NOTICE OF PRIVACY PRACTICES
This notice describes how medical information about you may be used and disclosed and how you can receive access to this information. Please review it carefully.
1. Your Rights
You have the right to:
- Receive 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
- Receive a list of those with whom we’ve shared your information
- Receive a copy of this privacy notice
- Choose someone to act for you
- File a complaint if you believe your privacy rights have been violated
2. Our Uses and Disclosures
We may use and share your information as we:
- Provide you services
- Run our organization Bill for services we provided Help with public health and safety issues
- Do research
- Comply with the law Address workers’ compensation, law enforcement, and other government requests Respond to lawsuits and legal actions
3. Your Choices
You have some choices in the way that we use and share information as we:
- Tell family and friends about your outcomes
- Provide disaster relief
- Provide mental health care
- Market our services and sell your information
4. File a complaint if you feel your rights are violated
- You can complain if you feel we have violated your rights by contacting us using the information on page 1.
- 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
- We will not retaliate against you for filing a complaint.
Effective Date: January 1, 2016
Notice of Privacy Practices_CLT ADM