Privacy Policy Notice

Your Rights.
Our Responsibilities.

This notice describes how your privacy is protected.

Your Rights

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

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. Ask us how to do this. • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based 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. Ask us how to do this.
Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office phone) 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 certain health information for payment. • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.
Get a copy of this privacy notice
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy 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 make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
• You can complain if you feel we have violated your rights by contacting us. • You can file a complaint with the U.S. Department of Health and Human Services Office for Cnd Rights by sending a letter to 200 Independence Avenue. S.W. Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. • We will not retaliate against you for filing a complaint.

Our Uses and Disclosures

How do we typically use or share your health information? We typically use or share your health information in the following ways.

Treat you
•If you would like us to, we can with your written permission use your health information and share it with other professionals who are treating you. For example, if you are being treated by another therapist,   information can be shared to improve your care but only with your permission.
Run our organization
• We can use information to run our practice and contact you when necessary.
Bill for your services
• We can use your information for health information to bill and get payment from health plans. This includes only a date of service and diagnostic code. Additional information is not needed.
Safety Issues
• We can share health information about you for certain situations such as:

  • Reporting suspected child abuse or neglect.
  • Preventing or reducing a serious threat to anyone’s safety, such as a very serious suicidal concern.

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 we can in writing. If you tell us we can. you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.