Your Rights:

You have the right to:

• Get a copy of your paper or electronic medical record

• Correct your paper or electronic medical record

• Request confidential communication

• Ask us to limit the information shared

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

• Get a copy of this privacy notice

• Choose someone to act on your behalf

• File a complaint if you believe your privacy rights have been violated.

• To file a complaint, please contact us directly at: info@concordisbh.com or by calling 510-859-8082

• If you are not satisfied with how we handle a complaint or if you don’t feel we have handled your concern, you may also submit a formal complaint to:

• Region IX

  Office for Civil Rights

  U.S. Department of Health and Human Services

  90 7th Street, Suite 4-100

  San Francisco, CA 94103

  (800) 368-1019; (800) 537-7697 (TDD)

  (202) 619-3818 (fax)

  OCRMail@hhs.gov

• We will not retaliate against you for filing a complaint.

Uses and Disclosures of Protected Health Information:

We may use and share your information for the following purposes including:

• Treating you

• Running our organization

• Billing you for services

• Helping with public health and safety issues

• Communicating with you via reminders, texts or emails

• Notifying appropriate contacts in the event of a threat to your safety or the safety of someone else

• Responding to organ and tissue donation requests

• Working with a coroner or medical examiner

• Addressing workers’ compensation, law enforcement, and other government requests

• Responding to lawsuits and legal actions

Our Responsibilities:

• We are required by law to maintain the privacy and security of your protected health information.

• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

• We must follow the duties and privacy practices described in this notice and give you a copy of it.

• We will not use or share your information other than as described here unless you give us permission in writing. You may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice:

• We can change the terms of this notice at any time, and the changes will apply to all the information we have about you.

• The current HIPAA notice will be available upon request at any time and maintained on this web site.

• Please download a full copy of the HIPAA Notice of Privacy Practices at the link at the top of this page or request a written copy from me.

• For further inquires or concerns contact me at: info@concordisbh.com or by calling 510-859-8082.