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We make every effort to ensure that your health information is kept private. Federal guidelines require us to describe to you how health information about you may be used and disclosed and how you can get access to this information. More detailed information is available in the Clinic waiting areas and a copy is available upon request. 
How we may disclose your health information:
Health Care Operations: We may disclose information about you for the operation of our health care practice.
Treatment: We may disclose information to doctors, nurses, technicians, health students, or other personnel who are involved in taking care of you.
Appointment Reminders: We may use and disclose information to contact you as a reminder that you have an appointment.
Payment: We will disclose information to an insurance company or a third party to coordinate payment for the services you receive. We may also talk with the policy holder of your insurance coverage. As Required By Law: We will disclose information about you when required by federal, state, or local law.
Workers Compensation: We may release information about you for workers compensation or similar programs.
Serious Threat: We may use and disclose information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public.
Military and Veterans: If you are a member of the armed forces or separated/discharged from military services, we may release health information about you as required by military command authorities or the Department of Veterans Affairs, as may be applicable.
Public Health Risks: We may disclose information about you for public health activities such as to report births, deaths, child abuse or neglect, medication problems, product recalls, disease exposures, and adult abuse or neglect.
Health Oversight Activities: We may disclose information to a health oversight agency for activities authorized by law. For example audits, investigations, inspections, and licensure.
Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose information about you in response to a court or administrative order.
Law Enforcement: We may release information if asked to do so by a law enforcement official in reporting certain injuries or in response to a court order, subpoena, warrant, or similar process.
Coroner, Health Examiner: We may release information to a coroner, health examiner, or funeral director.
National Security: We may release information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.
Protective Services: We may disclose information about you to authorized federal officials so they may provide protection to the President, other persons or foreign heads of state or for special investigations.
Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release information about you to the correctional institution or law enforcement official.
Your rights regarding your health information:
Accounting: You have the right to request a list accounting for any disclosures of information we have made, except for disclosures for treatment, payment, and health care operations.
Inspect and Copy: You have the right to look at or get copies of your health information with limited exceptions. To inspect your records, you need to make the request in writing. We will charge you a cost-based fee of $14.00 for record retrieval, $21.00 per hour reviewing fee plus $1.07 per page copy charge, if you request copies. To request a copy of your records, complete a release form. We will charge you a $14.00 record retrieval fee plus $1.07 per page copy charge. Postage will be extra.
Amend: If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information.
Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment payment or health care operations.
Communications: You have the right to request that we communicate with you about health matters in a certain way or at a certain location.
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General:
Changes to Notice: We reserve the right to change this notice.
Complaints: If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services.
Other Uses: Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission.
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