Notice of Privacy Practices

Effective April 1, 2015

Your Information. Your Rights. Our Responsibilities.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights

You have the right to:

  • Get a copy of your paper or electronic medical record
  • Provide information to make your paper or electronic record accurate such as, correct information that you have provided to us that needs updated or corrected
  • Request confidential communication about yourself
  • Ask us to limit the information we share
  • Get a list of those with whom we’ve shared your information
  • Get a copy of this privacy notice
  • Choose or elect a representative to act for you with respect to your health care and/or financial responsibilities
  • File a complaint if you believe your privacy rights have been violated

Your Choices

You may choose who information may be shared with where that information would be public:

  • Tell family and friends about your condition
  • Provide disaster relief
  • Include you in a hospital directory
  • Provide mental health care
  • Market our services and sell your information
  • Raise funds

Our Uses and Disclosures

We may use and share your information as we:

  • Treat you
  • Run our organization
  • Bill for your services
  • Help with public health and safety issues
  • Do research
  • Comply with the law
  • Respond to organ and tissue donation requests
  • Work with a medical examiner or funeral director
  • Address workers’ compensation, law enforcement, and other government requests
  • Respond to lawsuits and legal actions
  • One of the forms that you sign when you first come to see us is an authorization to release your information in these respects.  You may be asked from time to time to update that authorization

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 an electronic or paper copy of your medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request.
  • Ask us to correct your medical record
  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.
  • Request that our communications concerning you and your care be addressed in particular ways
  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care or if it would prevent us from processing the financial and insurance paperwork and communications in order to be paid for the services and care provided.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law or your contract with your insurance company requires us to share that information.

Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.
  • File a complaint if you feel your rights are violated
  • You can complain if you feel we have violated your rights by contacting us using the information on page 1.
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting
  • We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interests. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In the following instances, we never share your information unless you give us written permission:

  • Marketing purposes
  • Sale of your information
  • Most sharing of psychotherapy notes

In the case of fundraising:

  • We may contact you for fundraising efforts, but you can tell us not to contact you again.


Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:

Help with public health and safety issues

We can share health information about you for certain situations such as:

  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety

Do research

From time to time, research may be conducted and in those instances, depending upon the research protocol, information may be confidentially shared within the research process to further the study.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

  • For workers’ compensation claims
  • For law enforcement purposes or with a law enforcement official
  • With health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share and use protected health information about you and your care in response to a lawsuit, an administrative order, or subpoena.  Depending upon the circumstances, our name and demographic information may be redacted.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see:

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

West Virginia Law

You should note that most of the above summary of permitted uses and disclosures of PHI is based upon FEDERAL REQUIREMENTS.  Those requirements are to be followed unless West Virginia law offers PHI greater protection.  In certain situations, West Virginia has adopted stronger protections for PHI than the federal provisions.  Since we are providing your health care in West Virginia, these laws will apply, even if you are a citizen of another state.

In West Virginia, if you are a patient with mental health conditions for which mental health care is sought, there are additional release authorizations that must be provided before protected health information is release to third parties.  This office does not engage in the practice of delivering mental health care.  If for any reason you believe that you are entitled to the special protected health information applicable to a person seeking and being treated for a mental health condition, please let us know. Mental health information may not be disclosed without the proper patient authorization; by qualified court order; or where necessary to protect someone from clear and substantial danger of imminent harm.  For this purpose, mental health information included the fact that someone is our patient or has received treatment (mental health treatment); information related to diagnosis or treatment and protected health information concerning physical, mental or emotional condition and advice, instructions or prescriptions related to such care, treatment or diagnosis.  Since our office is not a mental health provider, it is essential for you to talk to us if you believe this applies to you.

Also, in West Virginia, minors are given certain protections where the minor is treated for conditions such as venereal disease; receives birth control; has prenatal care or drug rehabilitation.  Our office generally does not engage in these types of health care services, either, with the exception of dermatologic conditions associated with venereal disease.  Where a minor receives treatment or services for any of these categories of conditions, we are not required to release protected health information or disclose that we have seen the minor (even to parents or guardians).

Under West Virginia law, the identity of a person who has received and HIV-related test and the results of such test may not be generally disclosed without the person’s consent.  However, disclosure is permitted to certain parties, such as to the victim of a sexual assault or to health care workers involved in the treatment of the person.  Recipients of such information under one of these exceptions are prohibited from re-disclosing the PHI.  We also cannot disclose to third-parties PHI concerning substance abuse treatment or genetic testing without patient authorization or appropriate court order.

Privacy Officer

Susan Touma, MD

422 Kinetic Park Drive Suite B

Huntington, WV 25701

  • It is our policy to never sell your personal information for any reason.
  • We do reserve the right to send out promotional mailers from our office for special events and promotional sales in our office.
  • You always have access to review your EMR through our patient portal

If you have any questions or concerns, you may contact our office to help you set up your portal.  A link to the portal is always available on our website: