![]() If you feel your rights have been violated you may contact the designated Privacy Officer, Ask for a paper copy of this document even if you have agreed to receive the notice electronically.We will ask for proof of this relationship before we take any action. If you have given someone medical power of attorney or they are your legal guardian, that person can exercise your rights and make choices about your health information. Revoke an authorization to use or disclose PHI at any time except where action has already been taken.For additional requests we will charge a reasonable, cost based fee. One request per year will be provided free of charge. We will provide a list for the past six years for the request. Ask us for a list or an accounting of the times we have shared your health information for reasons other than treatment, payment, healthcare operations, and when you have asked us to share information.If you pay for a service or health care item out of pocket in full and you ask us not to share that information for payment or our operations with your health insurer we will agree unless we are required by law to share that information. ![]() We are not required to agree with your request and may say “no” if it would affect your care.
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