Notice of Privacy Practices

Privacy Practices

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:

  • Tell family and friends about your condition

  • Market our services

  • Raise funds



Our Uses and Disclosures

We may use and share your information as we:

  • Treat you

  • Run our organization

  • Help with public health and safety issues

  • Do research

  • Comply with the law

  • Address law enforcement, and other government requests

  • Respond to lawsuits and legal actions



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

  • You can ask to see or get an electronic or paper copy of your medical 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 health information, usually within 30 days of your request. Ask us to correct your medical record.

  • You can ask us to correct 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.


    • 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 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.

    • 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, and health care operations, and certain other disclosures (such as any you asked us to make).





    Get a copy of this privacy notice:
    You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

    Choose someone to act for you:

    • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

    • We will make sure the person has this authority and can act for you before we take any action.


    File a complaint if you feel your rights are violated:

    • You can complain if you feel we have violated your rights by contacting us.

    • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

    • We will not retaliate against you for filing a complaint.



    Your Choices:
    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:

    • Share information with your family, close friends, or others involved in your care.

    • If you are not able to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.



    In the following cases, we never share your information unless you give us written permission:

    • Marketing purposes

    • Most sharing of psychotherapy notes



    In the case of fundraising:
    • We will not contact you for fundraising efforts


    How do we typically use or share your health information?

    We use or share your health information in the following ways:

    Treat you

    We use your health information and share it with other professionals who are treating you.

    Example: A doctor treating you for an injury asks another doctor about your overall health condition.

    Run our organization

    We 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.

    Advertising & Promotion

    For advertising and promotion, we may use your story and/or ultrasound images with all identifying information removed or de-identified to protect your privacy. www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.


    Help with public health and safety issues

    We can share health information about you for certain situations such as:

    • Preventing disease


    • Helping with product recalls


    • Reporting adverse reactions to medications


    • Reporting suspected abuse, neglect, or domestic violence


    • Preventing or reducing a serious threat to anyone’s health or safety



    Do research

    We can use or share your information for health research.

    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.

    Address law enforcement, and other government requests

    We can use or share health information about you:

      For law enforcement purposes or with a law enforcement official

      With health oversight agencies for activities authorized by law

    • 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.

    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. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.


    For more information: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

    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.

Back to top