HIPAA Notice of Privacy Practices

The following are statements of your rights with respect to your protected health information.  

You have the right to inspect and copy your protected health information (fees may apply) – Under federal law,  however, you may not inspect or copy the following records: Psychotherapy notes, information compiled in reasonable  anticipation of, or used in, a civil, criminal, or administrative action or proceeding, protected health information restricted  by law, information that is related to medical research in which you have agreed to participate, information whose  disclosure may result in harm or injury to you or to another person, or information that was obtained under a promise of  confidentiality. 

You have the right to request a restriction of your protected health information – This means you may ask us not to  use or disclose any part of your protected health information and by law we must comply when the protected health  information pertains solely to a health care item or service for which the health care provider involved has been paid out  of pocket in full. You may also request that any part of your protected health information not be disclosed to family  members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy  Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. By  law, you may not request that we restrict the disclosure of your PHI for treatment purposes. 

You have the right to request to receive confidential communications – You have the right to request confidential  communication from us by alternative means or at an alternative location. You have the right to obtain a paper copy of  this notice from us, upon request, even if you have agreed to accept this notice alternatively i.e. electronically.  

You have the right to request an amendment to your protected health information – If we deny your request for  amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your  statement and will provide you with a copy of any such rebuttal.  

You have the right to receive an accounting of certain disclosures – You have the right to receive an accounting of all  disclosures except for disclosures: pursuant to an authorization, for purposes of treatment, payment, healthcare operations;  required by law, that occurred prior to April 14, 2003, or six years prior to the date of this request.  

You have the right to obtain a paper copy of this notice from us even if you have agreed to receive the notice  electronically. We reserve the right to change the terms of this notice and we will notify you of such changes on the  following appointment. We will also make available copies of our new notice if you wish to obtain one.  

You have the right to 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. 

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health  care and any related services. This includes the coordination or management of your health care with a third party. For  example, your protected health information may be provided to a physician to whom you have been referred to ensure that  the physician has the necessary information to diagnose or treat you. 

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For  example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to  the health plan to obtain approval for the hospital admission.  

Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the  business activities of your physician’s practice. These activities include, but are not limited to, quality assessment,  employee review, training of medical students, licensing, and conducting or arranging for other business activities. For  example, we may disclose your protected health information to medical school students that see patients at our office. In  addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your  physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or  disclose your protected health information, as necessary, to contact you to remind you of your appointment, and inform  you about treatment alternatives or other health-related benefits and services that may be of interest to you. 

We may use or disclose your protected health information in the following situations, except SUD records as explained in  Feb 15, 2026 addendum, without your authorization. These situations include: as required by law, public health issues as  required by law, communicable diseases, health oversight, abuse or neglect, food and drug administration requirements,  legal proceedings, law enforcement, coroners, funeral directors, organ donation, research, criminal activity, military  activity and national security, workers’ compensation, inmates, and other required uses and disclosures. Under the law,  we must make disclosures to you upon your request. Under the law, we must also disclose your protected health  information when required by the Secretary of the Department of Health and Human Services to investigate or determine  our compliance with the requirements under Section 164.500.  

Other Permitted and Required Uses and Disclosures will be made only with your consent, authorization or  opportunity to object unless required by law. You may revoke the authorization, at any time, in writing, except to the  extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in  the authorization.