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
When it comes to your health information, you have certain rights.
This section explains your rights and some of our responsibilities to help
Get an electronic or paper copy of your medical record
Ask us to correct your medical record
Request confidential communications
Ask us to limit what we use or share
Get a list of those with whom we’ve shared information
Get a copy of this privacy notice
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.
Choose someone to act for you
File a complaint if you feel your rights are violated
For certain health information, you can tell us your choices about what
If you have a clear preference for how we share your information in the
situations described below, talk to us. Tell us what you want us to do, and
we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
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.
In these cases we never share your information unless you give us written
In the case of fundraising:
How do we typically use or share your health information? We typically use or share your health information in the following ways.
We can use your health information and share it with other professionals
who are treating you.
Example: A doctor treating you for an injury asks another doctor about
your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve
your care, and contact you when necessary.
Example: We use health information about you to manage your treatment
Bill for your services
We can use and share your health information to bill and get payment from
health plans or other entities.
Example: We give information about you to your health insurance plan so
it will pay for your services.
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 see:
Help with public health and safety issues
We can share health information about you for certain situations such as:
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it,
including with the Department of Health and Human Services if it wants to
see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or
funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government
We can use or share health information about you:
Respond to lawsuits and legal actions
We can share health information about you in response to a court or
administrative order, or in response to a subpoena.
For more information see:
We can change the terms of this notice, and the changes will apply to all
information we have about you. The new notice will be available upon
request, in our office, and on our web site.
If you have questions regarding your rights or want to request your
Last Updated: January 25, 2021