Know Your Rights

Access to Your
Personal Health Information

You have the right to copy and/or inspect much of the personal health information that we retain on your behalf.  Usually, this includes medical and billing records, but does not include psychotherapy notes.  All requests for access must be made in writing and signed by you or your representative.  We will charge you a fee if you request a copy of the information.  We will also charge for postage if you request a mailed copy and will charge for preparing a summary of the requested information if you request such summary.  You may obtain an access request form, including fees, from Health Information Management.

Electronic Health Record

You have the right to obtain a copy of your personal health information in an electronic format and you may request to have the information transmitted to a designated person, You may be charged a fee for the transmission of this information.


We may deny your request to inspect and copy your personal health information in certain very limited circumstances.  If you are denied access to your personal health information, you may request that the denial be reviewed.  Another licensed health care professional chosen by us will review your request and the denial.  The person conducting the review will not be the person who denied your request.  We will comply with the outcome of the review.

Amendments to Your
Personal Health Information

You have the right to request in writing that personal health information that we maintain about you be amended or corrected.  We are not obligated to make all requested amendments but will give each request careful consideration.  All amendment requests, in order to be considered by us, must be in writing, signed by you or your representative, and must state the reasons for the amendment/correction request.  If an amendment or correction you request is made by us, we may also notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary.  You may obtain an amendment request form from Health Information Resources.

Accounting for Disclosures of
Your Personal Health Information

You have the right to receive an accounting of certain disclosures made by us of your personal health information after April 14, 2003.  Requests must be made in writing and signed by you or your representative.  Accounting request forms are available from Health Information Resources.  The first accounting in any 12-month period is free; you will be charged a fee of $50.00 for each subsequent accounting you request within the same 12-month period.  We have 30 days to fulfill your request for an accounting of disclosures.

Restrictions on Use and Disclosure
of Your Personal Health Information

You have the right to restrict certain disclosures of personal health information to a health plan if you are paying out of pocket, in full, for the healthcare item or service.  You have the right to request other restrictions on certain of our uses and disclosures of your personal health information for treatment, payment, or health care operations.  A restriction request form can be obtained from Health Information Resources.  Except for a request to restrict disclosures to a health plan when you have paid out-of-pocket in full for the items or services received from us, we are not required to agree to your restriction request, but will attempt to accommodate reasonable requests when appropriate and we retain the right to terminate an agreed-to restriction if we believe such termination is appropriate.  In the event of a termination by us, we will notify you of such termination.  You also have the right to terminate, in writing or orally, any agreed-to restriction by sending such termination notice to Health Information Resources.

Deceased Individuals

We will comply with requirements for privacy of personal health information for a period of 50 years following the date of death of an individual.  Personal health information may be released for research purposes as permitted by law; and to family members and others who were involved in the care or payment for care of the decedent prior to death, unless doing so is inconsistent with any known prior expressed preference of the individual.

Notification of a Breach

We are required by law to notify you of a breach (a use or disclosure that was not permitted by law) of unsecured personal health information if it is determined that the breach may affect you.

This Notice of Privacy Practices is effective May 24, 2016.