Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities.

This notice describes how medical information about you may be used and disclosed by your healthcare provider and the medical practice responsible for your care (“Practice”) and how you can get access to this information. Please review it carefully.

Effective Date: January 2026

Your Rights

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

• Get a copy of your medical record – You can inspect or obtain an electronic or paper copy of your medical record. Copies are usually provided within 30 days. A reasonable cost-based fee may apply.
• Request corrections – You may ask us to correct information you believe is incorrect or incomplete. We will respond in writing within 60 days.
• Request confidential communications – You may ask us to contact you in a specific way or at a different address. Reasonable requests will be honored.
• Request limits on sharing – You may ask us not to use or share certain health information. We are not required to agree if it affects your care.
• Request an accounting of disclosures – You may request a list of disclosures made in the past six years, excluding treatment, payment, and operations.
• Get a copy of this notice – You may request a paper copy at any time.
• Choose a representative – A medical power of attorney or legal guardian may act on your behalf.

Your Choices

You can tell us how we share certain information, including sharing with family or during disaster relief situations.

Our Uses and Disclosures

• Treatment
• Payment
• Healthcare operations
• Appointment reminders and treatment alternatives
• De-identified and limited data sets
• Business associates
• Health Information Exchanges (HIE)

Uses Requiring Written Authorization

• Marketing communications
• Sale of information
• Psychotherapy notes
• HIV/AIDS information
• Sexually transmitted disease information
• Mental health records (where required by law)
• Substance use disorder records (42 CFR Part 2)
• Genetic information
• Certain minor treatment records

Our Responsibilities

• Maintain the privacy and security of your protected health information
• Notify you of breaches
• Follow the practices described in this notice

Complaints and Questions

You may file a complaint with the Practice’s Privacy Officer at privacy@toplinemd.com or with the U.S. Department of Health and Human Services.

We will not retaliate against you for filing a complaint.