Notice of Privacy Practices

Health Insurance Portability And Accountability Act (H.I.P.A.A.)

This notice describes how health information about you may be used and disclosed and how you can get access to your individually identifiable health information.

As a patient in the health and counseling office, you have a right to:

• Receive a copy of our notice of privacy practices
• Have access to and amend your health record
• have only the minimum necessary information shared
• Authorize before your personal health information is forwarded
• Have safe maintenance and protected access to your personal health information
• Restrict certain uses and disclosures of your personal health information
• Complain about alleged privacy violation by the health office to the privacy officer, Robert Chambers, 617.879.7751. *

* If you prefer to file a written complaint: If you believe your privacy rights have been violated, you may file a complaint at the following address:

Compliance Department – Privacy Complaints
PO Box 99378
Emeryville, CA 94662-9378