HIPAA PATIENT PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
YOUR PRIVACY IS IMPORTANT TO US.

OUR LEGAL DUTY

We are required by applicable federal and state law to maintain the privacy of your protected health information (PHI). We are also required to provide you with this Notice of our privacy practices, our legal duties, and your rights concerning your health information.

This Notice is effective as of 03/25/2025 and will remain in effect until replaced. We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes comply with applicable law. Any changes will apply to all PHI we maintain, including PHI created or received before the changes. When we make a significant change to our privacy practices, we will update this Notice and make it available upon request, in our office, and on our website.

You may request a copy of our most current Notice at any time. To do so, or to receive more information about our privacy practices, please contact us using the information at the end of this Notice.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

We may use or disclose your health information for purposes of treatment, payment, and healthcare operations as described below:

• Treatment: We may use or disclose your health information to a physician or other healthcare provider involved in your care.

• Payment: We may use and disclose your health information to obtain payment for services provided to you.

• Healthcare Operations: We may use and disclose your health information for our operational purposes, such as quality assessment, credentialing, training, accreditation, and licensing.

Other Uses and Disclosures

• Your Authorization: You may provide written authorization to use or disclose your health information for purposes not otherwise permitted by law. You may revoke your authorization in writing at any time. Revocation will not affect disclosures made prior to its receipt.

• Family and Friends Involved in Your Care: With your consent, or based on our professional judgment if you are incapacitated, we may disclose your health information to a family member, friend, or person involved in your care or payment for care, to the extent necessary.

• Notification and Disaster Relief: We may use or disclose your information to notify, or assist in notifying, a family member, personal representative, or someone responsible for your care of your location, condition, or death.

• Health-Related Communications: We will not use your information for marketing purposes without your express written authorization, as required by law.

• As Required by Law: We may use or disclose your health information when required by federal, state, or local law.

• Abuse, Neglect, or Domestic Violence: We may disclose your health information to appropriate authorities if we believe you are a victim of abuse, neglect, or domestic violence, as permitted or required by law.

• Serious Threat to Health or Safety: We may disclose health information when necessary to prevent a serious threat to your health and safety or the health and safety of others.

• National Security and Law Enforcement: We may disclose health information for lawful military, intelligence, national security, or law enforcement purposes as authorized by law.

• Correctional Institutions: If you are in custody, we may disclose necessary health information to correctional institutions or law enforcement for your care or safety or the safety of others.

• Appointment Reminders: We may use or disclose your health information to contact you with reminders about your appointments using phone, voicemail, email, letters, or postcards.

YOUR RIGHTS

You have the following rights regarding your protected health information:

Right to Access

You may inspect or request copies of your health records, with certain exceptions. Requests must be in writing. If requested, we will provide copies in your preferred format, if feasible. We may charge a reasonable, cost-based fee for copying, mailing, and staff time.

Right to an Accounting of Disclosures

You may request a list of certain disclosures of your health information made in the past six years, excluding those made for treatment, payment, healthcare operations, and certain other purposes. If requested more than once in a 12-month period, a reasonable cost-based fee may apply.

Right to Request Restrictions

You may request that we place additional restrictions on the use or disclosure of your health information. While we are not required to agree to all requests, we will comply with any restriction we do agree to (except in emergencies or where otherwise permitted by law).

Right to Request Confidential Communications

You may request that we communicate with you in a specific way or at a specific location (e.g., at home instead of work). Your request must be in writing and must include instructions on how payment will be handled under your requested method. We will accommodate reasonable requests.

Right to Amend

You may request in writing that we amend your health records if you believe they are inaccurate or incomplete. Your request must explain the reason for the amendment. We may deny your request if the information is complete and accurate or for other legal reasons. If denied, you may submit a written statement of disagreement.

Right to Receive a Paper Copy of This Notice

You have the right to receive a paper copy of this Notice, even if you agreed to receive it electronically.

QUESTIONS OR COMPLAINTS

If you have questions about our privacy practices or believe your privacy rights have been violated, you may contact us using the information below.

You also have the right to file a complaint with the U.S. Department of Health and Human Services (HHS), Office for Civil Rights. Upon request, we will provide the address and instructions for submitting your complaint.

We will not retaliate against you for filing a complaint.