Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
You have the right to:
- Get a copy of your paper or electronic medical record.
- Correct your paper or electronic medical record.
- Request confidential communications.
- Ask us to limit the information we share.
- Get a list of those with whom we’ve shared your information.
- Get a copy of this privacy notice.
- Choose someone to act for you.
- File a complaint if you believe your privacy rights have been violated.
Get an Electronic or Paper Copy of Your Medical Record
- 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 summary of your health information, usually within 30 days of your request.
- We may charge a reasonable, cost-based fee.
Ask Us to Amend Your Medical Record
- You can ask us to amend health information about you that you believe is incorrect or incomplete.
- Ask us how to do this.
- We may deny your request, but we will tell you why in writing within 60 days.
Request Confidential Communications
- You can ask us to contact you in a specific way (for example, at your home or office phone) or send mail to a different address.
- We will say “yes” to all reasonable requests.
Ask Us to Limit What We Use or Share
- You can ask us not to use or share certain health information for treatment, payment, or health care 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 completely out of pocket, you can ask us not to share that information with your health insurer for payment or operations.
- We will say “yes” unless a law requires us to share that information.
Electronic Exchange
Your information may be shared with other providers, laboratories, and radiology groups through our electronic health record (EHR) systems, including:
- Spruce Text
- Go High Level CRM
- Optimantra Health Record
- PracticeQ Health Record
Get a List of Those with Whom We’ve Shared Information
- You can request a list (an accounting) of the times we’ve shared your health information during the six years prior to your request.
- The list will include:
- Who we shared it with.
- Why we shared it.
- The list will not include disclosures made for treatment, payment, health care operations, or certain other permitted disclosures.
- One accounting per year is free. Additional requests within 12 months may incur a reasonable, cost-based fee.
Get a Copy of This Privacy Notice
You may request a paper copy of this notice at any time.
Choose Someone to Act for You
If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices about your health information.
We will verify that the person has the proper authority before taking any action.
Your Choices
For certain health information, you have choices about what we share.
If you have a clear preference for how we share your information in the following situations, let us know, and we will follow your instructions.
You may choose to:
- Share information with your family, close friends, or others involved in your care.
- Share information in a disaster relief situation.
If you are unable to tell us your preference, we may share your information if we believe it is in your best interest.
We may also share your information when necessary to lessen a serious and imminent threat to health or safety.
We Never Share Your Information Without Written Permission For:
- Marketing purposes.
- Most sharing of psychotherapy notes.
- Sale of your information.
For fundraising purposes, we may contact you, but you may tell us not to contact you again.
Our Uses and Disclosures
We typically use or share your health information to:
- Treat you.
- Run our organization.
- Bill for your services.
Treatment
We can use your health information and share it with other professionals who are treating you.
Health Care Operations
We can use and share your health information to:
- Operate our practice.
- Improve your care.
- Contact you when necessary.
Payment
We can use and share your health information to bill and receive payment from health plans or other entities.
How Else Can We Use or Share Your Health Information?
We are allowed or required to share your information in ways that contribute to the public good, including public health and research.
For more information, visit:
www.hhs.gov/ocr/privacy/understanding/consumers/index.html
Help with Public Health and Safety Issues
We may share your health information for situations such as:
- Preventing disease.
- Preventing or reducing a serious threat to health or safety.
- Product recalls.
- Reporting suspected abuse, neglect, or domestic violence.
- Reporting adverse reactions to medications.
Research
We may use or share your information for research when permitted by law.
Comply with the Law
We will share information when required by state or federal law, including with the U.S. Department of Health and Human Services if it needs to verify compliance with federal privacy laws.
Organ and Tissue Donation
We may share your health information in response to organ and tissue donation requests.
Medical Examiner or Funeral Director
We may share information with a medical examiner, coroner, or funeral director when appropriate.
Other Permitted Uses
We may also use or share your health information:
- For workers’ compensation claims.
- For law enforcement purposes.
- With health oversight agencies.
- For military, national security, or presidential protective services.
- In response to lawsuits or legal actions.
Our Responsibilities
We are required by law to:
- Maintain the privacy and security of your protected health information.
- Notify you promptly if a breach occurs that may have compromised your information.
- Follow the privacy practices described in this notice.
- Provide you with a copy of this notice.
We will not use or share your information in any other way unless you authorize us in writing.
You may change your authorization at any time by notifying us in writing.
For more information, visit:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
Changes to This Notice
We may change the terms of this notice.
Any changes will apply to all health information we maintain about you.
The updated notice will be available:
- Upon request.
- In our office.
- On our website.
You Have the Right to File a Complaint
If you believe your privacy rights have been violated:
- Ask our staff for a Privacy Complaint Form. Our Security Officer will review your complaint and promptly notify you of the actions our office will take.
OR
File a complaint with the:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, DC 20201
Phone: 1-877-696-6775
Website:
http://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html
We will not retaliate against you for filing a complaint.
Privacy Officer
Julia Montgomery, NP
Phone: (804) 601-8625
Effective Date
This Notice of Privacy Practices is effective January 1, 2025.
