HIPAA Information

The information contained in your health or medical record is the physical property of your Covered Entity. The information in it belongs to you. You have the following rights:

Right to Request Restrictions: You have the right to ask us not to use or disclose your medical information for a particular reason related to treatment, payment or our operations.  You may ask that family members or other individuals not be informed of specific medical information. That request must be made in writing to Our Designee.  We do not have to agree to your request.  If we agree to your request, we must keep the agreement, except in the case of a medical emergency.  Either you or your Covered Entity can stop a restriction at any time.

Right to Receive Confidential Communications: You have the right to ask that we communicate with you in a certain manner or at a certain place. If you want to request confidential communications the request must be made in writing to Our Designee. We must agree to your request if it is reasonable.

Right to Inspect and Copy Your Medical Information: You have the right to request to inspect and obtain a copy of your medical information. You must submit your request in writing to Our Designee.  If you request a copy of the information or we provide you with a summary of the information we may charge a fee for the costs of copying, summarizing and/or mailing it to you.  If we agree to your request we will tell you. We may deny your request under certain limited circumstances.  If your request is denied, we will let you know in writing and you may be able to request a review of our denial.

Right to Request Amendments to Your Medical Information: You have the right to request that we correct your medical information.  If you believe that any medical information in your record is incorrect or that important information is missing, you must submit your request for an amendment in writing to Our Designee.
We do not have to agree to your request. If we deny your request we will tell you why. You have the right to submit a statement disagreeing with our decision. We may deny your request if we determine that the information:

• Is not part of the medical information that we maintain.
• Is in records that you are not allowed to inspect and copy.
• Was not created by us.
• Is already accurate or complete.

Right to an Accounting of Disclosures of Health Information: You have the right to find out what disclosures of your medical information have been made. The list of disclosures is called an accounting. The accounting may be for up to six years prior to the date on which you request the accounting, but cannot include disclosures before April 14, 2003. We are not required to include disclosures for treatment, payment or healthcare operations or certain other exceptions. Requests for an accounting of disclosures must be submitted in writing to Our Designee. You are entitled to one free accounting in any 12 month period.  We may charge you for the cost of providing additional accountings. If there will be a charge for additional accountings we will notify you in advance.

Right to Obtain a Copy of the Notice - You have the right to request and get a paper copy of this notice and any revisions we make to the notice at any time.