NOTICE OF PRIVACY PRACTICES

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

Your rights:

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

You have a right to:

• Ask to see or get an electronic or paper copy of your medical record and other health information we have about you.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. You must make your request in writing.
• Ask us to correct your medical information if you think it is incorrect or incomplete.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days. You may respond with a statement of disagreement that will be added to the information you wanted changed.
• Ask us to contact you in a specific way (for example, home or cell phone) or to send mail to a different address.
  • We will say “yes” to all reasonable requests.
• Ask us not to use or share certain health information for treatment or our internal operations.
  • We are not required to agree to your request, and we may say “no” if it would affect your care.
• Ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you have asked us to make).
• Ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
• If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.
• You can complain if you feel we have violated your rights by contacting us using the information on the top right of this page. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

Your choices:

For certain health information, you have options about what we share. If you have a clear preference for how we share your information in the situations described below, let us know and we’ll follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care.
• Share information in a disaster relief situation
  • If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health of safety.