THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. My Pledge Regarding Health Information
I understand that your health information is personal, and I am committed to protecting it. I create records of the care and services you receive to provide quality care and comply with legal requirements. This notice outlines how I may use and disclose health information, your rights to that information, and my obligations regarding its use and disclosure. I am required by law to:
Keep your protected health information (PHI) private.
Provide you with this notice of my legal duties and privacy practices.
Abide by the terms of this notice.
I reserve the right to change the terms of this notice, with the updated version available upon request, in my office, and on my website.
II. How I May Use and Disclose Health Information About You
I may use and disclose your PHI in the following ways:
1. Treatment, Payment, or Health Care Operations:
I may use or disclose your health information to provide treatment, manage operations, or obtain payment for services, including consultations with other health care providers.
2. Legal Situations:
If you are involved in a legal matter, I may disclose your information in response to a court order or other lawful requests.
III. Certain Uses and Disclosures That Require Your Authorization
Some information, such as psychotherapy notes or information used for marketing purposes, requires your explicit authorization before being used or disclosed, except in specific situations outlined by law.
IV. Uses and Disclosures Not Requiring Your Authorization
I may use or disclose your PHI without your authorization under certain circumstances, including:
When required by law or public health activities.
For oversight activities, including audits or investigations.
For judicial or administrative proceedings.
For law enforcement purposes.
For research or specialized government functions.
To avert a serious threat to health or safety.
V. Disclosures Requiring Your Opportunity to Object
You have the right to object to certain disclosures of your PHI to family, friends, or others involved in your care, except in emergencies.
VI. Your Rights Regarding Your PHI
You have the following rights:
Request Limits: You may request restrictions on certain uses or disclosures.
Out-of-Pocket Payments: Restrict disclosures to health plans for services you paid for in full.
Communication Preferences: Request specific ways to be contacted.
Access to Records: Get an electronic or paper copy of your health records.
Amendments: Request corrections to your health information.
Accounting of Disclosures: Request a list of certain disclosures made.
Paper Copy of This Notice: Request a paper or electronic copy of this privacy notice.
Effective Date of This Notice
This notice is effective as of March 22, 2020.
Acknowledgement of Receipt of Privacy Notice:
Under HIPAA, you have certain rights regarding the use and disclosure of your PHI. By using this site or services, you acknowledge that you have received a copy of this notice.