Notice of Privacy Practices

You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable cost-based fee.

You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may say no to your request, but we will tell you why in writing within 60 days.

You can ask us to contact you in a specific way, for example by home or office phone, or to send mail to a different address. We will say yes to all reasonable requests.

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say no if it would affect your care. If you pay for a service or health care item out of pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say yes unless a law requires us to share that information.

You can ask for a list, called an accounting of disclosures, of the times we have shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures, such as any you asked us to make. We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

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.

You can complain if you feel we have violated your rights by contacting us at the address below. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints.

We will not retaliate against you for filing a complaint.

We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.

We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.

We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services.

We can share health information about you for certain situations such as preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone's health or safety.

We can use or share your information for health research.

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.

We can share health information about you with organ procurement organizations.

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

We can use or share health information about you for workers' compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services.

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Part 2 applies to records created or maintained by a federally assisted program that is primarily engaged in providing, diagnosing, treating, or referring patients for SUD treatment. If we create or maintain such records, they are protected under Part 2 in addition to HIPAA.

Records protected under Part 2 may not be used or disclosed in any civil, criminal, administrative, or legislative proceedings conducted by any federal, state, or local authority against a patient, without the patient's written consent, a court order, or another specific exception permitted by law.

Your written consent is required before we can disclose your Part 2 records for treatment, payment, or health care operations purposes, except in limited circumstances permitted by law. You have the right to revoke your consent at any time for future disclosures.

There are limited circumstances where Part 2 records may be disclosed without your consent, including in a medical emergency, for certain research and audit purposes, to report a crime on program premises or against program personnel, and pursuant to a valid court order. Any disclosure made without consent is limited to information necessary for the specific purpose.

Any person or entity that receives your Part 2 records is prohibited from re-disclosing them without your written consent or as otherwise permitted by law.

You may file a complaint with the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-877-SAMHSA-7 (1-877-726-4727) or through SAMHSA's website at samhsa.gov. You may also file a complaint with the HHS Office for Civil Rights as described in the Your Rights section above. We will not retaliate against you for filing a complaint.

Maintain the privacy and security of your protected health information

Notify you promptly if a breach occurs that may have compromised the privacy or security of your information

Follow the duties and privacy practices described in this notice and give you a copy of it

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, you may change your mind at any time. Let us know in writing if you change your mind.