Notice of Privacy Practices - page 3

When it comes to your health information, you have certain rights.
This section explains your rights and some of our responsibilities to help you.
Get an electronic
or paper copy
of your medical
record
You can ask to see or get an electronic or paper copy
of your medical record and other health information
we have about you. Ask us how to do this.
We will provide a copy or a summary of your health
information, usually within 30 days of your request.
We may charge a reasonable, cost-based fee.
Ask us to correct
your medical
record
You can ask us to correct health information about
you that you think is incorrect or incomplete. Ask us
how to do this.
We may say “no” to your request, but we’ll tell you
why in writing within 60 days.
Request
confidential
communications
You can ask us to contact you in a specific way (for
example, home or office phone) or to send mail to a
di erent address.
We will say “yes” to all reasonable requests.
Ask us to limit
what we use
or share
You can ask us
not
to use or share certain health
information for treatment, payment, or our operations.
We are not required to agree to your request, and
we may say “no” if it would a ect your care.
If you pay for a service or health care item out-
of-pocket in full, you can ask us not to share that
information for the purpose of payment or our
operations with your health insurer.
We will say “yes” unless a law requires us to share
that information.
Notice of Privacy Practices • Page 2
Your Rights
1,2 4,5,6,7,8