Clinic Privacy Notice
Your Health Information Rights
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to:
- request a restriction on certain uses and disclosures of your information
- obtain a paper copy of the notice of information practices upon request
- inspect and obtain a copy of your health record
- amend your health record
- obtain an accounting of disclosures of your health information
- requst communications of your health information by alternative means or at alternative locations
- revoke your authorization to use or disclose health information except to the extent that action has already been taken
Our Responsibilities
This organization is required to:
- maintain the privacy of your health information
- provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
- abide by the terms of this notice
- notify you if we are unable to agree to a requested restriction
- accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
We will not use or disclose your health information without your authorization, except as described in this notice.
If you believe your privacy rights have been violated, you can file a complaint with our Privacy Office or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. You may contact our Privacy Officer, Donna Poulin, at (207) 846-6163 or by e-mail at donna@womentowomen.com for further information about the complaint process.