Your Infor­ma­tion. 你的权利. Our Responsibilities

本通知描述有关您的医疗信息可能如何被使用和披露,以及您如何获得这些信息. Please review it carefully.


When it comes to your health infor­ma­tion, you have cer­tain rights. 本节解释您的权利以及我们帮助您的一些责任和义务.

Get an elec­tron­ic or paper copy of your med­ical record

  • 您可以要求查看或获取您的医疗记录和我们拥有的其他健康信息的电子或纸质副本. Ask us how to do this.
  • We will pro­vide a copy or a sum­ma­ry of your health infor­ma­tion, usu­al­ly with­in 30 days of your request. We may charge a rea­son­able, cost-based fee.
Ask us to cor­rect your med­ical record
  • 您可以要求我们更正您认为不正确或不完整的健康信息. Ask us how to do this.
  • 我们可能会说 no” to your request, but we’ll tell you why in writ­ing with­in 60 days.

Request con­fi­den­tial communications

  • 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.
  • 我们会说 yes” to all rea­son­able requests.

Ask us to lim­it what we use or share

  • 您可以要求我们不要使用或分享某些治疗健康信息, pay-ment, or our oper­a­tions. We are not required to agree to your request, and we may say no” if it would affect your care.
  • If you pay for a ser­vice or health care item out-of-pock­et in full, 您可以要求我们不要为了付款或我们与您的健康保险公司的操作而共享该信息. 我们会说 yes” unless a law requires us to share that information.
  • As part of our ongo­ing efforts to pro­vide qual­i­ty care to our patients, 正规博彩平台参与了各种电子-电子健康信息交换(HIE)。. 此活动可使其他社区卫生保健提供者方便地阅读您的医疗信息,以调整护理,并可避免重复检测.

Get a list of those with whom we’ve shared information

  • 你可以要求我们列出在你提出要求之前或之前的六年内,我们分享你的健康信息的次数, who we shared it with, 为什么.
  • We will include all the dis­clo­sures except for those about treat­ment, pay-ment, and health care oper­a­tions, and cer­tain oth­er dis­clo­sures (such as any you asked us to make). 我们每年免费提供一次会计服务,但会收取合理的费用, cost-based fee if you ask for anoth­er one with­in 12 months.

Get a copy of this pri­va­cy notice

  • 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.

Choose some­one to act for you

  • 如果你给了某人医疗委托书或者某人是你的法定监护人, 这个人可以行使你的权利,对你的健康信息做出选择.
  • 在我们采取任何行动之前,我们将确保该人具有此权限并可以为您行事.

File a com­plaint if you feel your rights are violated


对于某些健康信息,您可以告诉我们您对我们共享的内容的选择. 如果您对我们在以下情况下如何共享您的信息有明确的偏好, 跟我们谈谈. 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:

  • 与你的家人、亲密的朋友或其他参与照顾你的人分享信息
  • 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, 如果我们认为这符合您的最佳利益,我们可能会继续分享您的信息. 我们也可能在需要时分享您的信息,以减轻对健康或安全的严重和迫在眉睫的威胁.


  • Mar­ket­ing purposes
  • Sale of your information
  • Most shar­ing of psy­chother­a­py notes

In the case of fundraising:

  • 我们可能会就筹款事宜与您联系,但您可以告诉我们不要再与您联系.

Our Uses and Disclosures

How do we typ­i­cal­ly use or share your health infor­ma­tion? 我们以以下方式使用或共享您的健康信息.


  • 我们可以使用你的健康信息,并与其他治疗你的专业人士分享.

Run our organization

  • We can use and share your health infor­ma­tion to run our prac­tice, improve your care, and con­tact you when nec­es­sary.

Bill for your services

  • 我们可以使用和分享您的健康信息,以便从健康计划或其他实体中收取账单和付款.

How else can we use or share your health infor­ma­tion? 我们被允许或被要求以其他方式分享您的信息——通常是以对公共利益有贡献的方式, such as pub­lic health and research. 我们必须满足法律上的许多条件,才能出于这些目的分享您的信息. For more infor­ma­tion see: www.美国卫生和公众服务部.gov / o c / p r i v c y / h i p / u n d e r s t n d i n g / c o n s u m e r s / n d e x.html

Help with pub­lic health and safe­ty issues


  • 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


  • We can use or share your infor­ma­tion for health research.

Com­ply with the law

  • 如果州或联邦法律要求,我们将分享有关您的信息, 包括卫生和公众服务部,如果他们想看到我们遵守联邦隐私法的话.

Respond to organ and tis­sue dona­tion requests

  • 我们可以与器官支持治疗组织分享你的健康信息.

Work with a med­ical exam­in­er or funer­al director

  • We can share health infor­ma­tion with a coro­ner, med­ical exam­in­er, or funer­al direc­tor when an indi­vid­ual dies.

We can use or share health infor­ma­tion about you:

  • 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

Respond to law­suits and legal actions

  • 我们可以根据法院或行政命令分享您的健康信息, or in response to a subpoena.

Our Respon­si­bil­i­ties

  • 法律要求我们维护您受保护的健康信息的隐私性和安全性.
  • 如果发生可能危及您信息隐私或安全的违规行为,我们将立即通知您.
  • 我们必须遵守本通知所述的职责和私隐惯例,并给你一份副本.
  • 除非您以书面形式告知我们,否则我们不会使用或分享您的信息. If you tell us we can, you may change your mind at any time. Let us know in writ­ing if you change your mind.

For more infor­ma­tion see: www.美国卫生和公众服务部.gov / o p c r / r我y v c / h p / u n d e r s t n d i n g / c o n s u m e r s / n o t i c e p p.html

Changes to the Terms of This Notice

We can change the terms of this notice, and the changes will apply to all infor­ma­tion we have about you. 新的通知将根据要求在我们的办公室和网站上提供. This notice applies to The South Bend Clin­ic and all depart­ments, 单位, 网站, and loca­tions of The 正规博彩平台.