Notice of Privacy Practices

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This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record to provide you with quality care and to comply with certain legal requirements.

The law requires us to:

Keep your medical information private.

Give you this notice describing our legal duties, privacy practices, and your rights regarding your medical information.

Follow the terms of the notice that is now in effect.

We have a right to:

Change our privacy practices and the terms of this notice at any time, provided that the changes are permitted by law.

Make the changes in our privacy practices and the new terms of our notice effective for all medical information that we keep, including information previously created and received before the changes.

Notice of change to Privacy Practices:

Before we make an important change in our privacy practices, we will change this notice and make the new notice available upon request.

We will not use or disclose your medical information for any purpose not listed below, without your specific written authorization. Any specific written authorization you provide may be revoked at any time.

For treatment:

We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other people who are taking care of you. We may also share medical information about you to your other health care providers to assist them in treating you.

For payment:

We may use and disclose your medical information for payment purposes.

For health care operations:

We may use and disclose your medical information for our health care operations. This might include measuring and improving quality, evaluating the performance of employees, conducting training programs, and getting accreditation, certificates, licenses and credentials we need to serve you.

In addition to using and disclosing your medical information for treatment, payment, and health care operations. We may use and disclose medical information for the following purposes.

Victims of abuse, neglect, or domestic violence:

We may disclose medical information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may share your medical information if it is necessary to prevent a serious threat to your health or safety or the health or safety of others. We may share medical information when necessary to help law enforcement officials capture a person who has admitted to being part of a crime or has escaped from legal custody.

Law enforcement:

Under certain circumstances, we may disclose health information to law enforcement officials. These circumstances include reporting required by certain laws, reporting limited information concerning identification and location at the request of a law enforcement official, reports regarding suspected victims of crimes at the request of a law enforcement official, reporting death, crimes on our premises, and crimes in emergencies.

Court orders and judicial and administrative proceedings:

We may disclose medical information in response to a court or administrative order, subpoena, discovery request, or other lawful process, under certain circumstances. Under limited circumstances, such as a court order, warrant, or grand jury subpoena, we may share your medical information with a law enforcement official concerning the medical information of a suspect, fugitive, material witness, crime victim or missing person.

You have a right to:

Look at or get copies of your medical information. You must make your request in writing.

Receive a list of all the times we shared your medical information for purposes other than treatment, payment, health care operations and other specified exceptions.

Request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions.

Request that we change your medical information. We may deny your request if we did not create the medical information you want changed or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement that will be added to the information you want changed. If we accept your request to change information, we will make reasonable efforts to tell others, including people you name, of the change and to include the changes in any future sharing of that information.

If you have any questions regarding this Notice of Privacy Practices or about your protected health information, please ask your counselor for more information.