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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.

  1. Use and Disclosure of Health Information
    1. The Practice may use your health information, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, for purposes of providing your treatment, obtaining payment for your care and conducting healthcare operations. We have established policies to guard against unnecessary disclosure of your health information.


  1. To Provide Treatment: The Practice may use your health information to coordinate care within the agency and with others involved in your care, such as your attending physician, members of the interdisciplinary team and other healthcare professionals who have agreed to assist in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. We may also disclose your healthcare information to individuals outside of the agency involved in your care including family members, clergy whom you have designated, pharmacists, suppliers of medical equipment, or other healthcare professionals.
  2. To Conduct Health Care Operations: The Practice may use and disclose health information for our own operations in order to facilitate the function of the agency and as necessary to provide quality care to all of our patients. Health care operations includes such activities as: Quality assessment and improvement activities, Activities designed to improve health, Protocol development, case management and care coordination, Contacting healthcare providers and patients with information about treatment alternatives and other related functions that do not include treatment, Professional review and performance evaluation, Training programs including those in which students, trainees or practitioners in healthcare learn under supervision, Training of non-healthcare professionals, Business planning and development including cost management and planning related analyses and formulary development, Business management and general administrative activities. For example, The Practice may use your health information to evaluate its staff performance, combine your health information with other patients in evaluating how to more effectively serve all of our patients, disclose your health information to our staff and contracted personnel for training purposes, or use your health information to contact you as a reminder regarding a visit.
  3. For Media Purposes: The Practice may use information and/or photographs of patients and families who have agreed to work with us to communicate our mission and work in the community. Written authorization from the patient is required to obtain and to disclose any information, including photographs and/or interviews. If the patient is a minor, written authorization must be obtained from a parent or legal guardian. All interviews with patients must be coordinated through the management team and Practice personnel must accompany any and all news personnel at all times within any facility.
  4. For Appointment Reminders: We may use and disclose your health information to contact you as a reminder that you have an appointment for a visit.
  5. For Health Information Exchange: The Practice endorses, supports, and participates in electronic Health Information Exchange (HIE) as a means to improve the quality of your health and healthcare experience. HIE provides us with a way to securely and efficiently share patients’ clinical information electronically with other physicians and healthcare providers that participate in the HIE network. Using HIE helps your healthcare providers to more effectively share information and provide you with better care. The HIE also enables emergency medical personnel and other providers who are treating you to have immediate access to your medical data that may be critical for your care. Making your health information available to your healthcare providers through the HIE can also help reduce your costs by eliminating unnecessary duplication of tests and procedures. However, you may choose to opt-out of participation in the HIE, or cancel an opt-out choice, at any time.
  6. For Treatment Alternatives: The Practice may use and disclose your health information to tell you about or to recommend possible treatment options or alternatives that may be of interest to you.


  1. When Legally Required: The Practice will disclose your health information when it is required to do so by any Federal, State or local law.
  2. When There Are Risks to Public Health: The Practice may disclose your health information for public activities and purposes in order to:
    1. Prevent or control disease, injury or disability, report disease, injury, vital events such as birth or death and the conduct of public health surveillance, investigations and interventions.
    2. Report adverse events, product defects, to track products or to enable product recalls, repairs and replacements; to conduct post-marketing surveillance and compliance with requirements of the Food and Drug Administration.
    3. Notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
    4. Notify an employer about an individual who is a member of the workforce as legally required.
  3. To Report Abuse, Neglect or Domestic Violence: The Practice is allowed to notify government authorities if the agency believes a patient is the victim of abuse, neglect or domestic violence. We will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.
  4. To Conduct Health Oversight Activities: We may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. The Practice, however, may not disclose your health information if you are the subject of an investigation and your health information is not directly related to your receipt of healthcare or public benefits.
  5. In Connection with Judicial and Administrative Proceedings: The Practice may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when we make reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
  6. For Law Enforcement Purposes: As permitted or required by State law, The Practice may disclose your health information to a law enforcement official for certain purposes as follows:
    1. As required by law for reporting of certain types of wounds or other physical injuries pursuant to the court order, warrant, subpoena or summons or similar process
    2. For the purpose of identifying or locating a suspect, fugitive, material witness or missing person
    3. Under certain limited circumstances, when you are the victim of a crime
    4. To a law enforcement official if we have a suspicion that your death was the result of criminal conduct including criminal conduct at The Practice
    5. In an emergency in order to report a crime.
  7. To Coroners and Medical Examiners: The Practice may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.
  8. To Funeral Directors: The Practice may disclose your health information to funeral directors consistent with applicable law and, if necessary, to carry out their duties with respect to your funeral arrangements. If necessary, to carry out our duties, we may disclose your health information prior to and in reasonable anticipation of your death.
  9. For Organ, Eye or Tissue Donation: The Practice ma/y use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating the donation and transplantation.
  10. For Research Purposes: In some cases, you may be asked for specific permission to use and disclose your health information. In other cases, the approval board may waive the permission requirement subject to controls and limitations.
  11. Limited Data Set: We may use or disclose a limited data set of your health information, that is, a subset of your health information for which all identifying information has been removed, for purposes of research, public health, or healthcare operations. Prior to our release, any recipient of that limited data set must agree to appropriately safeguard your health information.
  12. In the Event of a Serious Threat to Health or Safety: The Practice may, consistent with applicable law and ethical standards of conduct, disclose your health information if we, in good faith, believes that such disclosure is necessary to prevent or to lessen a serious and imminent threat to your health or safety or to the health and safety of the public.
  13. For Specified Government Functions: In certain circumstances, the Federal regulations authorize The Practice to use or to disclose your health information to facilitate specified government functions relating to military and veterans, national security and intelligence activities, protective services for the President and others, medical suitability determinations and inmates and law enforcement custody.
  14. For Worker’s Compensation: The Practice may release your health information for worker’s compensation or similar programs.


