Your Provider May Use and Disclose Your PHI For:

1. For Treatment: Your PHI may be used by healthcare providers involved in your care to provide or
coordinate treatment. This may include consultations with other professionals involved in your
treatment.
2. For Payment: Your PHI may be necessary for billing and payment purposes, such as processing
insurance claims and determining coverage and eligibility.
3. For Health Care Operations: Your PHI may be used for healthcare operation activities, including
quality assessment, business management, and administrative purposes.
4. Required by Law: Your provider must disclose your PHI upon your request or as required for
investigations by the Department of Health and Human Services.
5. Without Authorization: Your provider may disclose information without your authorization in limited
circumstances, such as mandatory reporting of abuse, compliance with court orders, or to prevent
serious threats to health or safety.
6. Verbal Permission: Your provider may discuss your PHI with family members involved in your
treatment with your verbal consent.
7. With Authorization: Uses and disclosures not permitted by law will require your written authorization,
which you may revoke at any time.

Your Rights Regarding Your PHI:

• Right of Access to Inspect and Copy: You have the right to view and obtain copies of your PHI unless
access is restricted for specific reasons.
• Right to Amend: If you believe your PHI is incorrect or incomplete, you can request an amendment.
Your provider is not required to agree to this request.
• Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures of
your PHI made by your provider.
• Right to Request Restrictions: You may request limitations on the use or disclosure of your PHI,
although your provider is not obligated to agree.
• Right to Request Confidential Communication: You have the right to request communication in a
certain way or location regarding your medical matters.
• Right to a Copy of This Notice: You can request a paper copy of this notice at any time.