Notice of Privacy Practices

Your information. Your rights. Our responsibilities.

This notice describes how health information about you may be used and disclosed and how you can get access to this information.

Please review it carefully.

View PDF / Printable Version of our Notice of Privacy Practices Here.

Effective Date: April 14, 2003 | Last Revised Written and Web: February 16, 2026

Your Rights

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 health record

You can ask us in writing 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.
In most cases, we will grant your request. However, certain information is excluded from your right to access, including psychotherapy notes and information complied in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding. In other situations, we may deny your request, but we will tell you why in writing and explain your right to have the denial reviewed, if reviewable.
When access is granted, 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 health record

You can ask us in writing 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 in writing to contact you in a specific way (for example, home or office phone) or to send mail to a different 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 affect 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

Get a list of those with whom we’ve shared information

You can ask us in writing for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

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

Choose someone to act for you

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will make sure the person has this authority and can act for you before we take any action.

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 the last page of this notice.

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 hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share.

If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

Share information with your family, close friends, or others involved in your care or payment related to your care
Share information in a disaster relief situation

If you are not able to tell us your preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. When needed, we may also share your information to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

Marketing purposes
Sale of your information
Most sharing of psychotherapy notes

In the case of fundraising:

We may contact you for fundraising efforts, but you can tell us not to contact you again. You may opt out of receiving fundraising communications, or opt back in, by calling or writing to our Privacy Officer whose information is at the end of this notice

Our Uses and Disclosures

How do we typically use or share your health information?

Treat you

We can use your health information and share it with other professionals who are treating you.
We automatically keep health information about you in a community wide or shared electronic health record system established by Community Health Technology Network (CHTN), that allows your provider, specialists, and other health care facilities the ability to receive copies of all treatment records, emergency records, laboratory, radiology, and other results, even if your provider did not order the test or treatment.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary. We may share your health information with third-party business associates who perform services on our behalf, including JCMR, consultants, accountants, auditors, attorneys, and information technology vendors. These associates will also be required to protect your health information.

Example: We use health information about you to manage your treatment and services.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

We can share health information about you for certain situations such as; preventing disease,
helping with product recalls, reporting adverse reactions to medications, reporting suspected
abuse, neglect, or domestic violence and preventing or reducing a serious threat to anyone’s health
or safety

Do research

We can use or share your information for health research.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Example: We will share your health information to comply with mandatory state reporting requirements. These include reporting of births, deaths, injuries caused by a deadly weapon, victims of abuse or neglect, certain diseases and afflictions, such as HIV/AIDS and cancer, the dispensing of certain controlled substances, and drug diversion and fraudulent prescription activity.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Appointment reminders and treatment alternatives

We can use or share health information about you to provide you appointment reminders or
information about treatment alternatives or other health-related benefits and services that may be
of interest to you.
We may leave voicemail messages at the telephone number you provide to us, and we may
respond to your email address.
We may also send you a newsletter.

Inmates

We can share health information about you to a correctional institution or law enforcement official if you are an inmate of a correctional institution or under the custody of a law enforcement official.

Health oversight activities

We can share your health information to a health oversight agency for oversight activities authorized by law. These oversight activities include, for example, audits investigations, inspections, licensure or disciplinary actions, or other activities necessary for the appropriate oversight of the health care system, government benefit programs, and compliance with civil rights laws.

Serious threats to health or safety

We can use or share your health information if we believe that its use or disclosure is necessary to
prevent or lessen a serious and imminent threat to a person’s or the public’s health or safety and
the use or disclosure is to a person reasonably able to prevent or lessen the threat, or necessary for
law enforcement authorities to identify or apprehend an individual.

Immunizations

We may disclose immunization records to a school where you are or will be a student if the school
is required by law to have proof of immunizations prior to admitting a student. We will first obtain
your oral or written consent, or, where applicable, the oral or written consent of your parent or
guardian, prior to making the disclosure.

Substance Use Disorder (SUDS) Records

If we receive records from a Part 2 program (SUD treatment provider), we will only use or share
those records as allowed by federal law (42 CFH Part 2) and HIPAA. These records may be used for
treatment, payment and health care operations, and cannot be shared or used in civil, criminal,
administrative, or legislative proceedings against you, without your written consent or a court
order that meets Part 2 requirements. Anyone who receives SUD records is prohibited from re-sharing them unless allowed by law or with written patient authorization.

We can also use or share health information about you:

For workers’ compensation claims
For law enforcement purposes or with a law enforcement official
For special government functions such as military, national security, and presidential protective services

Health Information Exchange (HIE)

We may also participate in various electronic HIE’s that help other health care providers who
provide you with care to access our health information when needed. Unless you object or tell us
not to, your health information will be available to other HIE’s such as Care Everywhere or to other
providers who use EPIC software to create and maintain their electronic health record system.
If you wish to opt out of having your health information included in an HIE, you have the right to
request to do so in writing. You may also opt back in at any time by also doing so in writing.

Other applicable state and federal laws

Our use and disclosure of your health information must comply not only with the federal HIPAA
rules, but also with other applicable federal and state laws. For example, federal and/or state laws
place certain additional restrictions on the use or disclosure of health information for mental
health, substance abuse, HIV/AIDS conditions, and certain genetic information. We will comply
with all applicable federal and state laws. In some instances, your specific authorization may be
required.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach of unsecured protected health information occurs that 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 of it.
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Who Follows This Notice

We participate in an organized health care arrangement with physicians, allied health professionals, and other health care practitioners and entities that provide health care services to patients at our health care facility and service delivery sites. This notice will be followed by all participants in the organized health care arrangement, including all health care facilities and service delivery sites run by us, or workforce

(including all employees, students, volunteers and other workforce members), and all physicians, allied health professionals, and other health care practitioners who are not our agents or employees but who provide services and treatment to patients at our facilities. Participants in the organized health care arrangement may use and share your health information for treatment, payment and health care purposes related to the organized health care arrangement.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.