This notice describes how health information may be used and disclosed and how you can get access to this information. Please review it carefully.

I. Our Pledge Regarding Health Information:

At STEPHANE MEDICAL PLLC, we understand that health information about you and your health care is personal. We are committed to protecting your health information. We create a record of the care and services you receive from STEPHANE MEDICAL PLLC. This record is necessary to provide you with quality care and to comply with legal requirements. This notice applies to all records of your care generated by this practice. This notice explains how we may use and disclose your health information, your rights regarding this information, and our obligations. STEPHANE MEDICAL PLLC is required by law to:

Make sure that protected health information (PHI) that identifies you is kept private.

Provide you with this notice of our legal duties and privacy practices with respect to health information.

Follow the terms of the notice that is currently in effect.

We may change the terms of this notice, and such changes will apply to all the information we have about you. The updated notice will be available upon request, in our office, and on our website.

II. How We May Use and Disclose Health Information About You:

The following categories describe different ways that STEPHANE MEDICAL PLLC may use and disclose health information. For each category of uses or disclosures, we will explain what is meant and provide some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

For Treatment, Payment, or Health Care Operations: Federal privacy rules allow health care providers with a direct treatment relationship with the patient to use or disclose the patient's PHI without written authorization, in order to carry out treatment, payment, or health care operations. We may also disclose your PHI for the treatment activities of other health care providers without your written authorization. For example, if a health care provider consults with another licensed provider about your condition, we would be permitted to use and disclose your PHI to assist in the diagnosis and treatment of your condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard because other health care providers may need access to your full record to provide quality care. "Treatment" includes coordinating care, consultations between providers, and referrals of a patient for care from one provider to another.

Lawsuits and Disputes: If you are involved in a lawsuit, STEPHANE MEDICAL PLLC may disclose health information in response to a court or administrative order. We may also disclose health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to inform you about the request or to obtain a protective order for the information requested.

III. Certain Uses and Disclosures Require Your Authorization:

Session Notes: STEPHANE MEDICAL PLLC maintains "session notes," and any use or disclosure of such notes requires your authorization unless the disclosure is for the following purposes:

a. For use in treating you.

b. For use in training or supervising associates to improve their clinical skills.

c. For defending STEPHANE MEDICAL PLLC in legal proceedings initiated by you

d. For use by the Secretary of Health and Human Services to investigate our compliance with HIPAA.

e. As required by law, with the use or disclosure limited to the requirements of the law.

f. For health oversight activities regarding the originator of the session notes.

g. As required by a coroner performing duties authorized by law.

h. To help avert a serious threat to the health and safety of others.

Marketing Purposes: STEPHANE MEDICAL PLLC will not use or disclose your PHI for marketing purposes without your authorization.

Sale of PHI: STEPHANE MEDICAL PLLC will not sell your PHI in the regular course of business.

IV. Certain Uses and Disclosures Do Not Require Your Authorization:

Subject to certain limitations in the law, STEPHANE MEDICAL PLLC may use and disclose your PHI without your authorization for the following reasons:

When required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of the law.

For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.

For health oversight activities, including audits and investigations.

For judicial and administrative proceedings, including responding to a court or administrative order, although our preference is to obtain your authorization before doing so.

For law enforcement purposes, including reporting crimes occurring on our premises.

To coroners or medical examiners, when such individuals are performing duties authorized by law.

For research purposes, including studying and comparing patients who received one form of care versus those who received another form of care for the same condition.

For workers' compensation purposes, to comply with workers' compensation laws.

Appointment Reminders and Health-Related Benefits or Services: STEPHANE MEDICAL PLLC may use and disclose your PHI to contact you to remind you that you have an appointment with us. We may also use and disclose your PHI to inform you about treatment alternatives or other health care services or benefits that we offer.

V. Certain Uses and Disclosures Require You to Have the Opportunity to Object:

Disclosures to Family, Friends, or Others: STEPHANE MEDICAL PLLC may provide your PHI to a family member, friend, or another person involved in your care or in the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations

VI. Your Rights With Respect to Your PHI:

The Right to Request Limits on Uses and Disclosures of Your PHI: You have the right to ask STEPHANE MEDICAL PLLC not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and we may say "no" if we believe it would affect your care.

The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full: You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

The Right to Choose How We Send PHI to You: You have the right to ask STEPHANE MEDICAL PLLC to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests.

The Right to See and Get Copies of Your PHI: Other than "session notes," you have the right to get an electronic or paper copy of your medical record and other information that we have about you. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and we may charge a reasonable, cost-based fee for doing so.

The Right to Get a List of the Disclosures We Have Made: You have the right to request a list of instances in which STEPHANE MEDICAL PLLC has disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided an authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we provide will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a reasonable, cost-based fee for each additional request.

The Right to Correct or Update Your PHI: If you believe there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we correct the existing information or add the missing information. We may say "no" to your request, but we will tell you why in writing within 60 days of receiving your request.

The Right to Get a Paper or Electronic Copy of This Notice: You have the right to get a paper copy of this notice, and you also have the right to request a copy of this notice by e-mail. Even if you have agreed to receive this notice via e-mail, you may still request a paper copy at any time.