Your Rights

When it comes to your health information, you have certain rights. 

Get a copy of your medical record 

  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

  • You can ask us to correct health information about you that you think is incorrect or incomplete. 

Request confidential communications

Ask us to limit what we use or share

  • 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. 

  • 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

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.

  • 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 hhs.gov/ocr/privacy/hipaa/complaints.

  • 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. 

  • Share information with your family, close friends, or others involved in your care

  • Share information in a disaster relief situation

How do we typically use or share your health information? 

Medical treatment

Administration of our practice

Bill for your services

How else can we use or share your health information? 

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, funeral director or coroner

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

Respond to lawsuits and legal actions including subpoenas, court or administrative orders

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.

  • We will not use or share your information other than as described here unless you tell us we can in writing. We never market or sell personal information

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 website.

Other Instructions for Notice

  • This notice is effective November 10, 2020

  • IMAA PRIVACY OFFICER: Robert S. Enelow, M.D., staff@burkemed.net, 703-425-6010