Notice of Privacy Practices

Your rights

You have the right to:

• Get a paper or electronic copy of your medical record
• Ask us to correct your medical record
• Request confidential communications
• Ask us to limit what we use or share
• Get a list of certain disclosures of your information
• Get a paper copy of this notice
• Choose someone to act for you
• File a complaint if you believe your rights were violated

Your choices

You have choices about how we share information with family, friends, or others involved in your care, and in a disaster relief situation. We need your written permission for most marketing, any sale of your health information, and most sharing of psychotherapy notes.

Our uses and disclosures

We may use and share your health information to:

• Treat you and coordinate care with other professionals
• Run our practice and improve our services
• Bill for services and receive payment
• Address public health and safety matters
• Conduct health research when legal requirements are met
• Comply with federal and state law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers' compensation, law-enforcement, oversight, and other government requests
• Respond to court orders, subpoenas, lawsuits, and legal actions as permitted by law

To the extent we maintain substance use disorder patient records subject to 42 CFR part 2, we will not use or share information from those records in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a court order and subpoena.

How to exercise your rights

Get a copy of your record

You can ask to see or receive an electronic or paper copy of your medical record and other health information we maintain about you. We will usually provide a copy or summary within 30 days. We may charge a reasonable, cost-based fee.

Ask us to correct your record

You can ask us to correct information you believe is incorrect or incomplete. We may deny the request, but we will tell you why in writing within 60 days.

Request confidential communications

You can ask us to contact you in a specific way or at a different address. We will agree to reasonable requests.

Ask us to limit what we use or share

You can ask us not to use or share certain information for treatment, payment, or our operations. We are not always required to agree. If we agree, we may still share the information when needed for emergency treatment.

If you pay for a service or health care item in full out of pocket, you can ask us not to share that information with your health insurer for payment or our operations. We will agree unless the law requires us to share it.

Get a list of certain disclosures

You can ask for an accounting of certain times we shared your health information during the six years before your request, including who received it and why. The accounting does not include disclosures for treatment, payment, or health care operations and certain other disclosures. One accounting each year is free. We may charge a reasonable, cost-based fee for an additional request within 12 months.

Get a paper copy

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

Choose someone to act for you

A person with legal authority to act as your personal representative, such as a health care agent or legal guardian, may exercise your rights. We will verify that authority before taking action.

File a complaint

Contact our Privacy Officer if you believe we violated your privacy rights. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by writing to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting the HHS complaint page. We will not retaliate against you for filing a complaint.

Your choices in certain situations

Tell us what you want us to do if you have a preference about sharing information with family, close friends, or others involved in your care or payment for your care, or sharing in a disaster relief situation. We will follow your instructions.

If you cannot tell us your preference, we may share information when we believe it is in your best interest or when needed to lessen a serious and imminent threat to health or safety.

We do not sell your health information. We do not use your health information for fundraising. If those practices change, we will follow the authorization, notice, and opt-out rules that apply.

Additional detail about permitted uses

Treatment

We may use your health information and share it with other professionals who are treating you.

Practice operations

We may use and share your health information to run our practice, improve your care, and contact you when necessary.

Payment

We may use and share your health information to bill for services and obtain payment from you, a health plan, or another responsible party.

Public health and safety

We may share health information for purposes such as preventing disease, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to health or safety.

Research

We may use or share health information for research only when the conditions required by law are satisfied.

Law and oversight

We will share information when federal or state law requires it, including with the U.S. Department of Health and Human Services when it reviews our compliance with federal privacy law. We may also share information for authorized health oversight, workers' compensation, law-enforcement, and special government functions.

Legal proceedings

We may share health information in response to a court or administrative order or, when the legal requirements are met, a subpoena. Additional federal protections apply to substance use disorder patient records subject to 42 CFR part 2.

After death and organ donation

We may share health information with organ procurement organizations, coroners, medical examiners, or funeral directors as permitted by law.

Virginia protections

Virginia law recognizes a person's right to privacy in health records and limits disclosure and redisclosure of those records. Some records, including HIV test results and certain records involving minors, may have additional protections. We follow those limits when they are more protective than federal law.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information
• We will notify you promptly if a breach may have compromised the privacy or security of your information
• We must follow the duties and privacy practices described in this notice and give you a copy
• We will not use or share your information other than as described here unless you authorize us in writing

You may revoke a written authorization at any time by telling us in writing. A revocation does not undo a use or disclosure we already made in reliance on the authorization.

Changes to this notice

We may change this notice, and the revised terms may apply to all health information we maintain about you. The current notice will be available on our website, in our office, and upon request.

Contact

Current patients may use the secure patient portal. For information about data collected through the public website, see the Website Privacy Policy.