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.
This Notice is effective as of April 14, 2003
We are required by law to maintain the privacy of protected health information, and must inform you of our privacy practices and legal duties. You have the right to obtain a paper copy of this Notice upon request. We are required to abide by the terms of the Notice of Privacy Practices that is most current. We reserve the right to change the terms of the Notice at any time. Any changes will be effective for all protected health information that we maintain. The revised Notice will be posted in the waiting room. You may request a copy of the revised Notice at any time.
We have designated a Privacy Officer to answer your questions about our privacy practices and to ensure that we comply with applicable laws and regulations. Our Privacy Officer is Mary Beth Fisk.
Use and disclosure of your protected health information that we may make to carry out treatment, payment, and health care operations. We may use information in your record to provide treatment to you. We may use or disclose information from your record to obtain payment for the services you receive. We may use or disclose information from your record to allow health care operations.
You may ask us to restrict the use and disclosure of certain information in your record that otherwise would be allowed for treatment, payment, or health care operations. However, we do not have to agree to these restrictions.
You have a right to receive confidential communications from us. For example, if you want to receive bills and other information at an alternative address, please notify us.
You have a right to inspect the information in your record, and may obtain a copy of it. This may be subject to certain limitations and fees. Your request must be in writing.
If you believe information in your record is inaccurate or incomplete, you may request amendment of the information. You must submit sufficient information to support your request for amendment. Your request must be in writing.
You have the right to request an accounting of certain disclosures made by us.
You have the right to complain to us about our privacy practices (including the actions of our staff with respect to the privacy of your health information). You have the right to complain to the Secretary of the Department of Health and Human Services about our privacy practices. You will not face retaliation from us for making complaints.
Except as described in this Notice, we may not make any use or disclosure of information from your record unless you give your written authorization.
You may revoke an authorization in writing at any time, but this will not affect any use or disclosure made by us before the revocation. In addition, if the authorization was obtained as a condition of obtaining insurance coverage, the insurer may have the right to contest the policy or a claim under the policy even if you revoke the authorization.
Use or disclosure of your protected health information that we are required to make without your permission
In certain circumstances, we are required by law to make a disclosure of your health information. For example, state law requires us to report suspected child abuse or neglect. State law also mandates that we report suspected cases of elder abuse or abuse of the mentally disabled. We must also report information pertaining to sexual misconduct on the part of any person providing counseling. We must disclose information when necessary to prevent instances of harm to self or others. Within certain limits, protected health information Also, we must disclose information to the Department of Health and Human Services, if requested, to prove that we are complying with regulations that safeguard your health information.
Use or disclosure of your protected health information that we are allowed to make without your permission.
There are certain situations where we are allowed to disclose information from your record without your permission. In these situations, we must use our professional judgment before disclosing information about you. Usually, we must determine that the disclosure is in your best interest, and may have to meet certain guidelines and limitations.
Confidentiality of protected health information related to alcohol and drug abuse
The confidentiality of protected health information related to alcohol and drug abuse is protected by federal law and regulations. Violations of the applicable federal law and regulations are a crime, and may be reported to appropriate authorities.
We may not disclose any information about you unless you authorize the disclosure in writing, except as specified below.
We may disclose information about you if a court orders the disclosure.
We may disclose information about you in a medical emergency, to permit you to receive needed treatment.
We may disclose information about you for purposes of program evaluation, audits, or research.
We may disclose information about you if you commit a crime on our premises or against any person who works for us, or if you threaten to commit such a crime.
We are required to disclose information about you if we suspect child abuse or neglect.
Except as stated in this notice, you have the same rights and protections with respect to your health information as described in our general Notice of Privacy Practices.