YOUR RIGHTS: Right to access and/or amend your medical information. You can ask to see or get an electronic or paper copy of your medical record. We will provide a copy or a summary of your health information, usually within 30 days of your request. You can ask us to correct health information about you that you think is incorrect or incomplete. We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Right to request additional restrictions on use and disclosure of medical information. You can ask us to limit what we use or share of certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would effect your care. We will say “yes” unless a law requires us to share that information.

Right to request an accounting of disclosures of your medical information. You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

You can choose someone to act for you:

• If you have given someone medical power of attorney or if 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.

You can complain if you feel we have violated your rights by contacting us at 325-944-1515.

• You can file a complaint with the U.S. Dept of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.

Your Choices: For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to 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 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 your information when needed to lessen a serious and imminent threat to health or safety.

We may use or share your health information in the following ways: To treat you: We use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition. To run our organization: We use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We may send or communicate appointment reminders but subject to our normal confidentiality polices and any special instructions that you have given. You can ask us to contact you in a specific way (for example: home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.

We can also share health information about you for certain situations such as:

• 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
• For health research
• To comply with the law
• With organ procurement organizations
• With a coroner, medical examiner, or funeral director when an individual dies
• 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
• Response to lawsuits and legal actions, a court or administrative order, or in response to a subpoena.

Our Responsibilities:

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

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

For more information: https://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html. We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.