HIPPA Privacy Information



Public Health and Benefit Activities: We may use and disclose your medical
information, without your permission, when required by law, and when authorized
by law for the following kinds of public health and public benefit activities:
– for public health, including to report disease and vital statistics, child abuse,
and adult abuse, neglect or domestic violence;
– to avert a serious and imminent threat to health or safety;
– for health care oversight, such as activities of state insurance commissioners,
licensing and peer review authorities, and fraud prevention agencies;
– for research;
– in response to court and administrative orders and other lawful process;
– to law enforcement officials with regard to crime victims and criminal
– to coroners, medical examiners, funeral directors, and organ procurement
– to the military, to federal officials for lawful intelligence, counterintelligence,
and national security activities, and to correctional institutions and law
enforcement regarding persons in lawful custody; and
– as authorized by state worker’s compensation laws.
If a use or disclosure of health information described above in this notice is
prohibited or materially limited by other laws that apply to us, it is our intent to
meet the requirements of the more stringent law.

Business Associates: We may disclose your medical information to our
business associates that perform functions on our behalf or provide us with
services if the information is necessary for such functions or services. Our
business associates are required, under contract with us, to protect the privacy of
your information and are not allowed to use or disclose any information other than
as specified in our contract.

Data Breach Notification Purposes: We may use your contact information to
provide legally-required notices of unauthorized acquisition, access, or disclosure
of your health information.
Additional Restrictions on Use and Disclosure: Certain federal and state
laws may require special privacy protections that restrict the use and disclosure
of certain health information, including highly confidential information about you.
“Highly confidential information” may include confidential information under Federal
laws governing alcohol and drug abuse information and genetic information as
well as state laws that often protect the following types of information:
2. Mental health;
3. Genetic tests;
4. Alcohol and drug abuse;
5. Sexually transmitted diseases and reproductive health information; and
6. Child or adult abuse or neglect, including sexual assault.

Your Rights:

Access: You have the right to examine and to receive a copy of your medical
information, with limited exceptions. We will use the format you request unless
we cannot practicably do so. You should submit your request in writing to our
Privacy Officer.
We may charge you reasonable, cost-based fees for a copy of your medical
information, for mailing the copy to you, and for preparing any summary or
explanation of your medical information you request. Contact our Privacy Officer
for information about our fees.

Disclosure Accounting: You have the right to a list of instances in which we
disclose your medical information for purposes other than treatment, payment,
health care operations, as authorized by you, and for certain other activities.
You should submit your request to our Privacy Officer. We will provide you with
information about each accountable disclosure that we made during the period for
which you request the accounting, except we are not obligated to account for a
disclosure that occurred more than 6 years before the date of your request.

Amendment: You have the right to request that we amend your medical
information. You should submit your request in writing to our Privacy Officer.
We may deny your request only for certain reasons. If we deny your request, we
will provide you a written explanation. If we deny your request, you may have a
statement of your disagreement added to your medical information. If we accept
your request, we will make your amendment part of your medical information and
use reasonable efforts to inform others of the amendment who we know may
have and rely on the unamended information to your detriment, as well as persons
you want to receive the amendment.

Restriction: You have the right to request that we restrict our use or disclosure
of your medical information for treatment, payment or health care operations, or
with family, friends or others you identify. Except in limited circumstances, we
are not required to agree to your request. But if we do agree, we will abide by
our agreement, except in a medical emergency or as required or authorized by
law. You should submit your request to our Privacy Officer. Except as otherwise
required by law, we must agree to a restriction request if:
1. except as otherwise required by law, the disclosure is to a health plan for
purposes of carrying out payment or health care operations (and not for purposes
of carrying out treatment); and
2. the medical information pertains solely to a health care item or service for
which the health care provider involved has been paid out of pocket in full by the

Confidential Communication: You have the right to request that we
communicate with you about your medical information in confidence by means
or to locations that you specify. You should submit your request in writing to our
Privacy Officer.

Breach Notification: You have the right to receive notice of a breach of
your unsecured medical information. Breach may be delayed or not provided
if so required by a law enforcement official. You may request that notice be
provided by electronic mail. If you are deceased and there is a breach of your
medical information, the notice will be provided to your next of kin or personal
representatives if we know the identity and address of such individual(s).

Electronic Notice: If you receive this notice on our web site or by electronic
mail (e-mail), you are entitled to receive this notice in written form. Please contact
our Privacy Officer to obtain this notice in written form.


If you are concerned that we may have violated your privacy rights, or you
disagree with a decision we made about access to your medical information,
about amending your medical information, about restricting our use or disclosure
of your medical information, or about how we communicate with you about your
medical information (including a breach notice communication), you may contact
to our Privacy Officer.

You also may submit a written complaint to the Office for Civil Rights of the
United States Department of Health and Human Services, 200 Independence
Avenue, SW, Room 509F, Washington, D.C. 20201. You may contact the Office for
Civil Rights’ Hotline at 1-800-368-1019.
We support your right to the privacy of your medical information. We will not
retaliate in any way if you choose to file a complaint with us or with the U.S.
Department of Health and Human Services.

Please call (505) 293-7611, or Contact us by email, for answers to any questions You may have.