Privacy Policy

Your Information. Your Rights. Our Responsibilities.

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 Rights

You have the right to:

• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we:

• Tell family and friends about your condition
• Provide disaster relief
• Include you in a hospital directory
• Provide mental health care
• Market our services and sell your information
• Raise funds

Our Uses and Disclosures

We may use and share your information as we:

• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions

Details on Your Rights

Get an electronic or paper copy of your medical record

You can ask to see or get an electronic or paper copy of your medical record and other health information we have
about you. We will provide a copy or summary within 30 days. We may charge a reasonable fee.

Ask us to correct your medical record

You can ask us to correct health information about you that you think is incorrect or incomplete. We may say “no”
to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

You can ask us to contact you in a specific way (for example, at home or at work) or to send mail to a different address. We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

You can ask us not to use or share certain health information for treatment, payment, or operations. We are not
required to agree, and may say “no” if it would affect your care. If you pay for a service in full out-of-pocket,
we will honor your request not to share it with your insurer unless required by law.

Get a list of those with whom we’ve shared information

You can ask for an accounting of the times we’ve shared your health information for six years prior to your request.
We will include all disclosures except for those related to treatment, payment, and healthcare operations.
One free accounting per year; reasonable fees may apply for additional requests.

Get a copy of this privacy notice

You can request a paper copy at any time, even if you agreed to receive it electronically. We will provide it promptly.

Choose someone to act for you

If you have given someone medical power of attorney or have a legal guardian, they can exercise your rights and make choices about your health information.

File a complaint if you feel your rights are violated

You can complain to us using the contact info above, or to the U.S. Department of Health and Human Services:
200 Independence Avenue, S.W., Washington, D.C. 20201, 1-877-696-6775, or
www.hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.

More on Our Uses and Disclosures

We typically use or share your health information in these ways:

Treat you

We can share your health info with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health.

Run our organization

We can use and share your health information to run our practice, improve care, and contact you when necessary.

Bill for your services

We can use and share your information to bill and get payment from health plans or other entities.

Public health and safety issues

We can share health information about you for certain situations such as preventing disease, helping with recalls,
reporting adverse reactions, suspected abuse/neglect, or reducing serious health threats.

Do research

We can use or share your information for health research.

Comply with the law

We will share information if state or federal laws require it, including with the Department of Health and Human Services.

Organ and tissue donation requests

We can share health information with organ procurement organizations.

Work with a medical examiner or funeral director

We can share information when an individual dies.

Workers’ compensation, law enforcement, and government requests

We can share information for workers’ comp claims, law enforcement purposes, oversight agencies, and government functions like national security.

Respond to lawsuits and legal actions

We can share information in response to a court or administrative order, or subpoena.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.

• We will let you know promptly if a breach occurs that may compromise your information.
• We must follow the duties and practices described in this notice and give you a copy.
• We will not use or share your info other than as described here unless you provide written consent.

For more information see:

HHS HIPAA Notice Information