Judicial and Administrative Proceedings. If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or
administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process
instituted by someone else involved in the dispute, but only if efforts have been made, either by the requesting party or us, to tell you about the
request or to obtain an order protecting the information request.
Coroners, Medical Examiners, and Funeral Directors. We may release your PHI to a coroner or medical examiner. This may be necessary, for
example, to identify a deceased person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law
to enable them to carry out their duties.
Fundraising. We may contact you to provide you with information about our sponsored activities, including fundraising programs, as permitted by
applicable law. If you do not wish to receive such information from us, you may opt out of receiving the communications.
Other Uses and Disclosures of PHI
Your authorization is required, with a few exceptions, for disclosure of psychotherapy notes, use or disclosure of PHI for marketing, and for the sale of
PHI. We will also obtain your written authorization before using or disclosing your PHI for purposes other than those provided for in this Notice (or as
otherwise permitted or required by law). You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop
using or disclosing your PHI, except to the extent that we have already taken action in reliance on the authorization.
Your Health Information Rights
Access. You have the right to look at or get copies of your health information, with limited exceptions. You must make the request in writing. You may
obtain a form to request access by using the contact information listed at the end of this Notice. You may also request access by sending us a letter to
the address at the end of this Notice. If you request information that we maintain on paper, we may provide photocopies. If you request information
that we maintain electronically, you have the right to an electronic copy. We will use the form and format you request if readily producible. We will
charge you a reasonable cost-based fee for the cost of supplies and labor of copying, and for postage if you want copies mailed to you. Contact us using
the information listed at the end of this Notice for an explanation of our fee structure.
If you are denied a request for access, you have the right to have the denial reviewed in accordance with the requirements of applicable law.
Disclosure Accounting. With the exception of certain disclosures, you have the right to receive an accounting of disclosures of your health
information in accordance with applicable laws and regulations. To request an accounting of disclosures of your health information, you must submit
your request in writing to the Privacy Official. If you request this accounting more than once in a 12-month period, we may charge you a reasonable
cost-based fee for responding to the additional requests.
Right to Request a Restriction. You have the right to request additional restrictions on our use or disclosure of your PHI by submitting a written
request to the Privacy Official. Your written request must include (1) what information you want to limit, (2) whether you want to limit our use,
disclosure or both, and (3) to whom you want the limits to apply. We are not required to agree to your request except in the case where the disclosure
is to a health plan for purposes of carrying out payment or health care operations, and the information pertains solely to a health care item or service
for which you, or a person on your behalf (other than the health plan), has paid our practice in full.
Alternative Communication. You have the right to request that we communicate with you about your health information by alternative means or at
alternative locations. You must make your request in writing. Your request must specify the alternative means or locations, and provide satisfactory
explanation of how payments with be handled under the alternative means or location you request. We will accommodate all reasonable requests.
However, if we are unable to contact you using the ways or locations you have requested we may contact you using the information we have.
Amendment. You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the
information should be amended. We may deny your request under certain circumstances. If we agree to your request, we will amend your record(s)
and notify you of such. If we deny your request for an amendment, we will provide you with a written explanation of why we denied it and explain
Right to Notification of a Breach. You will receive notifications of breaches of your unsecured protected health information as required by law.
Electronic Notice. You may receive a paper copy of this Notice upon request, even if you have agreed to receive this Notice electronically on our Web
site or by electronic mail (e-mail).
Questions and Complaints
If you are concerned that we may have violated your privacy rights, or if you disagree with a decision we made about access to your health
information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate
with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of this Notice. You
also may submit a written complaint to the U.S. Department of Health and Human Services, Office of Civil Rights; 200 Independence Avenue, SW;
Washington DC 20201; (202) 619-0257; Toll Free: 1-877-696-6775.
We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the
U.S. Department of Health and Human Services.
If you want more information about our privacy practices or have questions or concerns, please contact us: