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information about health related services or appointment reminders. If you do not wish to receive
this type of information, you may request to opt-out of receiving this information by sending an
email to [email protected] or calling the phone number provided at the end of this notice.
Research; Death; Organ Donation:
We may use or disclose your health information for research
purposes in limited circumstances. We may disclose your health information to a coroner,
medical examiner, funeral director or organ procurement organization for certain purposes.
Public Health and Safety:
We may use and disclose your health information to the extent
necessary to avert a serious and imminent threat to your health or safety or the health or safety
of others. We may disclose your health information to appropriate authorities if we reasonably
believe that you are a possible victim of abuse, neglect, domestic violence or other crimes.
Required by Law:
We will use or disclose your health information when we are required to do so
by law.
Process and Proceedings:
We may disclose your health information in response to a court or
administrative order, subpoena, discovery request or other lawful process.
Law Enforcement:
We may disclose your health information, so long as applicable legal
requirements are met, to a law enforcement official, such as for providing information to the
police
about the victim of a crime.
Inmates:
We may disclose your health information if you are an inmate of a correctional
institution and we created or received your health information in the course of providing care to
you.
Military and National Security:
We may disclose your health information to military authorities if
you are a member of the Armed Forces. We may disclose your health information to authorized
federal officials for lawful intelligence, counterintelligence and other national security activities.
Workers’ Compensation:
We may disclose your health information as authorized by and to
the extent necessary to comply with laws relating to workers' compensation or other similar
programs, established by law, that provide benefits for work-related injuries or illness without
regard to fault.
Business Associates:
We may disclose your health information to persons who perform
functions, activities or services to us or on our behalf that require the use or disclosure of your
health information. To protect your health information, we require the business associate to
appropriately safeguard your information.
To You:
We will disclose your health information to you, as described in the Individual Rights
section of this notice.
USES AND DISCLOSURES THAT MAY BE MADE EITHER WITH YOUR AGREEMENT OR THE
OPPORTUNITY TO OBJECT
Unless you object, we may disclose to a member of your family, a relative, a close friend or any
other person you identify, orally or in writing, your health information that directly relates to that
person's involvement in your health care. If you are unable to agree or object to such disclosure,
we may disclose such information as necessary if we determine that it is in your best interest
based on our professional judgment. We may use or disclose your health information to notify
or assist in notifying a family member, personal representative or any other person that is
responsible for your care of your location or general condition.
USES AND DISCLOSURES BASED ON YOUR WRITTEN AUTHORIZATION
Marketing:
We must obtain your written authorization to use and disclose your health
information for most marketing purposes.
Sale of Health Information:
We must obtain your written authorization for any disclosure of your
health information which constitutes a sale of health information.
Other Uses:
Other uses and disclosures of your health information will be made only with your
written authorization, except as described in this notice or as otherwise required or allowed by
applicable law. In the event that we ask for your authorization to use or disclose your health
information, we will provide you with an appropriate authorization form. Once you've given us a
written authorization, you can revoke that authorization at any time, except to the extent that we
have taken action in reliance on your authorization.
INDIVIDUAL RIGHTS
Access:
You have the right to see or get an electronic or paper copy of your health information by
submitting a request to us in writing using the information listed at the end of this notice. There
are certain exceptions to your right to obtain a copy of your health information. For example,
we may deny your request if we believe the disclosure will endanger your life or that of another
person. Depending on the circumstances of the denial, you may have a right to have this decision
reviewed. We will charge you a fee to cover the costs incurred by us in complying with your
request.
Disclosure Accounting:
You have the right to an accounting of disclosures of your health
information made by us by submitting a request to us in writing using the information listed at
the end of this notice. This right only applies to instances when we or our business associates
disclosed your health information for purposes other than treatment, payment, health care
operations, upon your written authorization, and certain other activities. The right to receive this
information is subject to certain exceptions, restrictions and limitations. You must specify a time
period, which may not be longer than 6 years. You may request a shorter timeframe. You have the
right to one free request within any 12-month period, but we may charge you for any additional
requests in the same 12-month period. We will notify you about any such charges, and you are
free to withdraw or modify your request in writing before any charges are incurred.
Restriction Requests:
You have the right to request restrictions on the use and disclosure of your
health information by submitting a request to us in writing using the information listed at the