HIPAA – Your Information, Your Rights, Our Responsibilities

This describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully and Download a PDF of this informational page for your records.

 

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When It Comes To Your Health Information, You Have Certain Rights

• This explains your rights and some of our responsibilities to help you
• Ask for a paper copy of your medical record
• Ask us to correct your medical record
• Ask us to limit what we use or share

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.

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 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” if it would affect your care.

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.

 

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• Get a list
 of those with whom we’ve shared information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint 
if you feel your rights have been violated
  

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 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.

 by contacting us using the information on the back page.

If you feel that we have violated your rights you can lodge 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.

 

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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 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 • 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 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 because we want you to be safe!

Marketing purposes

Sale of your information

Most sharing of psychotherapy notes