Notice of Privacy Practices

You can ask to see or receive 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.

You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

We may say “no” to your request, but we will tell you why in writing within 60 days.

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 accommodate all reasonable requests.

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

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. We will say “yes” unless a law requires us to share that information.

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

We will include all disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting per year at no charge but may charge a reasonable, cost-based fee if you ask for another one within 12 months.

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.

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 authority to act for you before we take any action.

You can file a complaint by contacting us at the address or phone number listed at the end of this Notice.

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil 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.

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

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. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

We may contact you for fundraising efforts, but you can tell us not to contact you again. If we have SUD treatment records about you and use those records for fundraising, we will give you a clear and conspicuous opportunity to opt out of receiving fundraising communications.

We are allowed or required to share your information in other ways — usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information, visit: www.hhs.gov/hipaa/for-individuals/index.html.

Please be aware that once we disclose your health information to another person or entity as permitted by HIPAA, that information may be redisclosed by the recipient and may no longer be protected by HIPAA.

Unlike other medical information, SUD treatment records that are subject to Part 2 generally may not be used or disclosed for treatment, payment, or health care operations without your specific written consent, except as described below.

• To you (the patient)
• In a medical emergency, but we must attempt to get your consent and, if we cannot, we must document the attempt and the emergency
• For research, audit, or evaluation purposes, subject to applicable confidentiality safeguards
• As required by court order (described further below)
• To report suspected child abuse or neglect under applicable state law
• To qualified service organizations performing functions on our behalf, subject to a written agreement

SUD treatment records subject to Part 2, and testimony describing the content of those records, generally may not be used or disclosed in any civil, criminal, administrative, or legislative proceeding against you unless:

• You provide written consent authorizing the use or disclosure; or
• A court issues a special order after giving you notice and an opportunity to be heard, and the order is accompanied by a subpoena or other legal requirement compelling disclosure.

Example: If you are involved in a lawsuit or criminal proceeding, information about SUD treatment you received at this Practice cannot be used as evidence against you without your consent or a court order meeting the requirements described above.

When another federal or state law is more protective of your privacy than HIPAA, that more restrictive law applies. Part 2 is more restrictive than HIPAA in the areas described in this section. We will comply with the more protective requirement.