Access
You have the right to look at or get copies of your health information, with limited exceptions.  We ask you make your request in writing.  If you request a copy of the information, the first copy will be provided at no charge.  The second copy we will charge you a reasonable, cost-based fee for responding to these additional requests.  

Amendment
You have the right to request that we amend your health information.  Your request must be in writng, and it must explain why theinformation should be amended.  We may deny your request under certain circumstances.  

Accounting of Disclosures
You have the right to received a list of instances in which we have disclosed your health information for a purpose, other than treatment, payment, or healthcare operations.  To request accounting of disclosures, you must submit your request in writing to Client Records.  Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003.  If you request this accounting more than once in a 12-month period, we will charge you a reasonable, cost-based fee for responding to these additional requests.  

Restriction
You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations.  We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).  

Right to Request Confidential Communication
You have the right to request that we communicate with you about health matters in a certain way or at a certain location.  You must make this request in writing and it must specify the alternative means or location that you would like to receive information about your healthcare.  

Right to Obtain Papercopy of this Notice
You have the right to receive a paper copy of this notice upon request.  Copies will be available at the registration/reception desks at each clinic site.