This privacy policy outlines how your medical information may be used and disclosed, as well as how you can access this information. Please review it carefully.
Your Rights
You have the right to:
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Obtain a digital or physical copy of your medical record.
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Request corrections to your medical record.
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Request confidential communication.
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Limit the information we disclose.
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Receive a list of parties with whom we’ve shared your information.
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Obtain a copy of this privacy policy.
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Designate someone to act on your behalf.
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File a complaint if you believe your privacy rights have been violated.
Your Choices
You can make choices about how we:
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Share information about your medical condition with family and friends.
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Provide details for disaster relief efforts.
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Include your information in a hospital directory.
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Offer behavioral health and substance use disorder care.
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Use your information for marketing or fundraising purposes.
Our Uses and Disclosures
We may use and share your information to:
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Provide treatment.
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Manage our operations.
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Invoice for services rendered.
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Assist with public health and safety matters.
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Conduct research.
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Comply with legal and regulatory requirements.
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Respond to organ and tissue donation requests.
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Work with medical examiners and funeral directors.
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Address workers’ compensation, law enforcement, and government requests.
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Respond to lawsuits and legal proceedings.
Your Rights in Detail
Access to Your Medical Record
You can request a copy of your medical record and personal health information. A copy or summary will be provided within 30 business days. A reasonable fee may apply.
Request Corrections
If you believe your health information is incorrect or incomplete, you can request a correction. If denied, we will provide a detailed explanation within 60 business days.
Confidential Communications
You may request a preferred method of contact or an update to your mailing address. Unreasonable requests may be denied.
Limit the Use or Disclosure of Information
You can request that we do not use or share certain health information for treatment, payment, or operations. While we are not required to grant all requests, we will honor them when possible.
If you pay in full for a service out-of-pocket, you can request that we do not disclose this information to your insurer, unless required by law.
List of Information Disclosures
You can request a record of disclosures from the past six years, excluding those related to treatment, payment, or health care operations. One request per year is free; additional requests may incur a fee.
Obtain a Copy of This Policy
A physical copy of this policy is available upon request, even if you agreed to receive it electronically.
Designating a Representative
You may authorize someone to make decisions about your health information. We will verify their authority before taking any action.
Filing a Complaint
If you believe your rights have been violated, you can file a complaint:
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Directly with us using the contact information on page 1.
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With the U.S. Department of Health and Human Services Office for Civil Rights at 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting hhs.gov/ocr/privacy/hipaa/complaints.
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You will not face retaliation for filing a complaint.
Your Decisions
You may instruct us on how to share your health information in specific situations. You have the right to allow or restrict:
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Disclosures to family, friends, or others involved in your care.
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Disclosures for disaster relief purposes.
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Inclusion of your information in a hospital directory.
If you are unable to provide instructions (e.g., unconscious), we may share your information if it is in your best interest or to prevent a serious threat to health and safety. We will never share your information for:
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Marketing purposes.
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Sale of your information.
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Disclosure of psychotherapy notes without explicit authorization.
Fundraising
We may contact you for fundraising efforts, but you can request that we do not contact you again.
Our Uses and Disclosures in Detail
Treatment
We may use and share your health information with other professionals involved in your care. For example, a doctor treating you may consult with another physician regarding your condition.
Operations
We may use and disclose your health information to improve our services and manage your care.
Billing
We may use and share your health information to bill and receive payment from insurance plans or other entities.
Additional Uses and Disclosures
We may disclose your health information to:
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Public Health and Safety: Prevent disease, report adverse medication reactions, assist with recalls, and report abuse, neglect, or domestic violence.
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Research: Support medical studies.
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Legal Compliance: Fulfill obligations under state or federal law.
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Organ and Tissue Donation: Assist with donation requests.
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Medical Examiners and Funeral Directors: Support post-mortem medical procedures.
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Workers’ Compensation and Law Enforcement: Address claims, law enforcement requests, and government-mandated activities.
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Legal Proceedings: Respond to subpoenas, court orders, or other legal actions.
Our Responsibilities
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We are legally required to maintain the privacy and security of your health information.
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We will notify you promptly in the event of a data breach.
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We will follow the terms of this policy and provide a copy upon request.
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We will not use or disclose your health information for any purpose not outlined in this document without your written authorization.
To learn more, visit hhs.gov/hipaa.
Policy Updates
We reserve the right to update this policy at any time. Changes will apply to all information we hold and will be available in our offices and on our website.
Effective Date
This policy is effective as of Jan 01, 2025.
Our Commitment
We will never market or sell your personal health information.