Our practice is dedicated to maintaining the privacy of current and former patient’s health and financial information as required by our internal policies and applicable law. We reserve the right to change our privacy practice and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make changes in our privacy practices and the new terms of our Notice effective for all PHI that we maintain, including PHI we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request. You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information contained in this Notice.
We use and disclose PHI about you for providing services, payment and operations. For example:
In addition to our use of your PHI for providing services, payment or operations as specified above, you may give us written authorization to use your PHI to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us written authorization, we cannot use or disclose your PHI for any reason except to those described in this Notice.
To your family and friends:
We must disclose your PHI to you, as described in the Patient Rights section of this Notice. We may disclose your PHI to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may do so. Persons involved with care: We may use or disclose PHI to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are present, then prior to use or disclosure of your PHI, we will provide you with an opportunity to object to such use or disclosures. In the event of your incapacity or emergency circumstances, we will disclose PHI based on a determination using our professional judgment disclosing only PHI that is directly relevant to the person’s involvement in your care. We will also use our professional judgment disclosing only PHI that is directly relevant to the person’s involvement in your care. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays or other similar forms of PHI.
Required by Law:
We may use or disclose your PHI when we are required to do so by law for any reason.
Abuse & Neglect:
We may disclose your PHI to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect or domestic violence or the possible victim of other crimes. We may disclose your PHI to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.
Appointment Reminders & Practice Updates:
We may use or disclose your PHI to provide you with appointment reminders and practice updates such as voicemails, emails, postcards or letters.
Marketing Health-Related Services:
We will not use your PHI for marketing communications without your written authorization. We will never sell your to PHI or personal information to a marketing entity.
In certain instances, we may share your information if it could help with product recalls or reporting adverse reactions to medications. When possible, we will ask for your written permission to do so. In addition, we may use or share your de-identified PHI for health research purposes, meaning we would not include any of your identifying information in doing so.
We may disclose to the military authorities of the PHI of Armed Forces personnel under certain circumstances. We may disclose to military authorities the PHI of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials PHI required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to a correctional institution or law enforcement official having lawful custody of protected PHI of of inmate or patient under certain circumstances.
We will let you know promptly should a security of information breach occur to any of our online or other operations in which your privacy & PHI may have been compromised. In the unfortunate incident that this occurs, we are not liable for such breaches.
You have the right to inspect and obtain a copy of your protected PHI, with limited exceptions. If you request a copy of your information, we may charge you a fee for the costs of copying, mailing, emailing or other costs incurred by us as a result of complying with your request. Requests for access to your protected PHI must be made in writing. We will provide a copy or summary of your information usually within 30 days of your request.
Account of Disclosures:
You have the right to receive a list of instances ini which we or our business associates disclosed your PHI for purposes, other than services, payment, operations and certain other activities for the last 6 years. You must submit your request in writing to the contact information provided at the top of this notice. Your first request within a 12-month period is free of charge, but our practice may charge you for additional requests made within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
You have the right to request a restriction in our use or disclosure of your PHI for services, payment or operations. Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies or when the information is necessary to provide services. In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to the contact information provided at the top of this notice. Your request, in a clear and concise manner, should describe: the information you wish restricted, whether you are requesting to limit our practice’s use, disclosure or both or to whom you want the limits to apply.
You have the right to request that we communicate with you about your PHI by alternative means or to alternative locations. Your request must be in writing and specify the alternative means or location, and provide satisfactory explanation on how payments will be handled under the alternative means or location you request. For example, you can ask us to contact you in a specific way such as a home or office phone number or send mail to a certain address. We will say “yes” to all reasonable requests.
You have the right to request that we amend your information stored in our system, including your PHI, that you think is incorrect, incomplete or otherwise needs to be changed. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances. If we say “no” to your request, we’ll tell you why in writing within 60 days.
If you receive this Notice on our website, client portal or by electronic email (e-email), you are still entitled to receive this Notice in written form. You can ask us for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will promptly provide a paper copy to you via the USPS.
If at any time you change your mind to any of the above preferences you previously stated, let us know in writing and we will let you know if we can say “yes” or “no” to your request within the reasonable limitations of services, payments and operations.
If you want more information about our privacy practices or have questions or concerns, please contact us. If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI or in response to a request you made to amend or restrict the use or disclosure of your PHI or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information provided to you. You can also file a complaint with the U.S. Department of Health and Human Services Office, Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, or by calling , calling 1-877-696-6775. We will not retaliate against you for filing a complaint.