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 me to limit the information shared • Get a list of those with whom I’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

Please contact me directly at elizabethwardmd@gmail.com or by calling 415-498-0481.

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

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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

Uses and Disclosures of Protected Health Information

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

• Treating you

• Running my 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

• 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

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

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

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

• I will not use or share your information other than as described here unless you tell me I can in writing. You may change your mind at any time. Let me know in writing if you change your mind.

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

I can change the terms of this notice at any time, and the changes will apply to all the information I have about you. The current HIPAA notice will be available upon request at any time and maintained on this website.

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Please download a full copy of the HIPAA Notice of Privacy Practices at the link above or request a written copy from me.

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For further inquiries or concerns contact me at: elizabethwardmd@gmail.com or by calling 415-498-0481.