Protected health information (PHI) is maintained as a written and/or electronic record of your contact for healthcare services with our practice. We maintain the confidentiality of your PHI and follow specific rules when using or disclosing it. We will only use or disclose your PHI as described in this Notice unless you authorize other use or disclosure in writing.

YOUR RIGHTS UNDER THE PRIVACY RULE

• You have the right to receive a copy of this Notice of Privacy Practices.

• You have the right to inspect and obtain a copy of your PHI. We have the right to charge a reasonable fee for copies as established by federal guidelines.

• You have the right to request an amendment to your PHI. In certain cases, we may deny your request.

• You have the right to request that we not disclose your PHI for the purposes of treatment, payment, or healthcare operations. We will abide this except in emergency circumstances when the information is needed for your treatment. In certain cases, we may deny your request for a restriction.

• You have the right to request a listing of disclosures we have made of your PHI to entities outside of our practice except for those made upon your request, or for purposes of treatment, payment, or healthcare operations.

• You have the right to receive written notification if the practice discovers a breach of your unsecured PHI, and determines through a risk assessment that notification is required.

• You have the right to ask questions about your privacy rights, file a complaint, or submit a written request for access, restriction, or amendment of your PHI by notifying the practice's owner.
  

EXAMPLES OF HOW WE MAY USE OR DISCLOSE PROTECTED HEALTH INFORMATION

• We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services.

• We may use and disclose your PHI to obtain payment for your healthcare services.

• We may use or disclose your PHI as needed to support the business activities of our practice.

• We may use and disclose your PHI so that you may be contacted about appointments or with information about your treatment plan.

• We may use and disclose your PHI so a member of your family, a relative, a close friend, or any other person that you identify, can be informed of information that directly relates to that person’s involvement in your healthcare, unless you object. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine based on professional judgment that it is in your best interest.

• We may disclose your PHI without your written authorization for the following reasons: if required by state or federal law; for public health activities; in cases of abuse, neglect, or domestic violence; to avert a serious threat to health or safety; in response to a court or administrative order that meets certain requirements; to a coroner, medical examiner, or funeral director; to address worker’s compensation, law enforcement, and certain other government requests; if requested by the Department of Health and Human Services in order to determine our compliance with the requirements of the Privacy Rule.