Privacy Officer Contact Information: via email at email@example.com or phone (760) 284-5368.
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.
By acknowledging receipt, you agree that you have received this notice on behalf of yourself.
You have the right to:
You have some choices in the way that we use and share information as we:
Our Uses and Disclosures
We may use and share your information as we:
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
Ask us to correct your medical record
Request confidential communications
Ask us to limit what we use or share
Get a list of those with whom we have shared information
Get a copy of this privacy notice
Choose someone to act for you
File a complaint if you feel your rights are violated
For certain health information you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.In these cases, you have both the right and choice to tell us to:
In these cases we never share your information unless you give us written permission:
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
We can use your health information and share it with other professionals who are treating you.Example: A telemedicine doctor treating you for ADHD conditions and symptoms shares information with your primary care provider.
Example: We may send you appointment reminders.
Example: We may send you information about treatment alternatives.
Run Our Organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Example: We use health information about you to provide you information about our health-related products and services.
Example: We use health information about you to improve the way we provide care to patients, including developing and improving the technologies that we use to deliver care.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information on your rights under HIPAA visit: https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html
Help with public health and safety issues
We can share health information about you for certain situations such as:
We will share your information with service providers, known as “business associates,” who assist us with treating you, obtaining payment for treatment, and with our operations. Before doing so, we require each business associate to sign a contract agreeing to maintain the privacy and security of your information.
We can use or share your information for health research. Also, we may use aggregated information about user trends, characteristics, and preferences that we have compiled through third parties to help our outreach activities. This data is not specific information about you or anyone else specifically but rather generalized information about groups of people. If you do not wish for your data to be included, please contact us via one of the methods at the top of this notice.
Comply With The Law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
Respond to Lawsuits and Legal Actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Many state laws further restrict how we may use and share your health information. For example, state laws may require that we obtain your permission before sharing information about substance use disorders, sexually transmitted diseases, or psychotherapy information. We will follow these more stringent state laws.
Notice Regarding Use of Technology
We may use electronic software, services, and equipment, including without limitation email, video conferencing technology, cloud storage and servers, internet communication, cellular network, voicemail, facsimile, electronic health record, and related technology to share your health information with you and others. We will encrypt your information where encryption is reasonable, unless you instruct us otherwise, such as if you instruct us to send test results through unencrypted email or text. We will take reasonable measures to safeguard the data transmitted, as well as ensure its integrity against intentional or unintentional breach or corruption. However, in very rare circumstances security protocols could fail, causing a breach of privacy or security of PHI.
Changes to the Terms of 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 upon request, in our office, and on our website.