Your Information.

Your Rights.

Our Responsibilities.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.  The following is a summary of our practices.  For a full copy, please ask at your next appointment.


You have a right to:

  • Get a copy of your paper or electronic medical record
  • Correct your paper or electronic medical record
  • Request confidential communication
  • Ask us to limit the information we share
  • Get a list of those with whom we've shared your information
  • Get a copy of this privacy notice
  • Choose someone to act for you
  • File a complaint if you believe your privacy rights have been violated
    • You can ask to see your medical record and we will provide a copy or summary of your information, usually within 30 days.  There may be a charge associated with copying but it is cost-based.  If you feel that there are inaccuracies in your record, you may ask us to correct it.  We may say "no" to this request but we will tell you why in writing within 60 days.  
    • You can ask us to contact you through your preferred way and/or limit whether we leave messages for you.  We will say "yes" to all reasonable requests.
    • If you have a guardian or have given someone medical power of attorney, that person can exercise your rights and make choices about your health information.  We will make sure the person has this authority before we take action
    • You can always discuss concerns with our privacy officer.  If you don't feel this is a viable option, you can file a complaint with the US Dept of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Ave,SW, Washington DC 20201 or by calling 1.877.696.6775
    • We will never retaliate for complaints.



You have some choices in the way that we use and share information as we:

  • Tell family and friends about your condition
  • Provide mental health care
  • Market our services
    • You decide whether or not we discuss your details with friends or family members that may be involved in your care.  By default, we do not share information unless we are mandated by law (such as cases of child abuse, cases of suicidal or homicidal intent) unless you specifically ask us to.


We may use and share your information as we:

  • Treat you
  • Run our organization
  • Bill for your services
  • Help with public health and safety--suspected child abuse, neglect, domestic violence, reducing serious threats to anyone's health or safety
  • Do research
  • Comply with the law--we share if state or federal law requires it
  • Address workers' compensation, law enforcement, and other government requests
  • Respond to lawsuits and legal actions
    • We can use your health information and share it with other professionals who are treating you.
    • We can use and share your information to run our practice, improve your care and contact you when necessary.
    • We use and share health information to bill and get payment from health plans or other entities.


Note:  If you are being treated within a long-term care facility, documentation will become part of your medical record that is maintained at that location.

We take your privacy very seriously.  We will discuss instances in which we may need to disclose your information.  If you have any questions, just ask.



We are required by law to maintain the privacy and security of your protected health information

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information

We must follow the duties and privacy practices described in this note and give you a copy of it.

We will not use or share your information other than as described here unless you tell us we can in writing.  If you tell us we can and change your mind at any time, just let us know in writing.


Changes to the Terms of this Notice--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 our website.  

 effective Jan 1, 2015