Privacy and non-discrimination Policy
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You have the right to inspect and copy your Protected Health Information (reasonable fees may
apply): Pursuant to your written request, you have the right to inspect and copy your Protected
Health Information in paper or electronic format. Under federal law, you may not inspect or copy
the following types of records: psychotherapy notes, information compiled as it relates to civil,
criminal, or administrative action or proceeding; information restricted by law; information related
to medical research in which you have agreed to participate; information obtained under a
promise of confidentiality; and information whose disclosure may result in harm or injury to
yourself or others. We have up to 30 days to provide the Protected Health Information and may
charge a fee for the associated costs.
You have a right to a summary or explanation of your Protected Health Information: You have
the right to request only a summary of your Protected Health Information if you do not desire to
obtain a copy of your entire record. You also have the option to request an explanation of the
information when you request your entire record.
You have the right to obtain an electronic copy of medical records: You have the right to request
an electronic copy of your medical record for yourself or to be sent to another individual or
organization when your Protected Health Information is maintained in an electronic format. We
will make every attempt to provide the records in the format you request; however, in the case
that the information is not readily accessible or producible in the format you request, we will
provide the record in a standard electronic format or a legible hard copy form. Record requests
may be subject to a reasonable, cost-based fee for the work required in transmitting the
electronic medical records.
You have the right to receive a notice of breach: In the event of a breach of your unsecured
Protected Health Information, you have the right to be notified of such breach.
You have the right to request Amendments: At any time if you believe the Protected Health
Information we have on file for you is inaccurate or incomplete, you may request that we amend
the information. Your request for an amendment must be submitted in writing and detail what
information is inaccurate and why. Please note that a request for an amendment does not
necessarily indicate the information will be amended.
You have a right to receive an accounting of certain disclosures: You have the right to receive an
accounting of disclosures of your Protected Health Information. An “accounting” being a list of
the disclosures that we have made of your information. The request can be made for paper
and/or electronic disclosures and will not include disclosures made for the purposes of:
treatment; payment; health care operations; notification and communication with family and/or
friends; and those required by law.
You have the right to request restrictions of your Protected Health Information: You have a right
to restrict and/or limit the information we disclose to others, such as family members, friends,
and individuals involved in your care or payment for your care. You also have the right to limit or
restrict the information we use or disclose for treatment, payment, and/or health care
operations. Your request must be submitted in writing and include the specific restriction
requested, whom you want the restriction to apply, and why you would like to impose the
restriction. Please note that our practice/your physician is not required to agree to your request
for restriction with the exception of a restriction requested to not disclose information to your
health plan for care and services in which you have paid in full out-of-pocket.
You have a right to request to receive confidential communications: You have a right to request
confidential communications from us by alternative means or at an alternative location. For
example, you may designate we send mail only to an address specified by you which may or
may not be your home address. You may indicate we should only call you on your work phone
or specify which telephone numbers we are allowed or not allowed to leave messages on. You
do not have to disclose the reason for your request; however, you must submit a request with
specific instructions in writing.
CHANGES TO THIS NOTICE
We reserve the right to change the terms of this notice and will notify you of such changes. We
will also make copies available of our new notice if you wish to obtain one. We will not retaliate
against you for filing a complaint.
If at any time you believe your privacy rights have been violated and you would like to register a
complaint, you may do so with us or with the Secretary of the United States Department of
Health and Human Services.
If you wish to file a complaint with us, please submit it in writing to our Privacy/Compliance
Officer to the address listed on our website.
If you wish to file a complaint with the Secretary of the United States Department of Health and
Human Services, please go to the website of the Office for Civil Rights
(www.hhs.gov/ocr/hipaa/), call 202-619-0257 (toll free 877-696-6775), or mail to:
Secretary of the US – Department of Health and Human Services
200 Independence Ave S.W.
Washington, D.C. 20201
To file a complaint with the practice, submit your complaint in writing to Yun Sun Lee, M.D. All
complaints shall be investigated without repercussion to you. You will not be penalized for filing