HIPAA Notice of Privacy Practices

Covered Entity & Business Associate

Uses and Disclosures of Your Health Information

We may use and share your protected health information (PHI) for the following purposes:

• Treatment: To provide and coordinate your medical care, including sharing information with physicians, nurse practitioners, lab partners, and pharmacies involved in your treatment
• Payment: To process payments for services rendered, including billing and claims
• Healthcare Operations: To support quality improvement, staff training, compliance activities, and operational management of the practice

Minimum Necessary Standard

We access only the minimum amount of health information necessary to provide the services you have requested. Staff access to PHI is limited based on role and need.

Your Rights

When it comes to your health information, you have the following rights:

• Right to access your records: You can request an electronic or paper copy of your medical record. We will provide a copy or summary within 30 days of your request.
• Right to request amendments: You can ask us to correct health information you believe is incorrect or incomplete.
• Right to request restrictions: You can ask us to limit how we use or share certain health information for treatment, payment, or operations.
• Right to confidential communications: You can ask us to contact you in a specific way (for example, by phone only, or to send mail to a specific address).
• Right to an accounting of disclosures: You can request a list of instances where we have shared your health information for purposes other than treatment, payment, or operations for the six years prior to your request.
• Right to a copy of this notice: You can ask for a paper copy of this notice at any time.
• Right to file a complaint: If you believe your privacy rights have been violated, you can file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights.

Your Choices

• We will not use or share your information for marketing purposes without your written permission
• We will never sell your information
• You may authorize sharing with family members or others involved in your care

Breach Notification

We are required by law to maintain the privacy and security of your protected health information. In the event of a breach of unsecured PHI, we will notify affected patients within 60 days of discovering the breach, as required by federal law.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information
• We must follow the duties and privacy practices described in this notice
• We will not use or share your information other than as described here unless you tell us we can in writing
• If you give us permission, you may revoke it at any time by contacting us in writing

Contact Information

For questions about this notice or to exercise your rights, contact:

To file a complaint with the federal government, contact:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775
www.hhs.gov/ocr/privacy/hipaa/complaints/