HIPAA Privacy Notice

PRIVACY NOTICE

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.

This Privacy Notice is being provided to you as a requirement of a federal law, the Health
Insurance Portability and Accountability Act (HIPAA). This Privacy Notice describes
how we may use and disclose your protected health information to carry out treatment,
payment, or health care operations and for other purposes that are permitted or required
by law. It also describes your right to access and control your protected health
information. Your “protected health information” means any written or oral information
about you, including demographic data that can be used to identify you, created or
received by your health care provider, which relates to your past, present, or future
physical or mental health or condition.

Uses and Disclosures of Protected Health Information for Treatment, Payment,
and Health Care Operations

We may use your protected health information for the purposes of providing treatment,
obtaining payment for treatment, and conducting health care operations. Your protected
health information may be used or disclosed only for these purposes unless we have
obtained your authorization or the use or disclosure is permitted or required by the
HIPAA regulations or other law. Disclosures of your protected health information for the
purposes described in this Privacy Notice may be made in writing, orally, or by electronic
means.

1. Treatment. We will use and disclose your protected healthcare information to
provide, coordinate, or manage your health care and related services, including
coordination and management with third parties for treatment purposes. Here are
some examples of how we may use or disclose your protected health information for
treatment:

2. Payment. We will use your protected health information to obtain payment for the
services we provide you. We may disclose your protected health information to
another provider involved in your care for their payment activities. Here are some
examples of how we may use or disclose your protected health information for
payment:

3. Health Care Operations. We may use and disclose your protected health

information to facilitate our own health care operations and to provide quality care to
all our patients. Health care operations include such activities as: quality assessment
and improvement, employee review activities, conducting or arranging for medical
review, legal services, and auditing functions, including fraud and abuse detection
and compliance reviews, business planning and development, and business
management and general administrative activities. In certain situations, we may also
disclose your protected health information to another provider or health plan for their
health care operations. Here are some examples of how we may use or disclose
your protected health information for health care operations:

4. Other Uses and Disclosures. As part of the functions above, we may use or disclose
protected health information to provide you with appointment reminders, to inform
you of treatment alternatives, or to provide you with information about other health related
benefits and services which may be of interest to you.

Uses and Disclosures of Protected Health Information (PHI) Permitted
without Authorization or Opportunity for the Individual to Object
The federal privacy rules allow us to use or disclose your protected health information
without your authorization and without you having the opportunity to object to such use
or disclosure in certain circumstances, including:
1. When Required By law. We will disclose your protected health information
when we are required to do so by federal, state, or local law.
2. For Public Health Reasons. We may disclose your protected health information as
permitted or required by law for the following public health reasons:
3. To Report Abuse, Neglect, or Domestic Violence. We may notify government
authorities if we believe a patient is a victim of abuse, neglect, or domestic violence.
We will make this disclosure only when specifically authorized or required by law,
or when the patient agrees to the disclosure.
4. For Health Oversight Activities. We may disclose your protected health information
to health oversight activities authorized by law, including audits; civil,
administrative, or criminal investigations; inspections; licensure or disciplinary
actions; civil, administrative, or criminal proceedings or actions; or other activities
necessary for appropriate oversight.
5. For Judicial or Administrative Proceedings. We may disclose your protected
health information in the course of any judicial or administrative proceeding in
response to an order of a court or administrative tribunal as expressly authorized by
such order. We may disclose your protected health information in response to a
subpoena, discovery request, or other lawful process that is not accompanied by an
order of a court or administrative tribunal if we have received satisfactory assurances
that you have been notified of the request or that an effort has been made to secure a
protective order.
6. For Law Enforcement Purposes. We may disclose your protected health
information to a law enforcement official for law enforcement purposes, including:
7. To Coroners, Medical Examiners, and Funeral Directors. We may disclose
protected health information to a coroner or medical examiner for the purpose of
identifying a deceased person, determining a cause of death, or other duties as
authorized by law. We may disclose protected health information to funeral directors,
consistent with applicable law, as necessary to carry out their duties with respect to the
decedent. In some cases such disclosures may occur prior to, and in reasonable
anticipation of, the individual’s death.
8. For Organ or Tissue Donation. We may use or disclose your protected health
information to organ procurement organizations or other entities engaged in the
procurement, banking, or transplantation of cadaveric organs, eyes, or tissue for the
purpose of facilitating donation and transplant.
9. For Research Purposes. We may use or disclose your protected health information for
research purposes when an institutional review board that has reviewed the research
Revised May 2024
proposal and protocols to safeguard the privacy of your protected health information
has approved such use or disclosure.
10. To Avert a Serious Threat to Health or Safety. We may, consistent with applicable
law and standards of ethical conduct, use or disclose your protected health information
if we believe, in good faith, that such use or disclosure is necessary to prevent or lessen
a serious and imminent threat to your health and safety or that of the public.
11. For Specialized Government Function. We may use or disclose your protected health
information, as authorized or required by law, to facilitate specified government
functions related to military and veterans activities, national security and intelligence
activities, protective services for the President and others, medical suitability
determinations, correctional institutions and other law enforcement custodial situations.
12. For Worker’s Compensation. We may use and disclose your protected health
information, as necessary, to comply with worker’s compensation laws or similar
programs.

