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
• Share information in a disaster relief situation
• Include your information in a hospital directory
• Contact you for fundraising efforts
If you are not able to tell us your preference, for example if you are
unconscious, we may go ahead and 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.
In these cases we never
share your information
unless you give us
• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes
In the case of fundraising:
• We may contact you for fundraising efforts, but you can tell us not to
contact you again.
Notice of Privacy Practices • Page 3
How do we typically use or share your health information? We typically use or share your health
information in the following ways.
• We can use your health information and
share it with other professionals who are
Example: A doctor treating you
for an injury asks another doctor
about your overall health condition.
We can use and share your health information
to run our practice, improve your care,
and contact you when necessary.
Example: We use health information
about you to manage your treatment
Bill for your
• We can use and share your health information
to bill and get payment from health plans or
Example: We give information
about you to your health insurance
plan so it will pay for your services.
Our Uses and Disclosures
continued on next page