- HIPAA notice
Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
This template is not a substitute for a completed HIPAA Notice of Privacy Practices. Before publication, identify the legal covered entity, effective date, privacy officer, locations, affiliated covered entities if any, complaint contacts, and all state-specific requirements.
Our responsibilities
We are required by law to maintain the privacy and security of protected health information, provide this notice of our legal duties and privacy practices, follow the notice currently in effect, and notify affected individuals following a breach of unsecured protected health information as required by law.
How we may use and disclose information
Treatment
We may use and share health information to provide, coordinate, or manage your care and related services, including communication among clinicians, pharmacies, laboratories, and other professionals involved in treatment.
Payment
We may use and disclose information to bill and obtain payment for services, determine coverage, or support prior authorization when applicable.
Health care operations
We may use and disclose information for quality assessment, training, credentialing, compliance, auditing, customer service, security, and other operations permitted by law.
Other permitted or required uses
We may disclose information as permitted or required for public health and safety, health oversight, legal proceedings, law enforcement, workers’ compensation, organ donation, research under applicable safeguards, disaster relief, and other purposes described in the final approved notice.
Your rights
Subject to applicable law, you may request access to or copies of records, request correction, request confidential communications, ask for certain restrictions, receive an accounting of certain disclosures, obtain a paper copy of this notice, and choose someone to act for you.
Your choices
For certain uses—such as some marketing communications, sale of protected health information, or sharing psychotherapy notes—your written authorization may be required. You may revoke an authorization in writing, except to the extent action has already been taken.
Complaints
You may complain to our Privacy Officer and to the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint. Insert the correct contact information before launch.
Electronic communication and telehealth
We use secure systems for clinical communication. Patients should use the designated portal, protect passwords, join visits from private locations, and avoid sending protected health information through ordinary email, text messages, or public website forms unless specifically instructed through an approved process.