Uses and Disclosures of Protected Health Information Permitted
without Authorization but with an Opportunity for the Individual to
Object
We may use your protected health information to maintain a directory of patients in our
facility. The information included in the directory will be limited to your name, your location
in our facility, and your condition described in general terms.
We may disclose your protected health information to a friend or family member who is
involved in your medical care or payment for care. In addition, if applicable, we may disclose
medical information about you to an entity assisting in a disaster relief effort so that your
family can be notified about your condition, status, and location.
You may object to these disclosures. If you do not object to these disclosures, or we
determine
in the exercise of our professional judgment that it is in your best interest for us to disclose
information that is directly relevant to the person’s involvement with your care, we may
disclose your protected health information.

Uses and Disclosures of Protected Health Information Which You Authorize
Other than the uses and disclosures described above, we will not use or disclose your
protected health information without your written authorization. Authorizations are for
specific uses of your protected health information, and once you give us authorization,
any disclosures we make will be limited to those consistent with the terms of the
authorization. You make revoke your authorization, by submitting a revocation in writing,
at any time, except to the extent that we have already taken action in reliance upon your
authorization.
Your Rights Regarding Your Protected Health Information
You have the following rights regarding your protected health information:
1. The Right to Request Restriction of Uses and Disclosures. You have the right to
request that we not use or disclose certain parts of your protected health information
for the purposes of treatment, payment, or healthcare operations. You also have the
right to request that we do not disclose your protected health information to friends or
family members who may be involved in your care, or for notification purposes as
described earlier in this notice. Your request must be made in writing and must state
the specific restriction requested and the individuals to whom the restrictions apply.
We are not required to agree to a restriction you may request. We will notify you if
we do not agree to your restriction request. If we do agree to the restriction request,
we will not use or disclose your protected health information in violation of the
agreed upon restriction, unless necessary for the provision of emergency treatment.
We may terminate our agreement to a restriction if you agree to the termination in
writing, if you agree to the termination orally and the oral agreement is documented, or if
we notify you of termination of the agreement and the termination applies only to
protected health information created or received by us after you receive the notice
of termination of the restriction.
Requests for restriction must be made in writing to the Privacy Officer.
2. The Right to Request Confidential Communications. You have the right to request
that you receive communications of protected health information from us by
alternative means or at alternative locations. We must accommodate any reasonable
request of this nature. We may condition the provision or accommodation by
requesting information from you describing how payment will be handled, or by
requesting specification of an alternate address or alternate form of contact.
Requests for confidential communications must be made in writing to the Privacy
Officer
3. The Right to Inspect and Copy Protected Health Information. You have the right
to inspect and obtain a copy of your protected health information that is maintained in
a designated record set for as long as we maintain the protected health information.
The designated record set is a collection of records maintained by us, which contains
medical and billing information used in the course of your care, and any other
information used to make decisions about you.
By law, you do not have the right to access psychotherapy notes, information compiled
in reasonable anticipation of, or for use in, a civil, criminal, or administrative
proceeding, and protected health information which is subject to a law which
prohibits access to protected health information. Depending on the circumstance of
your request, you may have the right to have a decision to deny access reviewed.
We may deny your request to inspect or copy your protected health information if, in
our professional judgment, we determine that the access requested is likely to
endanger you or another person, or is likely to cause substantial harm to another
person referenced within the protected health information. You have the right to request
a review of a denial of access.
Requests for access to your protected health information must be made in writing to
the Privacy Officer.
4. The Right to Amend Protected Health Information. You have the right to request
that we amend your protected health information in a designated record set for as long
as we maintain that information. In certain cases we may deny your request. If we
deny your request you will be notified in writing, and you will have the right to file a
statement of disagreement. If we do so, we will provide a copy of our rebuttal to you.
Requests for amendment of protected health information must be made in writing to the
Privacy Officer and must include a reason to support the requested amendments.
5. The Right to Receive an Accounting of Disclosures of Protected Health
Information. You have the right to request an account of disclosures of your
protected health information made by us. This right applies to disclosures made by
us except for disclosures to carry out treatment, payment, or health care operations
as described in this Notice or incidental to such use; to you or your personal
representatives; pursuant to your authorization; for our directory, or other notification
purposes, or to persons involved in your care; or for certain other disclosures we are
permitted to make without your authorization.
Requests for accounting of disclosures must specify a time period sought for the
accounting, with the maximum time period being six years prior to the date of the
request. We are not required to provide accounting disclosures made before April 14,
2003. We will provide the first disclosure accounting you request during any 12-month
period without charge.
6. The Right to Obtain a Paper Copy of this Notice. Upon request, we will provide a
paper copy of this Notice.

Your Rights Regarding Your Protected Health Information
We are required by law to maintain the privacy of your health information and to provide
you with this Privacy Notice of our legal duties and privacy practices with respect to
protected health information. We are required to abide by the terms of the Notice
currently in effect. We reserve the right to change the terms of this Notice and to make
any new provisions effective for all protected health information that we maintain. If we
change the Notice, we will provide a copy of the revised Notice through in-person contact.

Your Rights Regarding Your Protected Health Information
You have the right to express complaints to us and to the Secretary of the Department of
Health and Human Services if you believe that your privacy rights have been violated.
If you wish to complain to us, please do so in writing to the Privacy Officer.
You will not be penalized for filing a complaint.