Privacy Policy

You have the right to inspect and copy your protected health information (fees may apply) – Pursuant

to your written request, you have the right to inspect or copy your PHI whether in paper or electronic format.

Under federal law, however, you may not inspect or copy the following records: Psychotherapy notes,

information compiled in reasonable anticipation of, or used in, a civil, criminal, or administrative action or

proceeding, PHI restricted by law, information that is related to research in which you have agreed to

participate, information whose disclosure may result in harm or injury to you or to another person, or

information that was obtained under a promise of confidentiality.

You have the right to request a restriction of your protected health information – This means you may

ask us not to use or disclose any part of your PHI for the purposes of treatment, payment, or healthcare

operations. You may also request that any part of your PHI not be disclosed to family members or friends who

may be involved in your care or for notification purposes as described in this Notice. Your request must state

the specific restriction requested and to whom you want the restriction to apply. We are not required to agree

to your requested restriction except if you request that we not disclose PHI to your health plan with respect to

healthcare for which you have paid in full out of pocket.

You have the right to request to receive confidential communications – You have the right to request

confidential communication from us by alternative means or at an alternative location. You have the right to

obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice

alternatively i.e. electronically.

You have the right to request an amendment to your protected health information – This request must

be made in writing and we have 30-days to reply. If we deny your request for amendment, you have the right

to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide

you with a copy of any such rebuttal. We may deny amending your PHI if we did not create the information or

if the treating provider who created the information is no longer available to make the amendment.

You have the right to receive an accounting of certain disclosures – You have the right to receive an

accounting (listing) of disclosures, paper or electronic, except for disclosures: pursuant to an authorization, for

purposes of treatment, payment, healthcare operations; required by law, that occurred prior to April 14, 2003,

or six years prior to the date of the request.

You have the right to receive notice of a breach – We would notify you if your unsecured PHI held by our

practice or a business associate has been breached. “Unsecured” is information that is not secured through the

use of technology or methodology identified by the Secretary of the U.S. Department of Health and Human

Services to render the PHI unusable, unreadable, and undecipherable to unauthorized users.

You have the right to obtain a paper copy of this Notice from us even if you have agreed to receive the

Notice electronically. We will also make available copies of our new Notice if you wish to obtain one.

We reserve the right to change the terms of this Notice. The new Notice will be available upon request,

posted in our office, and on our website.