this  authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

You can complain if you feel we have violated your rights   by contacting us. You can 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 www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate   against you for filing a complaint.


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   information in the situations described below, talk to us. Tell us what you   want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us   to: 

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

· Share information in a disaster relief   situation 

· Contact you for fundraising efforts

If you are not able to tell us your preference, for example if   you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed   to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless  you give us written permission:

· Marketing purposes 

· Sale of your information

In the case of fundraising: We may contact you   for fundraising efforts, but you can tell us not to contact you again.


How do we typically use or share your health information? We   typically use or share your health information in the following ways.

· Treat you

We can use your health   information and share it with other professionals who are treating you. Example: A doctor treating you for   an injury asks another doctor about your overall health condition.

· Run our organization 

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

· Bill for your services

We can use and share your   health information to bill and get payment from health plans or other   entities. Example: We give   information about you to your health insurance plan so it will pay for your   services.

How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. 

For more information: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html 


Help with public  health and safety issues

We can share health information about you for certain situations such as preventing disease;   helping with product recalls; reporting adverse reactions to medications;   reporting suspected abuse, neglect, or domestic violence; and, preventing or   reducing a serious threat to anyone’s health or safety. 

Do research

We can use or share   your information for health research.

Comply with the law

We will share information about you if state or federal laws require   it, including with the Department of Health and Human Services if it wants to   see that we’re complying with federal privacy law.

Work with a medical  examiner or funeral director 

We can share health information with a coroner, medical examiner, or funeral director when an   individual dies.

Address workers’  compensation, law enforcement, and other government requests

We can use or share  health information about you for workers’ compensation claims, for law enforcement   purposes, or with a law enforcement official. We can also use or share health   information about you with health oversight agencies for activities   authorized by law for special government functions such as military, national   security, and presidential protective services.

Respond to lawsuits  and legal actions 

We can share health information about you in response to a court or administrative order, or in   response to a subpoena.


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. 

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

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, and on our web site.