Privacy Policy
Last updated October 3, 2026.
Your Information. Your Rights. Our
Responsibilities.
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.
Your Rights
You have the right to:
Get a copy of your paper or electronic medical record
Correct your paper or electronic medical record
Request confidential communication
Get a list of those with whom we’ve shared your information
Get a copy of this privacy notice
Choose someone to act for you
File a complaint if you believe your privacy rights have been violated
Your Choices
You have some choices in the way that we use and share information as we:
Tell family and friends about your condition
Provide disaster relief
Include you in a hospital directory
Provide mental health care
Market our services and sell your information
Raise funds
Our Uses and Disclosures
We may use and share your information as we:
Treat you
Run our organization
Bill for your services
To the extent that we have your substance use disorder patient records, subject to 42
CFR part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.
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 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, office, or cell
phone) or to send mail to a different address.
We will say “yes” to all reasonable requests.
You can 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,” for example, if it could affect your care. If we agree to your request, we
may still share this information in the event that you need emergency treatment.
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 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 someone has authority to act as your personal representative, such as if someone
has your 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 page 1. 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
https://www.hhs.gov/hipaa/filing-a-complaint/index.html.
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 for your care
Share information in a disaster relief situation
Include your information in a hospital directory
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. We
may also share your information when needed 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.
If we have your substance use disorder patient records, subject to 42 CFR part 2, we will
give you clear and obvious notice in advance and a choice about whether to receive
fundraising communications that use your Part 2 information.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Treat you
We can use your health information and share it with other professionals who are
treating you.
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.
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.
In all cases, including those listed below, if we have substance use disorder patient
records about you, subject to 42 CFR part 2, we cannot use or share information in
those records in civil, criminal, administrative, or legislative investigations or
proceedings against you without (1) your consent or (2) a court order and a subpoena.
Reporting suspected abuse, neglect, or domestic violence
Preventing or reducing a serious threat to anyone’s health or safety.
We can use or share health information about you:
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.
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 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 in this notice
unless you tell us we can in writing. If you tell us we can, you may change your mind
at any time.
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
web site.
Effective Date of this Notice 10/3/2026
Insert name or title of the privacy official (or other privacy contact) and his/her
email address and phone number.
We never market or sell personal information.