While receiving care from our facility, information regarding your medical history, treatment, and payment for your healthcare may be originated and/or received by us. Information which can be used to identify you and which relates to your medical care or your payment for medical care is protected by state and federal law ("Protected Health Information"). To learn more about your rights and our responsibilities concerning your PHI, review the Legal Information or download the Notification Practices below.

Federal law grants you certain rights with respect to your Protected Health Information (PHI). Specifically, you have the right to:

• Receive notice of our policies and procedures used to protect your PHI;

• Request that certain uses and disclosures of your PHI be restricted; provided, however, if we may release the information without your consent or authorization, we have the right to refuse your request;

• Access to your PHI; provided, however, the request must be in writing and may be denied in certain limited situations;

• Request that your PHI be amended;

• Obtain an accounting of certain disclosures by us of your PHI for the past six years;

• Revoke any prior authorizations or consents for use or disclosure of PHI, except to the extent that action has already been taken; and

• Request communications of your PHI are done by alternative means or at alternative locations.

Federal law also imposes certain obligations and duties upon us with respect to your PHI. Specifically, we are required to:

• Provide you with notice of our legal duties and our facility's policies regarding the use and disclosure of your PHI;

• Maintain the confidentiality of your PHI in accordance with state and federal law;

• Honor your requested restrictions regarding the use and disclosure of your PHI unless under the law we are authorized to release your PHI without your authorization or consent, in which case you will be notified within a reasonable period of time;

• Allow you to inspect and copy your PHI during our regular business hours;

• Act on your request to amend PHI within sixty (60) days and notify you of any delay which would require us to extend the deadline by the permitted thirty (30) day extension;

• Accommodate reasonable requests to communicate PHI by alternative means or methods; and abide by the terms of this notice.

5007catc notice of information practices

5005catc medical records release form