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This Notice applies to all information and records related to your care that we have received or created. We will accommodate your reasonable requests. We may use and disclose your health information so that we can bill and receive payment for the treatment and services you receive. Basis for planning your care and treatment; Means of communication among the many healthcare professionals who contribute to your care; Legal document describing the care you received; Means by which you or your insurer can verify that services billed were actually provided; A tool in educating healthcare professionals; A source of data for medical research; A source of information for public health officials charged with improving the health of the nation; and A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve. There are some services provided in our organization through contracts with business associates. A bill may be sent to you or your insurance company. We may provide the directory information, including your religious affiliation, to any member of the clergy. Very limited information may be disclosed for payment purposes.

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We may deny, in whole or in part, your request to access, inspect and copy your protected health information under certain limited circumstances. We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. If you are a member of the armed forces, we may use and disclose your health information, as required by military command authorities. If we do agree to accept your requested restriction, we will comply with your request, except as needed to provide you emergency treatment. This Notice applies to all information and records related to your care that we have received or created. We will attempt to obtain an authorization as soon as possible. We will post a copy of the current Notice in all of our offices. These may include audits, investigations, inspections, licensure or other legal proceedings. This Notice describes your rights and our obligations regarding your health information, and informs you about the possible uses and disclosures of your health information. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your health information to the institution or official for certain purposes, including the health and safety of you and others, suspicious deaths, or in response to a valid subpoena, court order or warrant. You have the right to submit a request to amend your health record maintained by the Entities for as long as the information is kept by or for the Entities. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we have asked them to do and bill you or your insurer. For example, you can request that we contact you only at a certain telephone number. You have the right to request a reasonable accommodation regarding how you receive communications of health information. Information obtained by a nurse, physician or other member of your healthcare team will be recorded in your health record. You have the right to restrict or prohibit some or all of the foregoing uses or disclosures. A bill may be sent to you or your insurance company. You may revoke an authorization to use or disclose your health information for the purposes covered by that authorization, except where we have already relied on the authorization. We may provide the directory information, including your religious affiliation, to any member of the clergy. If you request that your information not be used or disclosed for fundraising purposes, we will ensure that you do not receive future fundraising communications. If necessary for your diagnosis or treatment in a behavioral health program, behavioral health information may be used and disclosed as permitted or required by law. The first accounting provided within a month period will be free; for further requests, a cost will be charged. If we believe that you have been a victim of abuse, neglect or domestic violence, we may use and disclose your health information to notify a government authority, if authorized by law or if you agree to the report. In addition, we will post a copy of the revised Notice on our website: For billing and payment purposes, we may disclose your health information to your representative, insurance or managed care company, Medicare, Medicaid or another third party payer. You have the right to request restrictions on the health information we disclose about you to a family member, friend or other person who is involved in your care or the payment of your care.

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  1. Your physician will document, in your health record, his or her expectations of the members of your healthcare team.

  2. Unless you agree, the termination of the restriction is only effective with respect to protected health information created or received after we have informed you of the termination. You have the right to request restrictions on the health information we disclose about you to a family member, friend or other person who is involved in your care or the payment of your care.

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