Our Responsibilities

Each time you visit a healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and billing-related information. State and Federal law protects the confidentiality of this information. Protected Health Information (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical and mental health or condition, along with related health care services. 

We are required by law to maintain the privacy of your PHI and to provide you with this notice of our legal duties and privacy practices with respect to your PHI. This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with all applicable laws. You may request a written copy of this information be provided to you at any time. We reserve the right to change the terms of our Notice of Privacy Practices at any time, and we will provide you with a revised policy electronically, via mail, or in person.

How We Are Permitted to Use and Disclose Your PHI

For Treatment. We may use medical and clinical information about you to provide you with treatment services. We may disclose health information about you to other healthcare providers including doctors, nurses, technicians (e.g. clinical laboratories), and other personnel who may be involved in your care. We may communicate your information either orally or in writing my mail or facsimile. We may also provide a subsequent healthcare provider with information that should assist them in treating you. For example, your health information may be provided to a physician to whom you have been referred so as to ensure that the physician has appropriate information regarding your previous treatment and diagnosis.

For Payment. We may use and disclose your medical information so that we can receive payment for the treatment services provided to you. For example, we may need to give your insurance company information regarding your care before it approves or pays for the health care services we recommend and provide for you.

For Healthcare Operations. We may use and disclose your PHI for certain purposes in connection with the operation of my professional practice and business activities. These activities may include, but are not limited to, quality assessment activities, consultation, licensing, legal advice, and information systems support. We may use or disclose your PHI, as necessary, to contact you to remind you of your appoointment by telephone call, text messaging, or email. We may also contact you by mail.

Business Associates. Our organization contracts with some outside vendors (business associates) for certain services. Examples may include collections agencies, billing companies, medical records storage, and software vendors. When these services are contracted, we may disclose your PHI to our business associate(s) so that they can perform the job that we have asked them to do and bill you or your third-pasrty payer for services rendered. To protect your health information, we require the business associate to appropriately safeguard your information through a written contract or Business Associate Agreement (BAA).

Without Your Authorization. State and Federal law also permits us to disclose information about you without your authorization in a limited number of situations, such as with a court order.

With Your Authorization. We must obtain written authorizations from you for other uses and disclosures of your PHI. We will not use or disclose your PHI for marketing purposes. We will not sell your PHI. You may revoke such authorizations in writing in accordance with 45 CFR. 164.508(b)(5). Such revocation of authorization will not be effective for actions we may have taken in reliance on your authorization of the use or disclosure.

Incidental Use and Disclosure. We are not required to eliminate every risk of an incidental use or disclosure of your PHI. Specifically, a use or disclosure of your PHI that occurs as result of, or incident to an otherwise permitted use or disclosure is permitted as long as we have adopted reasonable safeguards to protect your PHI, and the information being shared was limited to the minimum necessary.

Other Uses and Disclosures That Do Not Require Your Authorization

Required by Law. We may use or disclose your PHI to the extent that use or disclosure is required by law, made in compliance with the law, and limited to the relevant requirements of the law. Examples of this type of disclosure include healthcare licensure related reports, public health reports, and law enforcement reports. Under the law, we must make certain disclosures of your PHI to you upon you request. In addition, we must make disclosures to the U.S. Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of privacy rules.

Health Oversight. We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies, seeking this information include government agencies and organizations that provide financial assistance to the program (such as third-party payers) and peer review organizations performing utilization and quality control. If we disclose PHI to a health oversight agency, we will have an agreement in place that requires the agency to safeguard the privacy of your information.

Abuse or Neglect. We may disclose your PHI to a state or local agency that is authorized by law to receive reports of abuse or neglect. However, the information we disclose is limited to only that information which is necessary to make the required mandated report.

Deceased Clients. We may disclose PHI regarding deceased clients for the purpose of determining the cause of death, in connection with laws requiring the collection of death or other vital statistics, or permitting inquiry into the cause of death.

Research. We may disclose PHI to researchers if (a) an Institutional Review Board reviews and approves the research and a waiver to the authorization requirement; (b) the researchers establish protocols to ensure the privacy of your PHI; and (c) the researchers agree to maintain the security of your PHI in accordance with applicable loss and regulations.

