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PATIENT PRIVACY   it with and why. We will include   Services Office for Civil Rights by   in your best interest. We may also share   •  Bill for your services. We can use and   •  Reporting adverse reactions to   We can use or share your health   PATIENT PRIVACY
          Example: We use health information
          about you to manage your
                                               medications
 all the disclosures except for those
 sending a letter to 200 Independence
 your information when needed to lessen
                                                                                information:
          treatment and services.
 Avenue, S.W., Washington, D.C.
 a serious and imminent threat to health
                                             •  Reporting suspected abuse, neglect
 about treatment, payment, and
                                                                                 •  For workers’ compensation claims
                                               or domestic violence
                                                                                 •  For law enforcement purposes or
 20201, calling 1-877-696-6775, or
 healthcare operations, and certain
 or safety.
          share your health information to
                                                                                   with a law enforcement official
                                             •  Preventing or reducing a serious
 visiting www.hhs.gov/privacy. We
 other disclosures (such as any you
          bill and get payment from health
 will not retaliate against you for
 asked us to make). We’ll provide one
                                                                                 •  With health oversight agencies for
                                               threat to anyone’s health or safety
 In these cases we never share your
                                                                                   activities authorized by law
 filing a complaint.
 accounting a year for free, but will
          plans or other entities. Example: We
                                             •  Do research. We can use or share
 information unless you give us
 charge a reasonable, cost-based fee
                                               your information for health research.
 if you ask for another one within 12
          health insurance plan so it will pay
                                                                                   such as military, national security,
 •  Marketing purposes
 can tell us your choices about what
          for your services.
 months.  For certain health information, you   written permission:  give information about you to your   •  Comply with the law. We will share   •  For special government functions
                                               information about you if state or
                                                                                   and presidential protective services
 •  Sale of your information
 we share.                                     federal laws require it, including   •  Respond to lawsuits and legal
 Get a copy of this privacy notice.   If you have a clear preference for how we   •  Most sharing of psychotherapy notes  We are allowed or required to share   with the Department of Health and   actions We can share health
 share your information in the situations   •  We may contact you for fundraising   your information in other ways –   Human Services if it wants to see that   information about you in response to
 Choose someone to act for you.  described below, tell us what you   efforts, but you can request not to be   usually in ways that contribute to the   we’re complying with federal privacy   a court or administrative order, or in
 •  If you have given someone medical   want us to do, and we will follow your   contacted further.  public good, such as public health and   law.  response to a subpoena.
 power of attorney or if someone is   instructions. In these cases, you have both   research.   •  Respond to organ and tissue
 your legal guardian, that person   the right and choice to tell us to:  We typically use or share your health   •  We have to meet many conditions   donation requests. We can share   We are required by law to maintain
 can exercise your rights and   •  Share information with your family,   information in the following ways.  in the law before we can share your   health information about you with   the privacy and security of your
 make choices about your health   close friends, or others involved in   •  Treat you. We can use your health   information for these purposes. For   organ procurement organizations.  protected health information.
 information.   your care  information and share it with other   more information see: www.hhs.  •  Work with a medical examiner or   •  We will let you know promptly if
 •  Share information in a disaster relief   gov/ocr/privacy/understanding/        a breach occurs that may have
 File a complaint if you feel your rights  situation  professionals who are treating you.   consumers/index.html.  funeral director. We can share health   compromised the privacy or security
 are violated.  •  Include your information in a   Example: A doctor treating you for   information with a coroner, medical   of your information.
 •  You can complain if you feel we have   hospital directory  an injury asks another doctor about   We can share your health information   examiner or funeral director when   •  We must follow the duties and
 violated your rights by contacting   If you are not able to tell us your   your overall health condition.  for certain situations such as:   an individual dies.  privacy practices described in this
 the Privacy Officer at 337-528-7891.   preference, for example if you are   •  Run our organization. We can use   •  Preventing disease  •  Address workers’ compensation, law   notice and give you a copy of it.
 You can file a complaint with the U.S.   unconscious, we may go ahead and   and share your health information to   •  Helping with product recalls  enforcement, and other  government   n  We will not use or share your
 Department of Health and Human   share your information if we believe it is   run our practice, improve your care,   requests.  information other than as described
 and contact you when necessary.
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