Notice of Privacy Practices

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.

Our Commitment to Your Privacy

I am dedicated to maintaining the privacy of your protected health information (PHI). In conducting my practice, I will create records regarding you and the treatment and services I provide to you. I am required by law to maintain the confidentiality of health information that identifies you.

How I May Use and Disclose Your Health Information

•Treatment: I may use your PHI to provide, coordinate, or manage your care. For example, I may consult with another healthcare provider regarding your treatment with your consent.

•Payment: I may use and disclose your PHI so that the services you receive may be billed to and payment collected from you, an insurance company, or a third party.

•Healthcare Operations: I may use and disclose your PHI to operate my business, such as for quality assessment or clinical supervision.

•Required by Law: I will disclose your PHI when required to do so by federal, state, or local law.

Special Situations & Mandatory Reporting (Maryland Specifics)

Under Maryland law, I must disclose your PHI without your authorization in the following situations:

•Child or Adult Abuse/Neglect: If I have reason to believe a child or vulnerable adult has been subjected to abuse or neglect.

•Serious Threat to Health or Safety: To prevent a serious and imminent threat to your health and safety or the health and safety of the public or another person.

•Lawsuits and Disputes: If you are involved in a lawsuit or dispute, I may disclose PHI in response to a court or administrative order.

Your Rights Regarding Your PHI

•Right to Inspect and Copy: You have the right to look at or get copies of your health information, with limited exceptions.

•Right to Amend: If you feel that health information I have is incorrect or incomplete, you may ask me to amend the information.

•Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures I made of your PHI for purposes other than treatment, payment, or healthcare operations.

•Right to Request Restrictions: You have the right to request a restriction on the PHI I use or disclose for treatment, payment, or healthcare operations. I am not required to agree to your request unless you pay for a service in full out-of-pocket.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with me or with the Secretary of the Department of Health and Human Services.