YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.

This document details how your medical information may be used and disclosed, and how you can access this information. Please review it carefully.

Your Rights

• Obtain a copy of your digital or physical medical record
• Make corrections to your digital or physical medical record
• Request confidential communication
• Request that we limit the information we disclose
• Obtain a list of those with whom we’ve shared your information
• Access a copy of this privacy disclosure document
• Delegate someone to act on your behalf
• File a complaint if you believe your privacy rights have been violated

Your Choices

You have several choices regarding how we use and share information. You may choose whether we:

• Disclose information about your medical condition to family and friends
• Provide disaster relief
• Include your information in a hospital directory
• Provide behavioral health and substance use disorder care
• Market our services or sell your information
• Secure funding

Our Uses and Disclosures

We may use and share your information as we:

• Provide treatment to you
• Operate our organization
• Invoice for services rendered
• Assist with public health and safety issues
• Conduct research
• Comply with laws and regulations
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Reply to lawsuits and legal actions

What Are My Rights?

You have specific rights regarding your health information, and our organization is responsible for supporting those rights.

• Obtain a copy of your medical record: Request access to your digital or physical health records. We’ll provide them within 30 business days and may charge a reasonable fee.
• Request to revise your medical record: If you believe something is incorrect, we’ll review your request and respond within 60 business days.
• Request confidential communications: Ask us to contact you at specific addresses or phone numbers.
• Request limits on disclosures: You may ask us not to share certain information for treatment or operations. We’ll honor these requests unless restricted by law.
• Obtain a disclosure list: Request a list of when and why your information was shared (within six years of the request).
• Delegate someone to act for you: A legal guardian or medical power of attorney may exercise your rights.
• File a complaint: If you believe your privacy rights were violated, you can contact us or the U.S. Department of Health and Human Services (HHS). No retaliation will occur.

Learn more about your rights at hhs.gov.

Your Decisions

You have the right to tell us how we may share your information. We’ll follow your instructions in situations such as:

• Disclosing information to family or friends involved in your care
• Sharing data during a disaster relief effort
• Including your name in a hospital directory

If you cannot express your preferences (for example, if you are unconscious), we may share information if it’s in your best interest or necessary to prevent harm.

Our Responsibilities

• Maintain the privacy and security of your protected health information
• Notify you promptly if a data breach occurs
• Follow all duties and privacy practices outlined in this notice
• Refrain from using or sharing your information without written or verbal authorization

Changes to This Notice

We may update this privacy notice at any time. Updated versions will be available in our offices and on our website.

Additional Resources

For more information about your rights under HIPAA, visit: https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html

Effective Date: July 1, 2024

Our organization will never market or sell your personal information.