NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. MY PLEDGE REGARDING HEALTH INFORMATION
The provider commits to protecting personal health information and maintains records of care and services. They are legally required to:
- Keep protected health information (PHI) confidential
- Provide notice of privacy practices and legal duties
- Follow current notice terms
- Make updated notices available upon request
II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
For Treatment, Payment, or Health Care Operations: Healthcare providers may use or disclose PHI without written authorization to provide treatment, coordinate care, consult with other providers, or handle referrals.
Lawsuits and Disputes: Health information may be disclosed in response to court orders or administrative requests, with efforts made to notify the patient beforehand.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION
- Session Notes: Authorization required unless used for treatment, training, legal defense, HIPAA compliance investigations, or preventing serious health threats
- Marketing Purposes: PHI will not be used for marketing
- Sale of PHI: PHI will not be sold
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION
PHI may be disclosed without authorization for:
- Required disclosures by state or federal law
- Public health activities and abuse reporting
- Health oversight activities and audits
- Judicial and administrative proceedings
- Law enforcement purposes
- Coroners or medical examiners
- Research purposes
- Specialized government functions
- Workers' compensation purposes
- Appointment reminders and health-related communications
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT
Disclosures to Family, Friends, or Others: PHI may be provided to individuals involved in your care or payment unless you object.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI
- Right to Request Limits: You may request restrictions on PHI use, though the provider may decline if it affects care
- Right to Request Restrictions for Out-of-Pocket Expenses: You may restrict disclosures for self-paid services
- Right to Choose Contact Method: You may request specific contact methods or addresses
- Right to See and Copy PHI: You may obtain electronic or paper copies within 30 days; reasonable fees may apply
- Right to Disclosure List: You may request an accounting of PHI disclosures from the past six years within 60 days; first request is free
- Right to Correct or Update PHI: You may request corrections or additions to your records within 60 days
- Right to Paper or Electronic Copy of Notice: You may obtain this notice in your preferred format
EFFECTIVE DATE OF THIS NOTICE
This notice became effective January 1, 2026.
Acknowledgement of Receipt of Privacy Notice
Recipients acknowledge receipt of the HIPAA Notice of Privacy Practices by checking a provided box.