Know Your Patient Rights

Patients have the right to:

Get an electronic or paper copy of your medical record:

• You may ask to see or to get an electronic or paper copy of your medical record and other PHI. Ask us how to obtain this copy.
• We will provide a copy or a summary of your PHI, usually within 30 days of your request. We may charge a reasonable, cost-based fee. Ask us to correct your medical record:
• You may ask us to correct any PHI about you that you think is incorrect or incomplete. Ask us how to make a correction.
• We may approve or deny your request to correct your PHI, and/or add information about that request to your medical record.
• If we deny your request, we will tell you why in writing within 60 days.

Request confidential communications:

• You may ask us to contact you in a specific way (for example, by home telephone or by email) or to send mail to a different address.
• We will agree to all reasonable requests.
• You are responsible for providing us with the physical address, phone number, and/or email address at which you would prefer to be contacted, and with any changes to that contact information.

Ask us to limit what we use or share:

• You may ask us not to use or share certain PHI for treatment, payment, or our operations. We are not required to agree to your request, and may deny it if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you may ask us not to share that information with your health insurer for the purpose of payment or our operations. We will generally agree to such a request, but may not agree if a law requires us to share that information or if we conclude that failing to do so would be illegal or fraudulent.

Get a list of those with whom we have shared information:

• You may ask for a list (also called an “accounting”) of the times that we have shared your PHI in the six years prior to the date of your request, with whom we have shared it, and why.
• We will include all of the disclosures except for those regarding treatment, payment, and health care operations, and certain other disclosures (such as any that you asked us to make).
• We will provide one accounting per year for free, but we will charge a reasonable, cost-based fee if you ask for another accounting within 12 months.

Get a copy of this privacy notice:

• You may 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 upon request.

Choose someone to act for you:

• If you have given someone a medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices about your PHI.
• We will make reasonable efforts to see that the person has the authority to act for you before we take any action that may concern your PHI.

File a complaint if you feel your rights are violated:

• If you feel that we have violated your rights, you may complain by contacting us using the information on page 1.
• You may also file a complaint with the U.S. Dept. of Health & Human Services Office for Civil Rights, by sending a letter to 200 Independence Ave. S.W., Washington, D.C. 20201; by calling 1-877-696-6775; or by visiting www.hhs.gov/ocr/privacy/hipaa/complaints.
• We will not retaliate against you for filing a complaint.

Patient Information

• Pay Your Bill
• Billing & Insurance Information
• Patient Rights
• Preparing for Surgery
• What is Anesthesia?