The Practice will not disclose your health information without your written authorization for any circumstances not listed above, including psychotherapy notes, marketing and the sale of protected health information. If you or your representative authorize us to use or to disclose your health information, you may revoke that authorization in writing at any time.


You have the following rights regarding your health information that The Practice maintains:

  1. Right to request restrictions. You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on our disclosure of your health information to someone who is involved in your care or the payment of your care. We are not required to agree to your request, unless your request is for a restriction on a disclosure to a health plan for purposes of payment or healthcare operations (and is not for purposes of treatment) and the medical information you are requesting to be restricted from disclosure pertains solely to a healthcare item or service for which you have paid out of pocket in full. If you wish to make a request for restrictions, please contact the Practice. The Practice may terminate a restriction after you have been informed.
  2. Right to receive confidential communications. You have the right to request that we communicate with you in a certain way. For example, you may ask that we conduct communications pertaining to your health information only with you privately with no other family members present. If you wish to receive confidential communications, please contact the Practice. We will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications.
  3. Right to inspect and to copy your health information. You have the right to inspect and to copy your health information, including billing records. A request to inspect and to copy records containing your health information may be made to the Practice. If you request a copy of your health information, we may charge a reasonable fee for copying and assembling costs associated with your request. You have the right to request that The Practice provide you, an entity or a designated individual with an electronic copy of your electronic health record containing your health information.
  4. Right to amend healthcare information. You or your representative have the right to request that we amend your records if you believe that your health information is incorrect or incomplete. That request may be made as long as the information is maintained by us. A request for an amendment of records must be made in writing to the Practice. We may deny the request if it is not in writing or does not include a reason for the amendment. The request also may be denied if your health information records were not created by us, if the records you are requesting are not part of our records, if the health information you wish to amend is not part of the health information you or your representative are permitted to inspect and copy, or if, in the opinion of The Practice, the records containing your health information are accurate and complete.
  5. Right to an accounting. You or your representative have the right to request an accounting of disclosures of your health information made by The Practice for certain reasons, including reasons related to public purposes authorized by law and certain research. The request for an accounting must be made in writing to the Practice. The request should specify the time period for the accounting. Accounting requests may not be made for periods of time in excess of six (6) years. We would provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.
  6. Right to a paper copy of this Notice. You or your representative have a right to a separate paper copy of this Notice at any time even if you or your representative have received this Notice previously. To obtain a separate paper copy, please contact the Practice.


  1. The Practice is required by law to maintain the privacy of your health information, to provide to you and your representative this Notice of its duties and privacy practices, and to notify all affected individuals following a breach of unsecured protected health information. We are required to abide by the terms of this Notice as may be amended from time to time. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that it maintains. You or your personal representative have the right to express complaints to us and to the U.S. Secretary of the Department of Health and Human Services if you or your representative believe that your privacy rights have been violated.
  2. Any complaints to The Practice should be made in writing.
  3. We encourage you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.