When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

• You have the right ask to see or get an electronic or paper copy of your medical record. We may ask you to put your request in writing. We must comply with your request (with the exception of a few limited circumstances). Ask us how to do this. • We will provide a copy or a summary of your health information, usually within 30 days of your request. Federal law allows us to charge you a reasonable, cost-based fee, if not otherwise prohibited by State law.

• You may ask us to amend health information about you that you think is incorrect or incomplete. Your request must be in writing. Ask us how to do this. • We may say no to your request, but we’ll tell you why in writing within 60 days (unless we request an additional 30 days to respond and we will tell you why we need the additional 30 days).

• You may ask us to contact you in a specific way (for example, home, office or cell phone) or to send mail to a different address. • We will say yes to all requests we believe are reasonable.

• You may ask us not to use or share certain health information for treatment, payment or our operations. We are 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 may ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say yes unless a law requires us to share that information.

• You may 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. Your request must be in writing. • We will include all disclosures except for treatment, payment and healthcare operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting per year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

• You may ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We 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 we must honor the choices that person makes about your health information. • We must make sure the person has this authority and can act for you before we take any action.

• You may complain if you feel we have violated your privacy rights by contacting our Privacy Officer at: 2310 California Rd, Elkhart, IN 46514 or 574-264-0791.
• You may file a complaint with DHHS Office of Civil Rights. Visit • We will not retaliate against you for filing a complaint.


For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. We may not share your information under certain circumstances without your written permission (authorization). Once you give written permission, you may revoke the permission in writing at any time and we will no longer be able to share information going forward, but some information may have been already shared prior to the revocation.

• Share information with your family, close friends, or others involved in your care. • Share information in a disaster relief situation. • Appointment reminders: We may disclose your health information to contact you and remind you of an appointment. • Contact you for fundraising efforts, but you can tell us not to contact you again. If you 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. We 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.

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

How do we typically use or share your health information? We typically use or share your health information in the following ways.

• We may use your health information and share it with other professionals who are treating you.

• We may use and share your health information to bill and get payment from health plans or other entities.

• We may use and share your health information to run our practice, improve your care, and contact you when necessary.


How else may we use or share your health information? We are 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. We have to meet many conditions in the law before we can share your information for these purposes. For more information, see

• We may share health information for certain situations such as: • 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

• We may use or share your information for health research.

• We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

• We may share health information about you with organ procurement organizations.

• We may share health information with a coroner, medical examiner, or funeral director when an individual dies.

• We may use or share health information about you: • 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

• We may share health information about you in response to a court or administrative order, or in response to a subpoena.


• We are required by law to maintain the privacy and security of your protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice and give you a copy of it. • We 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: Changes to the Terms of This Notice We may change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request in our office and on our website.

Effective: April 1, 2019


Web Privacy Notice

This privacy notice discloses the privacy practices for This privacy notice applies solely to information collected by this website. It will notify you of the following:

What personally identifiable information is collected from you through the website, how it is used and with whom it may be shared.
What choices are available to you regarding the use of your data.
The security procedures in place to protect the misuse of your information.
How you can correct any inaccuracies in the information.

Information Collection, Use, and Sharing
We are the sole owners of the information collected on this site. We only have access to/collect information that you voluntarily give us via email or other direct contact from you. We will not sell or rent this information to anyone.

We will use your information to respond to you, regarding the reason you contacted us. We will not share your information with any third party outside of our organization, other than as necessary to fulfill your request.

Your Access to and Control Over Information
You may opt out of any future contacts from us at any time. You can do the following at any time by contacting us via the email address or phone number given on our website:

See what data we have about you, if any.
Change/correct any data we have about you.
Have us delete any data we have about you.
Express any concern you have about our use of your data.

We take precautions to protect your information. When you submit sensitive information via the website, your information is protected both online and offline.

While we use encryption to protect sensitive information transmitted online, we also protect your information offline. Only employees who need the information to perform a specific job (for example, billing) are granted access to personally identifiable information. The computers/servers in which we store personally identifiable information are kept in a secure environment.

If you feel that we are not abiding by this privacy policy, you should contact us immediately via telephone at 1.800.398.2058.

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