You have the following rights regarding your Health Information.

Right to Inspect and Copy.  You have a right to inspect and receive a copy of Health Information that may be used to make decisions about your care or payment for your care.   This includes medical and billing records, other than psychotherapy notes.  To inspect and receive a copy of this Health Information, you must make your request, in writing, to the Clinic Manager.

Right to Amend.  If you feel that Health Information we possess is incorrect or incomplete, you may ask us to amend the information.   You have the right to request an amendment for as long as the information is kept by or for our office.   We are not required to agree to your request.  If we agree, we will comply with your request.  To request an amendment, you must make your request, in writing, to the Clinic Manager.

Right to an Accounting of Disclosures.  You have the right to request a list of certain disclosures we made of Health Information for purposes other than treatment, payment and health care operations or for which you provided written authorization.  To request an accounting of disclosures, you must make your request, in writing, to the Clinic Manager.

Right to Request Restrictions.  You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations.  You also have the right to request a limit on the Health Information we disclose to someone involved in your care or the payment for your care, like a family member or friend.  For example, you could ask that we not share information about a particular diagnostic test result or treatment with your spouse.  To request a restriction, you must make your request, in writing, to the Clinic Manager.   We are not required to agree to your request.   If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

Right to Request Confidential Communications.  You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.   For example, you can ask that we only contact you by mail or at work.  To request confidential communications, you must make your request, in writing, to the Clinic Manager.  Your request must specify how or where you wish to be contacted.   We will accommodate reasonable request.

Right to a Paper Copy of This Notice.  You have the right to a paper copy of this notice.  Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.  To obtain a paper copy of this notice, please ask our reception staff.

Except for the following purposes, we will use and disclose Health Information only with your written permission.  You may revoke such permission at any time by writing to our Privacy Officer.  You may also request restricted disclosure of your health information.  (See “Right to Request Restrictions”)

Treatment  - We may use and disclose Health Information for your treatment and to provide you with treatment-related health care services.  For example, we may disclose Health Information to doctors, nurses, technicians, or other personnel, including the people outside our office, who are involved in your medical care and need the information to provide you with medical care.

Payment  -  We may use and disclose Health Information so that we or others may bill and/or receive payment from you, an insurance company, or a third party for the treatment and services you received.  For example, we may provide your health plan information to an insurer so that they will pay for your treatment.

Health Care Operations  We may use and disclose Health Information for day to day office business activity.  These uses and disclosures are necessary to make sure that all of our patients receive quality care and to operate and manage our office.  For example, we may use sign-in sheets and call you by name in the  waiting areas.

Appointment Reminders - Treatment Alternatives & Health Related Benefits & Services.  We may use and disclose Health Information to contact you and to remind you that you have an appointment with us.  We also may use and disclose Health Information to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.

Individuals Involved in Your Care or Payment for Your Care - When appropriate, we may share Health Information with a person who is involved in your medical care or payment for your care such as your family or a close friend.  We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.

Research -  Under certain circumstances, we may use and disclose Health Information for research.  For example, a research project may involve comparing the health of patients who received one  diagnostic procedure to those who received another, for the same condition.   Before we use or disclose Health Information for research, the project will go through a special approval process.  Even without special approval, we may permit researchers to look at records to help them identify patients who may be included in their research project or for other similar purposes, as long as they do not remove or take a copy of any Health Information.

As Required by Law.  We will disclose Health Information when required to do so by federal, state or local law.

To Avert a Serious Threat to Health or Safety.   We may use and disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of another person.  Disclosures however, will be made only to someone who may be able to help prevent the threat.

Business Associates.  We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services, if the information is necessary for such functions or services.  For example, we may use a third party to perform transcription services on our behalf; that third party would be our business associate.  All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as agreed upon.

Military and Veterans.  If you are a member of the armed forces, we may release Health Information as required by military command authorities.  We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.

Workers Compensation.  We may release Health Information for workers’ compensation or similar programs.   These programs provide benefits for work-related injuries or illness.

Public Health Risks.   We may disclose health Information for public health activities.  These activities generally include disclosures to:  prevent or control disease, injury or disability; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; and the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.   We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities.  We may disclose Health Information to a health oversight agency for activities authorized by law.  These oversight activities include, for example, audits, investigations, inspections, and licensure.   These activities are necessary for the government to monitored the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes.  If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order.  We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement.   We may release Health Information if asked by  law enforcement official if the information is:  (1) in response to a court order, subpoena, warrant, summons, or similar process; (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the person’ agreement; (4) about a death we believe may be the result of criminal conduct; (5) about the criminal conduct on our premises.  We may disclose Health Information in an emergency to  report a crime, the location of the crime or victims, or the identity, description or location of the  person who committed the crime.

National Security and Intelligence Activities.   We may release Health Information to authorized federal officials related to national security activities authorized by law.

Protective Services for the President and Others.  We may  disclose Health Information to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of the state, or to conduct special investigations.

Inmates or Individuals in Custody.  If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release Health Information to the correctional institution or law enforcement official (1) for the institution to provide you with health care; or (2) to protect your health and safety or the health and safety of others.