Criminal Activity or Threats to Personal Safety. We may disclose your PHI to law-enforcement officials, if we believe that disclosure of confidential information is necessary to prevent or less a serious and imminent threat to the health or safety of a person or the public.

Compulsory Process. We may be required to disclose your PHI if a court of competent jurisdiction issues an appropriate order, and if the rule of privilege has been determined not to apply. We may be required to disclose your PHI if we have been notified in writing at least 14 days in advance of a subpoena, or other legal demand, no protective order has been obtained, and a competent judicial officer has determined that the role of privilege does not apply.

Essential Government Functions. We may be required to disclose your PHI for certain essential government functions. Such functions include: assuring, proper execution of a military mission, conducting intelligence and national security activities that are authorized by law, providing protective services to the president, making medical suitability determinations for U.S. State Department employees, protecting the health and safety of inmates or employees in a correctional institution, and determining eligibility for or conducting enrollment in certain government benefit programs.

Law Enforcement Purposes. We may be authorized to disclose your PHI to law-enforcement officials for law-enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) in response to a law enforcement official's request for information about a victim or suspected a victim of a crime; (4) to alert law-enforcement of a person's death, if we suspect that criminal activity caused the death; (5) when we believe that protected health information is evidence of a crime that occurred on our premises; and (6) in a medical emergency, not occurring on our premises, when necessary to inform law-enforcement, about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.

Psychotherapy Notes. If kept as separate records, we must obtain your authorization to use or disclose psychotherapy notes with the following exceptions. We may use the notes for your treatment. We may also use or disclose, without your authorization, the psychotherapy notes for our own training, to defend ourselves in legal or administrative proceedings initiated by you, for the lawful activities of a corner or medical examiner or as otherwise required by law, or as required by state or federal departments of lawful oversight to investigate or determine our compliance with applicable regulations, and to avoid or minimize an imminent threat to anyone's health or safety. 

Your Rights Regarding Your PHI

You have the following rights regarding PHI that we maintain about you. Any requests with respect to these rights must be in writing. A brief description of how you may exercise these rights is included.

Right of Access to Inspect and Copy. You may inspect and obtain a copy of your PHI that is contained in a designated record set for as long as we maintain the record. A "designated record set" contains medical and billing records and any other records that we use for making decisions about you. Your request must be in writing. We may charge you a reasonable cost-based fee for the copying and transmitting of your PHI. We can deny you access to your PHI in certain circumstances. In some of those cases, you will have a right of recourse to the denial of access. Please contact me if you have questions about access to your medical record. Requests are usually honored within 30 days.

Right to Amend. You may request, in writing, that we amend your PHI that has been included in a designated record set. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

Right to an Accounting of Disclosures. You may request an accounting of disclosures made for treatment purposes or made as a result of your authorization, for a period of up to six years, excluding disclosures made to you. We may charge you a reasonable fee if you request more than one accounting in any 12-month period. Please contact us if you have questions about accounting of disclosures.

Right to Request Restrictions. You have the right to ask us not to use or disclose any part of your PHI for treatment, payment, or healthcare operations or to family members involved in your care. Your request for restrictions must be in writing and we are not required to agree to such restrictions. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. Please contact us if you would like to request restrictions on the disclosure of your PHI. You also have the right to restrict certain disclosures of your PHI to your health plan if you pay out-of-pocket in full for the healthcare we provide to you, unless a law requires us to share that information.

Right to Request Confidential Communication. You have the right to request that we communicate with you about health matters in a certain way. We will agree to the request to the extent that it is reasonable for us to do so. For example, you can ask that we use an alternative address for billing purposes. We ask that you submit these requests in writing.

Right to a Copy of This Notice. You have the right to obtain a copy of this notice from us. Any questions you have about the contents of this document should be directed to us.

Right to Notice of Breach. You have the right to be notified of any breach of your unsecured PHI.

Complaints. If you feel your rights were violated, you may complain by contacting us. You may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

Effective Date

Effective Date of this notice: March 20, 2025