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Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This notice of Privacy Practices describes how our practice may use and share your health information with others to carry out treatment, payment, or healthcare operations and for other purposes permitted or required by law. It also describes your rights to view and amend your Protected Health Information (PHI). PHI is information about you and the services you have received, including information such as your name, address, date of birth, diagnosis, treatment, or other information that could identify you and your past, present, or future physical or mental health or treatment you receive.

USES AND DISCLOSURES OF YOUR HEALTH INFORMATION

  • Your PHI may be used and shared by your physician, our office staff, and others outside of our office who are involved in your care and treatment to provide health care services to you, pay our claims for the health care provided to you, and any other use permitted or required by law.
  • Treatment: We will use and share your PHI to provide, coordinate, or manage your health care and related services, including coordinating or managing your health care with a third party (for example, sending your PHI to a specialist as part of a referral).
  • Payment: Your PHI will be used, as necessary, to receive payments for claims related to your services. For example, obtaining approval may require sharing your PHI with the health plan or submitting billing information to your insurance company or state payer. We may also disclose your PHI to our partners, such as billing and claims processing companies and other third parties who process insurance claims.
  • Company Operation: We may use or disclose, as necessary or appropriate, your PHI to support our healthcare operations. These activities include, but are not limited to, quality assessment activities, employee review activities, medical student training, licensing, health supervision audits or inspections, marketing, and fundraising activities, and conducting or arranging for other business activities. In addition, we may use a registration sheet at the registration desk where you will be asked to sign your name and indicate your clinician. We may also call you by name in the waiting room when your clinician is ready to see you. We may also provide your PHI to our attorneys, accountants, and consultants to ensure we comply with applicable laws.
  • Appointment Reminders: We may use and disclose your PHI to contact and remind you of your medical appointments by phone, text, or email.
  • Treatment Alternatives: We may use and disclose your PHI to inform you of possible treatment options, health-related benefits, and services that may interest you.

ADDITIONAL USES AND DISCLOSURES

  • As described below, we may use and disclose your PHI in other situations without your Authorization.
  • As Required by Law: We may disclose your PHI when required to do so under federal, state, or local law.
  • For Public Health Activities: We may disclose your PHI to public health or other authorities charged with preventing or controlling disease, injury, and disability or collecting public health data.
  • Abuse and Neglect: We may disclose your PHI to public officials who are authorized by law to receive reports of abuse, neglect, and domestic violence.
  • Health Oversight Activities: We may also disclose your PHI to organizations that oversee healthcare facilities and services, such as government agencies and benefit programs.
  • For Legal Proceedings: We may disclose your PHI during judicial or administrative proceedings, including in response to a subpoena or court order.
  • For Law Enforcement Purposes: We may disclose your PHI to law enforcement officials in certain circumstances where we suspect criminal conduct or to report a crime on our premises or in emergency situations.
  • A Coroner and for Organ Donation: We may disclose your PHI to coroners or medical examiners to identify a deceased person, determine the cause of death, or as otherwise required. We may also disclose your PHI to funeral directors, as necessary, to carry out their duties.
  • For Research: We may disclose your PHI to researchers if an institutional review board has approved such disclosures because appropriate safeguards have been taken to protect your PHI information.
  • To Prevent Serious Harm: We may disclose your PHI when necessary to prevent a serious threat to the safety and health of the public or a person, including yourself.
  • Government Functions: We may disclose your PHI to military officers if you are an active military member or to determine veterans’ eligibility and/or benefits. We may also disclose your PHI for national security, intelligence activities, the protection of the President and to determine the suitability of officers to work in a public office. If you are an inmate of a correctional facility, we may disclose your PHI information to correctional facility officers.
  • Workers’ Compensation: We may disclose your PHI as we are authorized to comply with workers’ compensation laws or similar programs that provide benefits for work-related injuries or illnesses.

OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES

  • Other uses and disclosures not described in this notice will only be made with your authorization or opportunity to object unless required by law. These include most uses and disclosures of psychotherapeutic notes (where applicable), uses and disclosures for marketing purposes, and disclosures that constitute a sale of your PHI. You may cancel any authorization you have granted, at any time, in writing.

YOUR RIGHTS

  • The following are statements of your rights concerning PHI.
  • You have the right to inspect and request a copy of your PHI information as long as we maintain your medical record. You must request a copy of your registration in writing. We may charge you a reasonable fee for processing your application and copying your record. In certain circumstances, we may deny your request, and you may have the right to request that our denial be reviewed. Depending on the reason for the denial, we may choose another licensed medical professional to review your application and the associated denial.
  • You have the right to request a restriction of your PHI. You may ask us not to use or share any part of your PHI for treatment, payment, or healthcare operations except in cases of emergency. You may also request that any part of your PHI not be disclosed to family, friends, or other individuals who may be involved in your care. While we will consider any reasonable request for restrictions, we are not required to grant your request unless you request a restriction of certain disclosures of your PHI to a health plan when you have paid for our services in full without charging the health plan.
  • You have the right to request that your PHI be disclosed to you confidentially. Your request should indicate how or where you wish to be contacted. We will accommodate reasonable requests.
  • You have the right to obtain a paper copy of this notice. Please ask us for a paper copy of this notice at any time.
  • You may have the right to request that we amend your PHI if you believe it is incorrect or incomplete as long as we keep your medical record. To request that we modify your PHI, you must request it in writing and explain why the modification is necessary. We may deny your request if
  • we have not created the PHI
  • the request relates to information we do not maintain
  • the request relates to information that you do not have the right to inspect, such as psychotherapy notes
  • we determine that your PHI is correct and complete.
  • If we deny your request for amendment, you have the right to submit a statement of disagreement. We can prepare a response to your statement and provide you with a copy of that response.
  • You have the right to receive accountability for certain disclosures of your PHI. Disclosure accounts do not apply to disclosures made for treatment, payment, and health care operations or for disclosures we have made to you or at your request. The first accountability requested in a twelve (12) month period is free, but we may charge you the costs of producing additional accounts during the same twelve (12) month period. The request must specify the applicable dates and must be in writing.
  • You will receive notifications of breaches of your unsecured PHI. If your PHI maintained by our office or its business associates has been breached, we will notify you and take reasonable steps to mitigate any damage that may result from the breach.
  • You have the right to file a complaint with our office or the Secretary of Health and Human Services if you believe we have violated your privacy rights. You can file a complaint with us by notifying our office. Filing a complaint will not affect your healthcare services in any way.
  • We reserve the right to change the terms of this notice. If we make revisions, you will be informed by posting the revised notice in the waiting area and on our website.
  • We are required by law to protect the privacy of your information, provide this notice of our privacy practices, follow the practices described in this notice, and notify you after an unsecured PHI breach. If you have any questions or complaints, please contact our office.