Notice of Privacy Practices

Our Commitment

We are required by law to protect the privacy of your health information, to give you this Notice describing our legal duties and privacy practices, and to follow the terms of the Notice currently in effect.

Treatment, Payment and Health Care Operations

We may use and share your health information without a separate authorization for these three purposes: to provide and coordinate your care, including sharing information with other clinicians involved in your treatment; to bill and obtain payment from you, your health plan or another payer; and to run this practice, including quality review, staff training, scheduling, and administrative operations.

Other Uses and Disclosures Permitted or Required by Law

In limited circumstances the law permits or requires us to share health information without your authorization. These circumstances include:

• Public health activities, including reporting communicable disease and adverse events
• Reporting suspected abuse, neglect or domestic violence
• Health oversight activities, audits and inspections by government agencies
• Judicial and administrative proceedings, subpoenas and court orders
• Law enforcement purposes, where the specific conditions in the regulation are met
• Coroners, medical examiners and funeral directors
• Organ and tissue donation
• Research that has been approved through the required review process
• Serious threats to health or safety
• Workers compensation, and specialized government functions such as military and national security

Uses and Disclosures That Require Your Written Authorization

Most uses and disclosures of psychotherapy notes, any use of your information for marketing, and any sale of your information require your written authorization. Other uses and disclosures not described in this Notice will be made only with your written authorization, which you may revoke in writing at any time, except to the extent we have already acted in reliance on it.

Your Rights

You have the following rights regarding the health information we keep about you. To exercise any of them, contact the practice using the details at the end of this Notice.

• Inspect and obtain a copy of your health information, including an electronic copy of an electronic record
• Request a correction to information you believe is incorrect or incomplete
• Request that we communicate with you confidentially, by a specific means or at a specific location
• Request a restriction on certain uses and disclosures, and require us to restrict disclosure to a health plan where you have paid for the service in full yourself
• Receive an accounting of certain disclosures we have made
• Receive a paper copy of this Notice, even if you agreed to receive it electronically
• Choose someone to act for you, such as a personal representative or someone with medical power of attorney
• Be notified if a breach occurs that may have compromised the privacy or security of your information

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the practice, and you may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint, and filing one will not affect your care.

Changes to This Notice

We may change this Notice, and any change applies to information we already hold as well as information we receive in the future. The current Notice will always be posted on this page, with its effective date shown above, and a copy is available at the practice on request.