Notice of Privacy Practices

Your rights

Get an electronic or paper copy of your record

You may ask to see or receive an electronic or paper copy of your medical record and other health information we maintain about you. We will provide a copy or summary, usually within 30 days, as required by law. We may charge a reasonable, cost-based fee.

Ask us to correct your record

You may ask us to correct health information you believe is incorrect or incomplete. We may deny the request in circumstances allowed by law, but we will explain why in writing, generally within 60 days.

Request confidential communications

You may ask us to contact you in a particular way or at a different address. We will agree to reasonable requests.

Ask us to limit what we use or share

You may ask us not to use or share certain information for treatment, payment, or healthcare operations. We are generally not required to agree if the restriction could affect care. If you pay in full out of pocket for a service or item, you may ask us not to share that information with your health plan for payment or healthcare operations; we will agree unless the law requires disclosure.

Get a list of certain disclosures

You may request an accounting of certain disclosures made during the six years before your request. The accounting does not include every disclosure, such as many disclosures for treatment, payment, healthcare operations, or disclosures you requested. One accounting in a 12-month period is free; additional requests may carry a reasonable, cost-based fee.

Get a copy of this notice

You may ask for a paper copy at any time, even if you agreed to receive it electronically.

Choose someone to act for you

A verified personal representative, such as a legal guardian or a person holding applicable medical power of attorney, may exercise your rights and make choices for you.

File a complaint

You may complain to our Privacy Official if you believe your privacy rights were violated. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by writing to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/hipaa/filing-a-complaint. We will not retaliate against you for filing a complaint.

Your choices

Tell us your preference regarding disclosures to family, close friends, or others involved in your care or payment; disaster-relief communications; and certain directory activities if applicable. If you cannot tell us your preference, we may share limited information when we believe it is in your best interest or to lessen a serious and imminent threat.

We will obtain your written authorization for most uses of psychotherapy notes, marketing, sale of health information, and other uses or disclosures not described by this notice or otherwise permitted by law. You may revoke an authorization in writing, except to the extent we already relied on it. If fundraising is ever conducted, you may opt out of future fundraising communications.

How we typically use and share health information

Treatment

We may use your information and share it with physicians, laboratories, pharmacies, and other professionals involved in your care. For example, we may send relevant information to a specialist who is treating you.

Healthcare operations

We may use and share information to run the Practice, manage services, improve quality, train staff, conduct compliance activities, and contact you when necessary.

Payment

We may use and share information to bill and receive payment from you, a health plan, or another responsible party, subject to the Practice's service and payment arrangements.

Appointments and care communications

We may contact you about appointments, intake steps, test results, treatment alternatives, and health-related services that may be relevant to your care. You may request confidential communication methods.

Other uses and disclosures permitted or required by law

We may use or share health information, subject to legal conditions and safeguards, to:

• Prevent disease, report adverse events or product problems, and support other public-health activities.
• Report suspected abuse, neglect, or domestic violence when authorized or required.
• Prevent or reduce a serious threat to health or safety.
• Conduct health research when legally authorized and appropriately reviewed.
• Comply with federal and state law and HHS compliance reviews.
• Respond to organ and tissue donation organizations.
• Work with a coroner, medical examiner, or funeral director after a death.
• Address workers' compensation, health oversight, law enforcement, and authorized government functions.
• Respond to court or administrative orders, subpoenas, lawsuits, and legal proceedings as permitted by law.

California and federal law may provide additional protection for certain information, including mental health, reproductive health, communicable disease, genetic, and substance use disorder information. The Practice will follow the more protective law when it applies. Counsel must confirm and customize these California provisions before this notice becomes effective.

Substance use disorder records

If the Practice receives patient records protected by 42 CFR Part 2, those records receive additional protections and will be used or disclosed only as permitted by law. Part 2 records will not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a court order and subpoena that meet legal requirements. If Part 2 information is ever used for fundraising, you will receive clear advance notice and a choice about whether to receive those messages.

Our responsibilities

• Maintain the privacy and security of protected health information.
• Notify affected individuals promptly if a breach may have compromised their information.
• Follow the duties and privacy practices described in the effective notice.
• Provide a copy of the notice and make it available on the Practice website and at the office.
• Use or disclose information only as described here, as authorized in writing, or as otherwise permitted or required by law.

We may change the terms of the effective notice, and the new terms may apply to all information we maintain. A revised notice will be available on request, in the office, and on the Practice website.