• You can ask to see or get an electronic or paper copy of your medical record and other health information TPC has about you. Ask us how to do this.
• TPC will provide a copy or a summary of your health information, within 15 days of your request. TPC may charge a reasonable, cost-based fee, for requests that TPC reasonably deems as overly burdensome. More information is available upon request.

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• TPC may say “no” to your request, but we’ll tell you why in writing within 60 days.

• 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.
• TPC will say “yes” to all reasonable requests.

• You can ask us not to use or share certain health information for treatment, payment, or our operations. TPC is 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, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. TPC will say “yes” unless a law requires us to share that information.

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• TPC will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). TPC will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. TPC will provide you with a paper copy promptly.

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• TPC will make sure the person has this authority and can act for you before we take any action.

• You can complain if you feel we have violated your rights by contacting us using the information above.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• TPC will not retaliate against you for filing a complaint.

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. TPC may also share your information when needed to lessen a serious and imminent threat to health or safety.

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

• TPC may contact you for fundraising efforts, but you can tell us not to contact you again.

TPC typically uses or shares your health information in the following ways.

Example: A provider treating you for an injury asks another provider about your overall health condition.

Example: TPC uses health information about you to manage your treatment and services.

Example: TPC gives information about you to your health insurance plan so it will pay for your services.

TPC is allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. TPC has to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

• 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

• 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

• TPC is required by law to maintain the privacy and security of your protected health information.
• TPC will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• TPC must follow the duties and privacy practices described in this notice and give you a copy of it.
• TPC will not use or share your information other than as described here unless you tell us we can in writing. 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.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.