HIPAA Notice of Privacy Practices

Draft pending counsel review. Draft pending counsel review.

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. You can:

• Get a copy of your health and claims records, electronic or paper. We will provide a copy or summary, usually within 30 days, and may charge a reasonable, cost-based fee.
• Ask us to correct your records if you think they are incorrect or incomplete. We may say no, but will tell you why in writing within 60 days.
• Request confidential communications, such as contact at a different phone or address. We will say yes to all reasonable requests.
• Ask us to limit what we use or share. We are not required to agree, except that if you pay for a service out-of-pocket in full, you can ask us not to share that information with your health insurer for payment or operations, and we will say yes unless a law requires us to share it.
• Get a list of those with whom we've shared information for six years prior to the date you ask, with certain exceptions.
• Get a copy of this privacy notice, on paper, at any time.
• Choose someone to act for you, such as a medical power of attorney or legal guardian.
• File a complaint if you feel your rights are violated. Contact our privacy officer (, (844) 744-0101), or the U.S. Department of Health and Human Services Office for Civil Rights, 200 Independence Avenue SW, Washington, D.C. 20201, 1-877-696-6775, www.hhs.gov/ocr/complaints. We will not retaliate against you for filing a complaint.

Your choices

You can tell us your choices about sharing information with family, close friends or others involved in your care, and in disaster-relief situations. If you are not able to tell us your preference, we may share information if we believe it is in your best interest. We never market or sell your information, or share psychotherapy notes, without your written permission.

Our uses and disclosures

• Treat you: for example, filling prescriptions and coordinating with your prescriber and care team.
• Run our organization: for example, quality review and staff training.
• Bill for services: for example, billing your health plan or other payer.
• Other ways we may share: public-health and safety issues (such as reporting adverse reactions or product recalls); research; complying with the law; organ and tissue donation requests; medical examiners or funeral directors; workers' compensation, law enforcement and other government requests; and lawsuits and legal actions.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. You may change your mind at any time in writing.

Changes to this notice

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 on request, in our pharmacy and on this website.

State law