Your information. Your rights. Our responsibilities.

Your rights

• Request a paper or electronic copy of your health record
• Ask to correct information you believe is wrong or incomplete
• Request confidential communication by a reasonable method or at a reasonable location
• Ask for limits on certain uses or disclosures
• Request a list of certain disclosures
• Obtain a copy of this notice
• Choose someone to act for you
• File a complaint without retaliation

Your choices

In certain situations, you may direct how information is shared with family, friends, disaster-relief organizations, fundraising communications, or marketing. Written authorizations may be revoked as permitted by law.

Permitted uses and disclosures

• Treatment and care coordination
• Billing, payment, and benefit verification
• Healthcare operations, quality, and safety
• Public-health, prevention, and required reporting
• Compliance with authorized laws, orders, and legal processes
• Workers’ compensation and permitted government functions
• Research when applicable requirements are met
• Preventing a serious threat and other uses permitted by law

Our responsibilities

• Protect the privacy and security of health information
• Notify affected individuals promptly when a breach may compromise information
• Follow the notice currently in effect and provide a copy
• Not use or disclose information outside the notice without authorization when authorization is required
• Revise and post the notice when privacy practices materially change

Substance-use-disorder records

The final review must determine whether the practice creates or maintains records governed by 42 CFR Part 2. When applicable, the final notice must include the protections and requirements that apply to those records.

Questions and complaints

Patients may contact the practice’s privacy representative. They may also submit a complaint to the U.S. Department of Health and Human Services Office for Civil Rights. The practice will not retaliate for a good-faith complaint.