HIPAA Policy

● 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. here

● 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.

● You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address.

● We will say “yes” to all reasonable requests.

●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,” for example, if it could affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment.

● If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that 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 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.

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

● If someone has authority to act as your personal representative, such as if someone has your 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.

● 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: https://www.hhs.gov/hipaa/filing-a-complaint/index.html.

● We will not retaliate against you for filing a complaint.

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 or payment for your care

● Share information in a disaster relief situation

In these cases we never share your information unless you give us written or digital consent:

● Marketing purposes

We can use your health information and share it with other professionals who are treating you.

i. Example: A doctor treating you for an injury asks another doctor about your overall health condition.

a. We can use and share your health information to bill and get payment from health plans or other entities.

i. Example: We give information about you to your health insurance plan so it will pay for your services.

a. We can use and share your health information to run our practice, improve your care, and contact you when necessary.

i. Example: We use health information about you to manage your treatment and services.

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.

In all cases, including those listed below, if we have substance use disorder patient records about you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.

1. Help with public health and safety issues

a. We can share health information about you for certain situations such as:

i. Preventing disease,

ii. Helping with product recalls,

iii. Reporting adverse reactions to medications,

iv. Reporting suspected abuse, neglect, or domestic violence,

v. Preventing or reducing a serious threat to anyone’s health or safety.

We can use or share your information for health research.

We can use or share health information about you:

i. For workers’ compensation claims,

ii. For law enforcement purposes or with a law enforcement official,

iii. With health oversight agencies for activities authorized by law,

iv. For special government functions such as military, national security, and presidential protective services.

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.

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