Your Information. Your Rights. Our Responsibilities.

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

You have the right to:

  • 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
  • Get a copy of this privacy notice
  • Choose someone to act for you
  • File a complaint if you believe your privacy rights have been violated

 

Your Choices

You have some choices in the way that we use and share information as we:

  • Provide mental health care
  • In emergency situations tell family and friends about your condition
  • Provide disaster relief

 

Our Uses and Disclosures

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
  • Do research
  • Comply with the law
  • Address workers’ compensation, law enforcement, and other government requests
  • Respond to lawsuits and legal actions

 

Your Rights

When it comes to your health information, you have certain rights.  This section explains your rights and some of our responsibilities to help you.

 

Get an electronic or paper copy of your medical record

  • You can ask to see or get an electronic or paper copy of your treatment record and other health information we have about you. Ask us how to do this.
  • We will provide a copy or a summary of your treatment and health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

 

Ask us to correct your medical record

  • You can ask us to correct treatment and health information about you that you think is incorrect or incomplete. Ask us how to do this.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days

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Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will say “yes” to all reasonable requests.

 

Ask us to limit what we use or share

  • You can ask us not to use or share certain treatment and health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

 

Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.