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Privacy Policy


Individually identifiable information about your past, present, or future health or condition, the provision of health care to you, or payment for health care is considered “Protected Health Information” (PHI). We are required to extend certain protections to your PHI, and to give you this Notice about our privacy practices that explains how, when and why we may use or disclose your PHI. Except in specified circumstances, we must use or disclose only the minimum necessary PHI.

We are required to follow the privacy practices described in this Notice though we reserve the right to change our privacy practices and the terms of this Notice at any time. You may request a copy of the new Notice from us, and a new copy of it will be posted in our office.


We use and disclose your PHI for many different reasons. Some of the uses or disclosures will require your prior written authorization; others, however, will not. The following describes and offers examples of our potential uses/disclosures of your PHI.


For treatment: We may disclose your PHI to doctors, nurses, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are otherwise involved in your care. Your PHI may also be shared with outside entities performing ancillary services relating to your treatment, such as lab work or x-rays, or for consultation purposes, or community mental health agencies involved in providing or coordinating your health care.

To obtain payment: We may use/disclose your PHI in order to bill or collect payment for your health care services.

For health care operations: We may use/disclose your PHI to facilitate the efficient and correct operation of the health services offered. For example, we might use your PHI in the evaluation of the quality of health care services that you have received or to evaluate the performance of the health care professionals who provide you with these services.

Other disclosures: We are permitted to contact you, without your prior authorization, to provide appointment reminders or information about alternative or other health-related benefits and services that may be of interest to you.


When required by law: We may disclose PHI when a law requires that we report information about suspected child and/or elder abuse and neglect or when a crime has been committed on the program premises or against program personnel, or in response to a court order. We must also disclose PHI to authorities that monitor compliance with these privacy requirements.

For public health activities: We may disclose PHI when we are required to collect information about disease or injury, or to report vital statistics to the public health authority.

To avoid harm: We may provide PHI to law enforcement personnel or persons able to prevent or mitigate a serious threat to the health or safety or a person or the public.

If disclosure is compelled or permitted by the fact that you are in such mental or emotional condition as to be dangerous to yourself or the person or property of others, and if we determine that disclosure is necessary to prevent the threatened danger. Disclosure is compelled or permitted by the fact that you tell us of a serious/imminent threat of physical violence by you against a reasonably identifiable victim or victims.

Disclosure is compelled or permitted if we determine that you pose a serious/imminent threat to your own safety and health.

For research purposes: In certain circumstance, we may provide PHI in order to conduct medical research.

For specific government functions: We may disclose PHI to correctional facilities in certain situations, to government benefit programs relating to eligibility and enrollment, and for national security reasons.

For health oversight activities: We may disclose PHI to another agency responsible for monitoring the health care system (i.e., investigating or assessing compliance to federal regulations).


For uses and disclosures beyond treatment, payment and operations purposes, we are required to have your written authorization, unless the use or disclosure falls within one of the exceptions described. Authorizations can be revoked at any time to stop future uses/disclosures except to the extent that we have already undertaken an action in reliance upon your authorization.


in the following situation, we may disclose a limited amount of your PHI if we inform you about the disclosure in advance and you do not object, as long as the law does not otherwise prohibit the disclosure. To families, friends, or others involved in your care: We may provide PHI to a family member, friend, or other individual who you indicate is involved in your care or responsible for the payment for your health care, unless you object in whole or in part. Retroactive consent may be obtained in emergency situations.


You have the following rights relating to protected health information:

To inspect and request a copy of your PHI

Unless your access to your records is restricted for clear and documented treatment reasons, you have the right to see your protected health information upon your written request. We will respond to your request within 30 days. If we deny you access, we will give you written reasons for the denial and explain any right to have the denial reviewed. If you want copies of your PHI, a charge for copying may be imposed, depending on your circumstances. You have the right to choose what portions of your information you want copied and to have prior information on the cost of copying.

To request restrictions on uses/disclosures

You have the right to ask that we limit how we use or disclose your PHI. We will consider your request, but are not legally bound to agree to the restriction. To the extent that we do agree to any restrictions on our use/disclosure of your PHI, we will put the agreement in writing and abide by it except in emergency situations. We cannot agree to limit uses/disclosure that are required by law.

To choose how we contact you

You have the right to ask that we send you information to an alternative address or by an alternative means. We must agree to your request as long as it is reasonably easy for us to do so.

To request amendment of your PHI

If you believe that there is a mistake of your PHI, you may request, in writing, that we correct or add to the record. We will respond within 60 days of receiving your request. We may deny the request if we determine that the PHI is (1) correct and complete; (2) not created by us and/or not part of our records, or (3) not permitted to be disclosed. Any denial will state the reasons for denial and explain your rights to have the request and denial, along with any statement in response that you provide, appended to your PHI. If we approve the request for amendment, we will change the PHI and so inform you, and tell others that need to know about the change in the PHI.


You have a right to receive a paper copy of this Notice and/or an electronic copy by email upon request.


I f you think we may have violated your privacy right, or you disagree with a decision we made about access to your PHI, you may file a complaint with the person listed below. You also may file a written complaint with Secretary of the U.S. Department of Health and Human Services at 200 Independence Avenue SW, Washington D.C., 20201 or call 1-877-696-6755. We will take no retaliatory action against you if you make such complaints.

To find out what disclosures have been made:

You have a right to get a list of when, to whom, for what purpose, and what content of your PHI has been released other than instances of disclosure: for treatment, payment, and operations; to you, your family, or the facility directory; or pursuant to your written authorization. The list also will not include any disclosures made for national security purposes, to law enforcement officials or correctional facilities, or disclosure made before April 2003. We will respond to your written request for such a list within 60 days of receiving it. Your request can relate to disclosures going as far back as six years. There will be no charge for up to one such list each year. There may be a charge for more frequent request.


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