Privacy Policy


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.
We care about our patients’ privacy and strive to protect the confidentiality of your medical information at this practice. Federal legislation requires that we issue this official notice of our privacy practices. You have the right to the confidentiality of your medical information, and this practice is required by law to maintain the privacy of that information. This practice is required to abide by the terms of the Notice of Privacy Practices currently in effect, and to provide notice of its legal duties and privacy practices with respect to protected health information. If you have any questions about this notice, please contact the Privacy Officer, listed in the upper right hand corner of this notice.


Any health care professional authorized to enter information into your medical record, all employees, staff and other personnel at this practice who may need access to your information must abide by this notice. All subsidiaries, business associates (e.g. billing services), sites and locations of this practice may share medical information with each other for treatment, payment purposes or health care operations described in this notice. With the exception of your treatment, only the minimum information needed to accomplish other tasks will be shared.


The following categories describe different ways that we may use and disclose medical information without your specific consent or authorization. Examples are provided for each category of uses or disclosures. Not all possible uses or disclosures are listed.

For Treatment. We may use medical information about you to provide you with medical treatment or services. Example: In treating you for a specific condition, we may communicate with a pharmacist about your allergies, to ensure proper choice of medications for your treatment. We may use or disclose your PHI to notify or assist in the notification of a family member, a personal representative, or another person responsible for the care of your location, general condition, or death. If you are available, we will give you an opportunity to object to these disclosures, and we will not make these disclosures if you object. If you are not available, we will determine whether a disclosure to your family or friends is in your best interest, considering the circumstances and based on our professional judgment. We may contact you to provide appointment reminders or to provide information about health-related services that may be of interest to you, or to get feedback from you about the care you have received in our practice.

For Payment. We may use and disclose medical information about you to obtain payments for services rendered. Example: We may need to send your protected health information, including but not limited to your name, address, office visit date, and codes identifying your diagnosis and treatment to your insurance company for payment.

For Research: We may use or disclose your PHI for research purposes, subject to the requirements of applicable law. For example, a research project may involve comparisons of the health and recovery of all patients who received a particular medication. All research projects are subject to a special approval process that balances research needs with a patient’s need for privacy. When required, we will obtain written authorization from you prior to using your health information for research.

Health Information Exchange. To help enhance the quality of your care, we may participate in Health Information Exchanges (HIE). Your healthcare providers can use this secure electronic network to share your health records for a better picture of your health needs. You may opt-out of having your PHI shared through the HIE any time either during registration or by submitting a written request to Health Information Management. Opting out of HIE sharing means your providers will need to obtain your records, as permitted or required by law and as described in this Notice, by other means (e.g., fax, mail, secure email).

For Healthcare Operations. We may use and disclose medical information about you for your healthcare operations to assure that you receive quality care. Example: We may use and disclose medical information to review our treatment and services and evaluate the performance of our staff in caring for you.

Business Associates. Certain aspects of our services may at times be performed through arrangements with outside persons or organizations known as business associates, such as computer/network support, billing, or collection services, and at times, to assist in your care. As such, it may be necessary for us to provide your PHI to these business associates. In all cases, business associates are obligated to protect your PHI in the same manner we are and we obtain written assurances from them stating their agreement to protect your PHI.

Fundraising. From time to time, we may use your PHI to contact you to raise money as part of our charitable fundraising efforts. You have the right to opt out of receiving fundraising communications and how to do this will be described in the communications you receive.

Confidential Communication. You have the right to request we communicate with you by specific means or locations (for example, asking that your mail be sent to a post office box rather than to your home). We will honor reasonable requests for confidential communication, as long as we can establish contact with you using the information you provide. If we are unable to reach you by your preferred method (for example, if your phone number is disconnected, or important messages are not returned) we may use any contact information you provide to the office to reach you.

Other Uses or Disclosures That Can Be Made without Consent or Authorization:

  • As required during an investigation by law enforcement agencies
  • To avert a serious threat to public health or safety
  • As required by military command authorities for their medical records
  • To workers’ compensation or similar programs for processing of claims
  • In response to a legal proceeding
  • To a coroner or medical examiner for identification of a body
  • If an inmate, to the correctional institution or law enforcement official
  • As required by the US Food and Drug Administration (FDA)
  • Our healthcare providers treatment activities
  • For other covered entities’ healthcare operations (to the extent permitted under HIPAA)
  • For other covered entities’ and providers’ payment activities
  • Use and disclosures required by law • Uses and disclosures in domestic violence or neglect situations
  • Health oversight activities
  • Other public health activities

Use and Disclosures of Protected Health Information Requiring Your Written Authorization: Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will only be made with your written authorization. If you give us authorization to use or disclose medical information about you, you may revoke that authorization in writing at any time. If you revoke your authorization, we will thereafter no longer use of disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain your records of the care we have provided you for a period of time dictated by law in our jurisdiction.

Your Individual Rights Regarding Your Medical Information Complaints. If you believe your privacy rights have been violated, you may file a complaint with the privacy Officer at this practice or the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized or discriminated against for filing a complaint.

Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations or to someone who is involved in your care or the payment of your care. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. To request restrictions, you must submit your request in writing to the Privacy Officer at this practice. In your request, you must tell us what information you want to limit.

Right to an Accounting of Non-Standard Disclosures. You have the right to request a list of the disclosures we made of medical information about you. To request this list, you must submit your request in writing to the Privacy Officer at this practice. Your request must state the time period (up to ix years, and not before April 14, 2003) for which you want to receive a list of disclosures. Your request should indicate in what form you want the list (e.g. on paper or electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you the cost for providing the list.

Right to Request Confidential Communications. You have the right to request how we should send communications to you about medical matters, and where you would like those communications sent. We will accommodate all reasonable requests that do not impose an unreasonable burden on the practice. If we are unable to establish contact with you through your preferred method or at your preferred location, we reserve the right to use any contact information you provide to the practice to establish contact.

Right to Inspect and Copy. You have the right to inspect and copy medical information that maybe used to make decisions about your care. Usually this includes medical and billing records but does not include psychotherapy notes, information compiled for use in a civil, criminal or administrative action or proceeding, and protected health information to which access is prohibited by law. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the privacy Officer of this practice. If you request a copy of the information, we reserve the right to charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain, very limited circumstances. If you are denied access to medical information, you may request that denial be reviewed. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

Right to Amend. You have the right to request changes to the PHI we maintain about you. We are not obligated to make all requested changes but will give each request careful consideration. All requests must be in writing (signed and dated) and sent to the Privacy Officer listed in the upper right-hand corner of this notice. The request must state the reasons for the change requested. If we make a change that you request, we might also notify others who have copies of the original record if we believe that such notification is necessary.

Right to Paper Copy of this Notice. You have the right to a paper copy of this Notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy. To obtain a copy of the current notice, please request one in writing from the privacy Office at this practice.

Changes to this Notice. We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of our current privacy policy on the practice’s website at its effective date in the upper right-hand corner of the first page.

Effective date: May 2023