HIPAA Notice of Privacy Practices

Your Rights

When it comes to your health information, you have certain rights. This section explains those rights and some of our responsibilities to help you.

• Get a copy of your health record. You can ask to see or get an electronic or paper copy of your medical record and other health information we hold about you. We will provide a copy or a summary within 30 days of your request, and may charge a reasonable, cost-based fee.
• Ask us to correct your health record. You can ask us to correct information you think is incorrect or incomplete. We may say no to your request, but we will tell you why in writing within 60 days.
• Request confidential communications. You can ask us to contact you in a specific way — a particular phone number, or by mail rather than email. 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 our 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, you can ask us not to share that information with your health insurer, and we will say yes unless a law requires us to share it.
• Get a list of those with whom we have shared information. You can ask for an accounting of the times we shared your health information in the six years before your request, who we shared it with, and why. We will include all disclosures except those about treatment, payment, and health care operations, and certain other disclosures. One accounting a year is free; we may charge a reasonable, cost-based fee for additional requests.
• Get a copy of this privacy notice. You can ask for a paper copy at any time, even if you agreed to receive this notice electronically. We will provide one promptly.
• Choose someone to act for you. If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will confirm that the person has this authority before we take any action.
• File a complaint if you feel your rights are violated. You can complain to us using the contact details at the end of this notice, or file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will never retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. Talk to us if you have a preference and we will follow your instructions.

You have both the right and the choice to tell us to

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation

If you are not able to tell us your preference — for example, if you are unconscious — we may go ahead and share your information if we believe it is in your best interest, or when needed to lessen a serious and imminent threat to health or safety.

We never share your information in these cases without your written permission

• Marketing. We will not use your health information for marketing purposes without your written authorization. Joining our email list is separate from your medical record, and you can unsubscribe at any time.
• Sale of your information. We will never sell your health information.
• Before-and-after photographs. Treatment photographs are part of your medical record. We will not publish, post or otherwise use an identifiable photograph of you — including on this website or on social media — without a separate written authorization, which you may revoke at any time.
• Psychotherapy notes. Most sharing of psychotherapy notes, where any exist.
• Fundraising. We may contact you for fundraising efforts, and you can tell us not to contact you again.

How We Typically Use or Share Your Health Information

We typically use or share your health information in the following ways.

• To treat you. We use your health information and share it with other professionals involved in your care — for example, consulting our medical director about a treatment plan, or sending records to another provider at your request.
• To run our practice. We use and share your information to run the practice, improve your care, and contact you when necessary — appointment reminders, follow-up checks after a treatment, and internal quality review.
• To bill for your services. We use and share your information to bill and take payment. We never put health information in a payment description.
• With our business associates. We share information with vendors who perform services on our behalf, such as the host of our electronic medical record. Each is bound by a written agreement requiring the same protection of your information that we provide.

How Else We May Use or Share Your Information

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good. We have to meet many conditions in the law before we can do so.

• Public health and safety issues — preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety
• Health research — when the research has been approved and meets the conditions set by law
• Compliance with the law — including sharing information with the U.S. Department of Health and Human Services if it wants to confirm we are complying with federal privacy law
• Organ and tissue donation requests — with organ procurement organizations
• Medical examiners, coroners, and funeral directors — when an individual dies
• Workers’ compensation, law enforcement, and other government requests — for workers’ compensation claims, for law enforcement purposes, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services
• Lawsuits and legal actions — in response to a court or administrative order, or to a 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 have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us in writing that we can. If you give that permission, you may change your mind at any time — just tell us in writing.

Changes to the Terms of This Notice

We can change the terms of this notice, and the changes will apply to all information we hold about you. The new notice will be available on request, in our office and on this page. The effective date at the top of this page tells you which version is currently in force.

How to File a Complaint

If you believe your privacy rights have been violated, contact our Data Privacy Officer using the details below. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights:

• By mail — 200 Independence Avenue S.W., Washington, D.C. 20201
• By phone — 1-877-696-6775
• Online — hhs.gov/ocr/privacy/hipaa/complaints

We will not retaliate against you for filing a complaint.

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