Notice of Privacy Practices

You can 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. We may charge a reasonable, cost-based fee.

You can ask us to correct health information about you that you think is incorrect or incomplete.

We may say “no” to your request, but we’ll tell you why in writing within 60 days.

You can ask us to contact you in a specific way or to send correspondence to a different address. We will say “yes” to all reasonable requests.

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

If you pay for a service out-of-pocket in full, you can ask us not to share that information for payment purposes. We will say “yes” unless a law requires us to share that information.

You can 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’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

You can ask for a copy of this notice at any time, even if you have agreed to receive it electronically. We will provide you with a 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 verify their authority before taking any action.

You can contact us using the contact form on this website.

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting hhs.gov/ocr/privacy/hipaa/complaints.

We will not retaliate against you for filing a complaint.

• 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, we may share your information if we believe it is in your best interest, or when needed to lessen a serious and imminent threat to health or safety.

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

We can use your health information and share it with other professionals who are treating you.

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

• Preventing disease
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

We can use or share your information for health research.

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.