Notice of Privacy Practices

Our commitment to your privacy

In accordance with Health Insurance Portability and Accountability Act of 1996 (HIPAA), we are dedicated to maintaining the privacy of your health information. This notice defines how health information about you is used and how you can get access to your health information. We are required by law to maintain the confidentiality of your health information.

Use and disclosure of your health information

The following conditions may require us to use or disclose your health information.

• To public health agencies that are authorized by law to collect information.
• For lawsuits and other proceedings in response to court or administrative order.
• By law enforcement officials, if required to do so.
• When necessary to reduce or prevent a serious threat to your health and safety, and to the safety of others. We will only disclose to a person/agency to help prevent the threat.
• If you are a member of the U.S. military and if required by appropriate authorities.
• To federal officials for intelligence and national security activities authorized by law.
• To correctional institutions or law enforcement officials if you are an inmate or under their custody.
• For Workers Compensation and similar programs.

Your rights regarding health information

• Communication: You can request that Stanley Jacobs, M.D., Inc. communicate with you about your health in a particular manner or at a certain location. You may want us to contact you only at home for example.
• You can request a restriction in our use or disclosure of your health information for treatment, payment, or health-care operations. You have the right to request that we restrict our disclosure to only certain individuals such as family members.
• You have the right to obtain a copy of the health information such as medical records and billing records, but not psychotherapy notes. You may amend your health information if you believe it is incorrect or incomplete. You must submit your request in writing to Stanley W. Jacobs, M.D., Inc. Attn: Medical Records 145 Foss Creek Circle, Healdsburg, Ca. 95448.
• You are entitled to receive a copy of Notice of Privacy Practice, and can obtain one by asking at any time. Please call the front office at 707-473-0220.
• If you believe your rights have been violated you may file a complaint with the Secretary of the Dept. of Health and Human Services.
• Our practice will obtain your written authorization for uses/disclosures that are not identified by this notice or permitted by applicable law.