Notice of privacy practices.

Your rights.

When it comes to your health information, you have certain rights. This section explains them and some of our responsibilities to help you.

Get a 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, 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, but we will tell you why in writing within 60 days.

Ask us to contact you in a certain way.

You can ask us to reach you a specific way (for example, a different phone number or email address) 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, and we may say no if it would affect your care.

If you pay for a service or item out of pocket in full, you can ask us not to share that information with your health insurer for payment or our operations. We will say yes unless a law requires us to share it.

Get a list of those we have shared your information with.

You can ask for a list (accounting) of the times we have shared your health information in the six years before the date you ask, who we shared it with, and why.

The list includes every disclosure except those for treatment, payment and health care operations, and certain others (such as any you asked us to make). We will provide one list a year for free. If you ask for another within 12 months, we may charge a reasonable, cost-based fee.

Get a copy of this notice.

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

Choose someone to act for you.

If you have given someone medical power of attorney, or 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 think your rights were violated.

You can complain to us using the contact information at the end of this notice.

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by writing to 200 Independence Avenue S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/hipaa/filing-a-complaint.

We will not retaliate against you for filing a complaint.

Your choices.

You can tell us your choices about some sharing.

If you have a clear preference for how we share your information in the situations below, tell us what you want and we will follow your instructions. You can tell us to:

• Share information with your family, close friends or others involved in your care.
• Share information in a disaster relief situation.

If you cannot tell us.

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

We never share it for these without your written permission.

• Marketing.
• Sale of your information.
• Most sharing of psychotherapy notes.

How we use and share your information.

We typically use or share your health information in the following ways.

To treat you.

We use your health information and share it with other professionals involved in your care. For example, we send orders to the lab that runs your blood work and prescriptions to your pharmacy.

To run the practice.

We use your health information to run the practice, improve your care and contact you when needed. For example, we use it to schedule your visits and send reminders.

To collect payment.

We use the information needed to process payment for your care. Our card processor receives only what it needs to take the payment, not your visit details.

With companies that help us.

We work with companies that help us provide care and run the practice, such as our medical record, scheduling, email and video visit systems, and a secure AI documentation tool that helps Dr. Nelson write visit notes. Each one that handles your health information must agree in writing to protect it.

Other ways we may share your information.

We are allowed or required to share your information in other ways, usually ones that serve public health or research. We have to meet many conditions in the law before we can share it for these purposes. Learn more at hhs.gov/hipaa/for-individuals.

Help with public health and safety.

• Preventing disease.
• Helping with product recalls.
• Reporting adverse reactions to medications.
• Reporting suspected abuse, neglect or domestic violence.
• 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 law requires it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.

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.

Address workers’ compensation, law enforcement and other government requests.

• For workers’ compensation claims.
• For law enforcement purposes or with a law enforcement official.
• With health oversight agencies for activities authorized by law.
• For special government functions such as military, national security and presidential protective services.

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.

Changes to this notice.

Questions or requests.