this disclosure if the patient agrees or when required or
authorized by law.
2. You have the right to reasonably request to receive confidential
communications of your PHI by alternative means or at alternative
locations. To make such a request, you may submit your request in
writing to the Privacy Officer.
Health Oversight Activities. We may disclose PHI to federal or
state agencies that oversee our activities (e.g., providing health
care, seeking payment, and civil rights).
3. You have the right to inspect and copy the PHI contained in our
Plan records, except:
Lawsuits and Disputes. If you are involved in a lawsuit or a
dispute, we may disclose PHI subject to certain limitations.
for information compiled in reasonable anticipation of,
or for use in, a civil, criminal, or administrative action
Law Enforcement. We may release PHI if asked to do so by a
law enforcement official:
if you are a prison inmate, and access would jeopardize
your health, safety, security, custody, or rehabilitation or
that of other inmates, any officer, employee, or other
person at the correctional institution or person
responsible for transporting you;
In response to a court order, warrant, summons or
To identify or locate a suspect, fugitive, material
witness, or missing person;
About the victim of a crime under certain limited
About a death we believe may be the result of criminal
About criminal conduct on our premises; or
In emergency circumstances, to report a crime, the
location of the crime or the victims, or the identity,
description or location of the person who committed the
(iii) for PHI contained in records kept by a federal agency or
contractor when your access is restricted by law; and
for PHI obtained from someone other than us under a
promise of confidentiality when the access requested
would be reasonably likely to reveal the source of the
In order to inspect or obtain a copy your PHI, you may
submit your request in writing to the Privacy Officer. If you request
a copy, we may charge you a fee for the costs of copying and
mailing your records, as well as other costs associated with your
Coroners, Medical Examiners and Funeral Directors. We may
release PHI to a coroner or medical examiner. We may also
release PHI about patients to funeral directors as necessary to
carry out their duties.
We may also deny a request for access to PHI under
certain circumstances if there is a potential for harm to yourself or
others. If we deny a request for access for this purpose, you have the
right to have our denial reviewed in accordance with the
requirements of applicable law.
National Security and Intelligence Activities. We may release
PHI about you to authorized federal officials for intelligence,
counterintelligence, other national security activities authorized
by law or to authorized federal officials so they may provide
protection to the President or foreign heads of state.
You have the right to request an amendment to your PHI but we
Serious Threats. As permitted by applicable law and standards
of ethical conduct, we may use and disclose PHI if we, in good
faith, believe that the use or disclosure is necessary to prevent
or lessen a serious and imminent threat to the health or safety of
a person or the public or is necessary for law enforcement
authorities to identify or apprehend an individual.
may deny your request for amendment, if we determine that the PHI
or record that is the subject of the request:
was not created by us, unless you provide a reasonable
basis to believe that the originator of PHI is no longer
available to act on the requested amendment;
Note: Information related to treatment of HIV, substance
abuse, or mental health diseases or genetic information may
enjoy certain special protections under applicable state and
is not part of your medical or billing records or other
records used to make decisions about you;
(iii) is not available for inspection as set forth above; or
is accurate and complete.
In any event, any agreed upon amendment will be
OTHER USES OF YOUR PHI
included as an addition to, and not a replacement of, already existing
records. In order to request an amendment to your PHI, you must
submit your request in writing to the Privacy Officer, along with a
description of the reason for your request.
Certain uses and disclosures of PHI will be made only with your
written authorization, including uses and/or disclosures: (a) of
psychotherapy notes (where appropriate); (b) for marketing
purposes; and (c) that constitute a sale of PHI under the Privacy
Rule. Other uses and disclosures of PHI not covered by this notice
or the laws that apply to us will be made only with your written
authorization. You have the right to revoke that authorization at any
time, provided that the revocation is in writing, except to the extent
that we already have taken action in reliance on your authorization.
You have the right to receive an accounting of disclosures of
PHI made by us to individuals or entities other than to you for the
six years prior to your request, except for certain routine disclosures.
To request an accounting of disclosures of your PHI, you must
submit your request in writing to the Privacy Officer. Your request
must state a specific time period for the accounting (e.g., the past
three months). The first accounting you request within a twelve (12)
month period will be free. For additional accountings, we may
charge you for the costs of providing the list. We will notify you of
the costs involved, and you may choose to withdraw or modify your
request at that time before any costs are incurred.
You have the right to request restrictions on our uses and
disclosures of PHI. However, we are not required to agree to your
request. To request a restriction, you may make your request in
writing to the Privacy Officer.
You have the right to receive a notification, in the event that
there is a breach of your unsecured PHI, which requires notification
under the Privacy Rule.