Last updated: November 4, 2026
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

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 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. We may charge a reasonable,
cost-based fee.

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.
- 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.

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 using the information on the back page.
- 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 Rights

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
- Share information in a disaster relief situation
- Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are
unconscious, we may go ahead and 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 these cases we never share your information unless you give us written
permission:

- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes

In the case of fundraising:

- We may contact you for fundraising efforts, but you can tell us not to
contact you again.

No mobile information will be shared with third parties/affiliates for
marketing/promotional purposes. All other categories exclude text messaging
originator opt-in data and consent; this information will not be shared
with any third parties.
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.

Treat you

- We can 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 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.

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, see:
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.

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:
- For workers\’ compensation claims
- For law enforcement purposes or with a law
enforcement official
- With health oversight agencies for activities
authorized by law
- For special government functions such as
military, national security, and presidential
protective services

Respond to lawsuits and legal actions

- We can use or 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 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.
- We will let you know promptly if a breach occurs that may have
compromised the privacy or security of your information.

For more information see:
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.