Your Information.
Your Rights.
Our Responsibilities.

This notice describes how medical information about you may be used and disclosed as directed by the Health Information Portability and Accountability Act of 1996 (HIPPA) Privacy Rule Please review it carefully.

You have the right to:
• Privacy and Confidentiality of your Personal Health Information (PHI)
• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated

You have some choices in regards to how we
use or share your information:
• If we tell family and friends about your medical care
• Who we disclose your medical information to (except in cases of emergencies and/or continuity of care necessities)

We may use and share your information as we:
• Treat you
• Run our organization & bill for your services
• Help with public health and safety issues
• In the event of a medical emergency
• Respond to organ and tissue donation requests
• Reports required by law related to birth, death, or diseases
• Address workers’ compensation, law enforcement, and other government requests
• Comply with the law, respond to lawsuits and respond to legal actions
• Reports required by law related to neglect or abuse
• For continuity of care with other health professionals that may be treating you