Other Uses and Disclosures Made Only With Your Written Authorization
We will not use or disclose your PHI except as described above unless we have your written authorization. If we maintain or receive psychotherapy notes about you, most disclosures of these notes require your authorization. If we contact you for our fundraising, we will provide you a right to opt out of such communications. Also, most uses and disclosures of PHI for marketing purposes, and sales of PHI, require your authorization. If you provide us with such an authorization, you may revoke the authorization in writing at any time. Your revocation will be effective for future uses and disclosures of PHI. However, the revocation will not be effective to the extent we already acted in reliance on your authorization.
The following information describes your rights with respect to your PHI.
Right to Request a Restriction
You have the right to request restrictions on the PHI we use or disclose about you. Your request must tell us: (1) what information you wish to limit; and (2) how you want to limit our use and/or disclosure.
We are not required to agree to your request. If we do agree, we will follow the restriction unless the information is needed to provide you emergency treatment.
Right to Request Confidential Communications
You may request that we communicate with you about PHI in an alternative manner or at an alternative location. Your request must specify what parts of your PHI that your request covers. It must also specify how and where you wish to be contacted. For example, you can ask that we only contact you at your work address or via your work e-mail.
Right to Inspect and Copy
You have the right to inspect and copy your PHI. This includes medical, billing, payment, enrollment, claims and other records used to make decisions about your health care benefits. However, you may not inspect or copy psychotherapy notes and certain other information.
Your request may include an electronic copy in certain cases if you make this request in writing.
If you request a copy of your PHI, we may charge a reasonable, cost-based fee.
We may deny your request to inspect and copy your PHI in certain limited cases. If we deny you access to your PHI, you may request a review of the denial. A licensed health care professional chosen by us will review your request and the denial. The person performing this review will not be the same person who denied your initial request. Under certain conditions, our denial will not be reviewable. If this event occurs, we will inform you in our denial that the decision is not reviewable.
Right to Amend
If you believe that your PHI is incorrect or incomplete, you may request that we amend your information. Your written request should include the reason the amendment is necessary.
In certain cases, we may deny your request for an amendment. For example, we may deny your request if the PHI is maintained by another entity, and not by us. If we deny your request, you have the right to file a statement of disagreement with us. We will link your statement of disagreement with the disputed information. All future disclosures of the disputed information will include your statement.
Right of an Accounting
You have a right to an accounting of most disclosures of your PHI, with certain exceptions. These exceptions include disclosures made for treatment, payment, health care operations, and certain other disclosures. An accounting will list the date(s) of the disclosure, to whom we made the disclosure, a brief description of the PHI disclosed, and the purpose for the disclosure.
Your request may be for disclosures made up to 6 years before the date of your request. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved. We will also provide you with an opportunity to withdraw or modify your request before you incur any costs.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this Notice, even if you have agreed to accept this Notice electronically.
We will notify you if there is a breach of your unsecured health information as required by law or where we otherwise deem appropriate.
If you believe that we have violated your privacy rights, you may file a complaint with us. All complaints must be in writing. You may also submit a complaint to the Secretary of the U.S. Department of Health and Human Services.
We will not penalize or in any other way retaliate against you for filing a complaint.