Introduction

NOTICE: THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. We make a record of the medical care we provide and may receive such records from others. We use these records to provide or enable other healthcare providers to provide quality medical care, to obtain payment for services provided to you as allowed by your health plan, and to enable us to meet our professional and legal obligations to operate this medical practice properly.

We are required by law to maintain the privacy of protected health information, provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and notify affected individuals following a breach of unsecured protected health information.

This notice describes how we may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information. If you have any questions about this Notice, please contact our Privacy Officer listed above.

Table of Contents

1. How This Medical Practice May Use or Disclose Your Health Information
2. When This Medical Practice May Not Use or Disclose Your Health Information
3. Your Health Information Rights
   
   1. Right to Request Special Privacy Protections
   2. Right to Request Confidential Communications
   3. Right to Inspect and Copy
   4. Right to Amend or Supplement
   5. Right to an Accounting of Disclosures
   6. Right to a Paper or Electronic Copy of this Notice
4. Changes to this Notice of Privacy Practices
5. Complaints

A. How This Medical Practice May Use or Disclose Your Health Information

This medical practice collects health information about you and stores it in a chart, computer, and electronic health record/personal health record. This is your medical record. The medical record is the property of this medical practice, but the information in the medical record belongs to you.

The law permits us to use or disclose your health information for the following purposes:

1. Treatment: Share information with employees or other providers involved in your care, pharmacists, labs, family members, or others who help care for you.
2. Payment: Provide necessary information to your health plan or other providers to obtain payment for services.
3. Health Care Operations: Use and disclose information for quality review, staff competency, audits, legal services, fraud detection, compliance programs, business planning, and communication with business associates under written contracts.
4. Appointment Reminders: Contact you about appointments, via phone, voicemail, or other messages.
5. Sign-In Sheet: May include your name on arrival or when calling patients.
6. Notification & Communication with Family: Notify family members or personal representatives about your location, general condition, or death, including in disaster situations.
7. Marketing: Contact you about treatments, therapies, care coordination, or products related to your care without payment, except as authorized. Paid marketing requires explicit written authorization.
8. Sale of Health Information: We will not sell your health information without prior written authorization.
9. Required by Law: Use and disclose information to comply with legal obligations, including abuse, neglect, judicial proceedings, or law enforcement requirements.
10. Public Health: Report to public health authorities for disease control, abuse reporting, FDA notifications, and other public health purposes.
11. Health Oversight Activities: Disclose information to oversight agencies during audits, investigations, inspections, or licensing proceedings.
12. Judicial & Administrative Proceedings: Disclose information when required by subpoena, court order, or other legal processes.
13. Law Enforcement: Disclose as required for law enforcement purposes, e.g., identifying suspects or complying with legal processes.
14. Coroners: Disclose for death investigations.
15. Organ or Tissue Donation: Share information with organizations involved in procuring, banking, or transplanting organs/tissues.
16. Public Safety: Disclose to prevent or lessen imminent threats to health or safety.
17. Proof of Immunization: Share with schools when required for student admission with your agreement.
18. Specialized Government Functions: Disclose for military, national security, or correctional purposes.
19. Workers’ Compensation: Disclose as required to comply with workers’ compensation laws.
20. Change of Ownership: Your health information becomes property of the new owner if this practice is sold or merged, though you may request copies transferred elsewhere.
21. Breach Notification: Notify you of breaches of unsecured protected health information via email, mail, or other methods as appropriate.

B. When This Medical Practice May Not Use or Disclose Your Health Information

Except as described above, this practice will not use or disclose your health information without your written authorization. You may revoke authorization in writing at any time.

C. Your Health Information Rights

1. Right to Request Special Privacy Protections: Request restrictions on certain uses/disclosures of your health information.
2. Right to Request Confidential Communications: Request to receive information at a specific location or via a specific method (e.g., email).
3. Right to Inspect and Copy: Request to inspect or obtain copies of your health information, in your preferred format if feasible, and send to a designated person. Fees may apply.
4. Right to Amend or Supplement: Request corrections or additions to your health information. Denials may be appealed in writing.
5. Right to an Accounting of Disclosures: Request an accounting of disclosures made, with certain exceptions (treatment, payment, health care operations, research, or disclosures to oversight agencies).
6. Right to a Paper or Electronic Copy of this Notice: Receive a paper copy upon request, even if previously provided electronically.

D. Changes to this Notice of Privacy Practices

We reserve the right to amend this Notice. Revised notices apply to all health information maintained by the practice. A copy will be posted in the reception area, provided at appointments, and available on our website.

E. Complaints

Complaints about this Notice or our handling of your health information should be directed to our Privacy Officer listed at the top of this Notice.