HIPAA Notice of Privacy Practices

About this notice

How this medical practice may use or disclose your health information

• Treatment. We use medical information about you to provide your medical care and may disclose it to employees and others involved in providing the care you need, including other health care providers, pharmacists, or laboratories. We may also disclose information to family members or others who can help when you are sick or injured, or after you die.
• Payment. We use and disclose medical information to obtain payment for the services we provide and may assist other health care providers in obtaining payment for services they provided to you.
• Health Care Operations. We may use and disclose information to operate this practice, review and improve quality, review professional competence and qualifications, obtain authorizations, conduct medical reviews, legal services, audits, compliance, business planning, and management. Business associates are required by written contract to protect protected health information.
• Appointment Reminders. We may use and disclose medical information to contact and remind you about appointments, including leaving a message when appropriate.
• Sign-In Sheet. We may ask you to sign in when you arrive and may call your name when ready to see you.
• Notification and Communication With Family. We may notify or assist in notifying family, a personal representative, or another person responsible for your care about your location or general condition, and may share information with someone involved in or paying for your care as permitted by law.
• Marketing. The legacy notice permits certain treatment-, case-management-, care-coordination-, practice-, and health-related communications without payment and requires written authorization for other marketing communications or compensated marketing as described in the notice.
• Sale of Health Information. We will not sell your health information without prior written authorization that discloses compensation.
• Required by Law and Public Health. We may use or disclose information as required by law and for permitted public-health purposes, including disease or injury control, certain abuse or neglect reports, FDA reporting, and exposure notifications.
• Health Oversight, Judicial Proceedings, and Law Enforcement. Information may be disclosed as permitted or required for audits, investigations, inspections, licensure, legal proceedings, court orders, subpoenas, warrants, and other lawful law-enforcement purposes.
• Coroners; Organ or Tissue Donation; Public Safety. Information may be disclosed for death investigations, organ or tissue procurement and transplantation, or to prevent or lessen a serious and imminent threat as permitted by law.
• Proof of Immunization; Specialized Government Functions. Information may be disclosed to a school with agreement where proof is required, and for permitted military, national-security, correctional, or custody purposes.
• Workers’ Compensation. Information may be disclosed as necessary to comply with workers’ compensation laws.
• Change of Ownership. If the practice is sold or merged, the health record becomes the property of the new owner, while you maintain the right to request transfer of copies to another physician or medical group.
• Breach Notification. In the case of a breach of unsecured protected health information, we will notify you as required by law. Notification may be provided by the practice, a business associate, email when a current address was provided, or other appropriate methods.

When this medical practice may not use or disclose your information

Your health information rights

• Right to Request Special Privacy Protections. You may request restrictions in writing. If you ask us not to disclose to a commercial health plan information about items or services paid in full out of pocket, we will abide by the request unless disclosure is required for treatment or legal reasons. Other requests may be accepted or rejected.
• Right to Request Confidential Communications. You may request in writing to receive information in a specific way or at a specific location. We will comply with reasonable requests specifying how or where communications should be sent.
• Right to Inspect and Copy. You may inspect and copy health information, with limited exceptions, by submitting a written request. Copies will be provided in a readily producible requested format, an acceptable alternative, or a readable electronic or hardcopy format as applicable. A reasonable cost-based fee may apply, and limited denials may be reviewed as described in the notice.
• Right to Amend or Supplement. You may request an amendment in writing with reasons. The practice may deny the request under circumstances described in the notice; you may submit a statement of disagreement, and related information will be maintained with subsequent disclosures.
• Right to an Accounting of Disclosures. You may request an accounting, subject to the exclusions described in the legacy notice, including certain treatment, payment, operations, authorized, family-notification, research, public-health, oversight, and law-enforcement disclosures.
• Right to a Paper or Electronic Copy. You have the right to notice of legal duties and privacy practices and to a paper copy even if you previously requested email delivery.

Changes to this notice

Complaints

• Email published in the legacy notice: OCRMail@hhs.gov
• Federal HIPAA complaint information: hhs.gov/hipaa/filing-a-complaint