Notice of Privacy Practices

(a) Treatment. We may use and disclose your medical information to provide, coordinate, or manage your medical treatment or related services — including sharing information with other providers who may be treating you, referring providers, or laboratories.

(b) Payment. We may use and disclose your medical information to obtain payment for the treatment and services you receive from us, such as providing information to your health plan to obtain approval for planned treatment.

(c) Health Care Operations. We may use or disclose your medical information to support the business activities of our practice. This includes reviewing treatment, employee performance reviews, training of personnel, licensing, and marketing activities. We may also share your information with third-party "business associates" who perform activities on our behalf, such as billing — always under a written contract requiring them to protect your privacy. You may contact our Privacy Contact to opt out of receiving marketing or fundraising materials. If we hold substance use disorder (SUD) records subject to 42 C.F.R. Part 2, we will give you notice and a choice before using that information in fundraising communications.

(d) Health Information Exchange. We may participate in a health information exchange (Exchange) that facilitates electronic sharing of medical and other health information with other participating health care providers for purposes of treatment, payment, or health care operations.

(a) Others Involved in Your Health Care. Unless you object, we may disclose relevant medical information to a family member, relative, or close friend involved in your care — or notify them of your location, general condition, or death. We may also disclose your information to entities assisting in disaster relief efforts.

(b) Emergencies. We may use or disclose your medical information for emergency treatment. We will try to obtain your consent as soon as reasonable after care is delivered.

(c) Communication Barriers. We may use and disclose your medical information if we are unable to obtain consent due to substantial communication barriers and, in our professional judgment, you intended to consent.

(a) Required by Law. We may use or disclose your information when required by federal, state, or local law. You will be notified of any such disclosure.

(b) Public Health. We may disclose your information to a public health authority for purposes of controlling disease, injury, or disability.

(c) Communicable Diseases. We may disclose your information, if authorized by law, to a person who may have been exposed to a communicable disease or who may be at risk of contracting or spreading it.

(d) Health Oversight. We may disclose your information to a health oversight agency for activities authorized by law, including audits, investigations, inspections, and licensure.

(e) Abuse or Neglect. We may disclose your information to a public health authority authorized to receive reports of child or elder abuse or neglect, or to a governmental entity if we believe you have been a victim of abuse, neglect, or domestic violence.

(f) Food and Drug Administration. We may disclose your information as required by the FDA, including for reporting adverse events, product defects, product recalls, or post-marketing surveillance.

(g) Legal Proceedings. We may disclose your information in the course of a judicial or administrative proceeding when required by court order, administrative tribunal, subpoena, or discovery request.

(h) Law Enforcement. We may disclose your information for law enforcement purposes as permitted by applicable law, including responding to court orders, warrants, and summonses; identifying or locating suspects or missing persons; and responding to medical emergencies where a crime is suspected.

(i) Coroners, Funeral Directors, and Organ Donors. We may disclose your information to a coroner or medical examiner for identification or cause-of-death purposes, to funeral directors as necessary for their duties, or to facilitate organ or tissue donation.

(j) Research. We may use or disclose your information for research in limited circumstances, generally only with your written authorization or when an IRB or Privacy Board has determined a waiver is appropriate and that the research meets strict privacy and minimal-risk requirements.

(k) Criminal Activity. We may disclose your information if we believe it is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, or to assist law enforcement in identifying or apprehending an individual.

(l) Organ and Tissue Donation. If you are an organ donor, we may release information to organizations handling organ procurement, transplantation, or organ donation banks.

(m) Military Activity and National Security. For members of the armed forces, we may use or disclose information as required by military command or for veteran benefits determinations. We may also disclose information to authorized federal officials for national security and intelligence activities.

(n) Workers' Compensation. We may disclose your information as authorized to comply with workers' compensation laws and similar programs providing benefits for work-related injuries or illness.

(o) Inmates. We may use or disclose your information if you are an inmate of a correctional facility and we created or received your health information in the course of providing care to you.

(p) Required Uses and Disclosures. We must make disclosures to you and to the Secretary of the Department of Health and Human Services when required to investigate or determine our compliance with HIPAA.

(q) Imminent Threat to Health and Safety. As allowed by law, we may disclose your information if we believe you pose a risk to your own health and safety or the health and safety of another person.

(a) Right to Inspect and Copy. You may inspect and obtain a copy of medical information about you originating in our practice. We may charge a reasonable fee for copying and mailing records. For information we maintain in electronic format, you have the right to receive it electronically; we will charge no more than actual labor cost. We will respond to your written request within thirty (30) days. Note that you may not have a right to inspect or copy psychotherapy notes.

(b) Right to Request a Restriction. You may ask us not to use or disclose part of your medical information for treatment, payment, or health care operations, or to specific family members or friends. Requests must be made in writing to our Privacy Contact. You have the right to restrict information sent to your health plan for services you paid for entirely out-of-pocket.

(c) We Are Not Always Required to Agree. If we believe it is in your best interest to permit use or disclosure, we are not required to agree to your restriction — except when the disclosure is for payment or health care operations purposes (not required by law) and the information pertains solely to a service you paid for in full without a health plan claim.

(d) Right to Receive Confidential Communications. You have the right to request that we communicate with you at a location other than your primary address. We will accommodate reasonable written requests.

(e) Right to Amend Your Medical Information. If you believe information we hold about you is incorrect or incomplete, you may request an amendment by contacting our Privacy Contact. We may deny your request in certain cases, in which case you have the right to file a statement of disagreement.

(f) Right to an Accounting of Disclosures. You have the right to receive a written accounting of disclosures we have made of your information — for purposes other than treatment, payment, or health care operations — for up to the prior six (6) years (after April 14, 2003). For information maintained electronically, you may request an accounting of electronic disclosures for the prior three (3) years. Submit your request in writing to our Privacy Contact.

(g) Written Authorization Required. Uses and disclosures not covered by this Notice will be made only with your written authorization. This includes most uses of psychotherapy notes; uses of your information for marketing purposes (with limited exceptions); and disclosures that constitute a sale of protected health information. You may revoke your authorization at any time, except to the extent we have already acted in reliance on it.

(h) Right to Be Notified of a Breach. You have the right to be notified if our practice (or a Business Associate) discovers a breach of unsecured protected health information.

(i) Complaints. You may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights: 200 Independence Avenue, S.W., Washington, D.C. 20201 · (877) 696-6775 · hhs.gov/hipaa/filing-a-complaint. We will not retaliate against you for filing a complaint.