Your Health Information Rights
Although your health record is the physical property of the healthcare provider, the information belongs to you. You have the right to:

  • Obtain a paper copy of this Notice upon request, even if you have received it electronically or from our website at
  • Inspect and copy your health record by using a written request form. We may charge you a reasonable fee for copying the information and for postage.
  • Complete a written request for an amendment of your health record. We are not obligated to make all requested amendments but we will give each request careful consideration.
  • Obtain an accounting of certain disclosures of your health information. We may charge a reasonable fee for more than one accounting in a 12 month period.
  • Make a written request for confidential communications of your health information by alternative means (e.g. fax versus mail) or at alternate locations (e.g. office versus home).
  • Request a restriction on certain uses and disclosures of your information by completing a request form. We are not required to agree to your restriction request but will attempt to accommodate reasonable requests when appropriate.
  • Provide written authorization for uses and disclosures not otherwise permitted by law.
  • Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Our Responsibilities

We are required to:

  • Maintain the privacy of your health information according to law.
  • Provide you with this Notice of our legal duties and privacy practices with respect to information we collect and maintain about you.
  • Abide by the terms of this Notice.
  • Notify you if we are unable to agree to a requested restriction.
  • Accommodate reasonable requests you may have to communicate health information by alternative means or alternative locations.

We reserve the right to change our practices and to make new provisions effective for all information we have about you. We will post the current Notice in our offices and on our website at We will provide copies of the current Notice in effect upon your request.
We will not use or disclose your health information without your authorization, except as described in this Notice. We will also discontinue to use or disclose your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.