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.
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 get an
electronic or paper copy of your medical record:
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
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:
In the case of fundraising:
We typically use or share your health information in the
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.
We can use and share your health information to run our
practice, improve your care, and contact you when
Example: We use health information about you to manage
your treatment and 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.
We can share health information about you for certain
situations such as:
We can use or share your information for health research.
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.
We can share health information about you with organ
We can share health information with a coroner, medical
examiner, or funeral director when an individual dies.
We can use or share health information about you:
We can share health information about you in response
to a court or administrative order, or in response to a
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