Notice of Privacy Practices

How We May Use and Disclose Your Health Information

• For Treatment. We may use and disclose your PHI to provide, coordinate, or manage your health care and related services — for example, sharing your PHI with another physician, laboratory, or pharmacy involved in your care.
• For Payment. We may use and disclose your PHI to bill and collect payment for the treatment and services you receive, including sharing information with your health insurance plan to determine eligibility or coverage.
• For Health Care Operations. We may use and disclose your PHI for our own operations — for example, to evaluate the quality of care we provide, train staff, conduct business planning, and carry out administrative functions necessary to run our practice.

Other Ways We May Use or Disclose Your Health Information Without Your Written Authorization

• As Required by Law. When federal, state, or local law requires disclosure.
• Public Health Activities. For example, to report births, deaths, or certain diseases to public health authorities.
• Health Oversight Activities. To a health oversight agency for audits, investigations, inspections, or licensure.
• Judicial and Administrative Proceedings. In response to a court or administrative order, subpoena, or discovery request, as permitted by law.
• Law Enforcement. For limited law-enforcement purposes, such as responding to a court order or identifying a suspect, fugitive, witness, or missing person.
• To Avert a Serious Threat to Health or Safety. To prevent or lessen a serious and imminent threat to your health or safety, or the health or safety of another person or the public.
• Organ and Tissue Donation. To organizations that handle organ, eye, or tissue procurement or transplantation, if you are an organ donor.
• Workers' Compensation. To comply with workers' compensation laws.
• Research. In limited circumstances, to researchers, when the research has been approved through an established process that protects the privacy of your information.
• Family, Friends, and Others Involved in Your Care. We may share limited information relevant to a person's involvement in your care or payment for care with a family member, friend, or other person you identify, or notify or assist in notifying such a person of your location or general condition, unless you object.
• Coroners, Medical Examiners, and Funeral Directors. As necessary to allow these parties to carry out their duties.
• Business Associates. We may share your PHI with contractors and vendors who perform services on our behalf ("business associates") — for example, our medical billing service — under a written agreement that requires them to protect your information.

Uses and Disclosures That Require Your Written Authorization

Your Rights Regarding Your Health Information

• Right to Inspect and Copy. You have the right to inspect and obtain a copy of your PHI that we use to make decisions about your care, with certain limited exceptions. We may charge a reasonable, cost-based fee for copies.
• Right to Request Amendment. You have the right to request that we amend your PHI if you believe it is incorrect or incomplete. We may deny your request in certain circumstances, and will explain our reasons in writing if we do.
• Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we have made of your PHI, generally for the six years prior to your request, other than disclosures for treatment, payment, health care operations, and certain other disclosures excluded by law.
• Right to Request Restrictions. You have the right to request a restriction on how we use or disclose your PHI for treatment, payment, or health care operations, or to family members involved in your care. We are not required to agree to every requested restriction, except that we must agree to a restriction on disclosure to a health plan when the disclosure is for payment or health care operations, is not otherwise required by law, and the PHI relates solely to a service you paid for in full out of pocket.
• Right to Request Confidential Communications. You have the right to request that we communicate with you about your health matters in a particular way or at a particular location — for example, by contacting you only at a specific phone number or address — and we will accommodate reasonable requests.
• Right to a Paper Copy. You have the right to a paper copy of this Notice at any time, even if you agreed to receive it electronically.
• Right to Be Notified of a Breach. You have the right to be notified if a breach occurs that may have compromised the privacy or security of your PHI.
• Right to Choose Someone to Act for You. If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices about your health information.

Our Responsibilities

• We are required by law to maintain the privacy and security of your PHI.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this Notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can, in writing — you may change your mind at any time by letting us know in writing.

Changes to This Notice

Complaints

• With us: contact our Privacy Officer using the information below.
• With HHS: Office for Civil Rights, U.S. Department of Health and Human Services, online at www.hhs.gov/ocr/complaints, or by calling 1-800-368-1019.