Bread for the City is dedicated to maintaining the privacy of your Health Information. We are required by  law to: 

• Maintain the privacy of your protected Health Information.
• Give you this notice of our legal duties and practices regarding your Health Information.
• Follow the current terms of our notice. 

Except for the following purposes, we will use and disclose Health Information only with your written  permission. You may take back your permission at any time by writing to our practice’s Privacy Officer. 

These are the ways we may use and disclose your protected Health Information:

Treatment. We may use and disclose Health Information for your treatment and to provide you  with treatment-related services. For example, we may disclose Health Information to doctors  outside our office who need the information to provide you with medical care.

Payment. We may use and disclose Health Information so that we or others may receive payment  from you or an insurance company. For example, we may give your health plan information so  that they can pay for treatment.

Health Care Operations. We may use and disclose Health Information to manage our operations  and make sure your medical care is of the highest quality. We also may share information with  other related parties, such as your health plan, for their health care operation activities.

Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and  Services. We may use and disclose Health Information to contact you and to remind you that you  have an appointment with us. We may also use and disclose Health Information to tell you about  treatment alternatives or health-related benefits and services that may interest you.

Individuals Involved in Your Care or Payment for Your Care. When appropriate, we may share  Health Information with a person who is involved in your medical care or payment for your care, such as your family or close friend. We may also notify your family about your location or general  condition or disclose this information to an entity assisting in a disaster relief effort.

Research. Under certain circumstances, we may use and disclose Health Information for  research. However, information provided to researchers will first be cleared of your name and  identifying information. For example, a researcher may review charts to look at patients’ medical  outcomes, but these charts will never contain your name. Before we release any information for research, the research project will first go through an approval process.

Mental Health. As permitted by The Mental Health Information Amendment Act of 2018, your  mental health information will be shared with health information exchanges (such as CPC HIE and CRISP) to provide faster access, better coordination of care, and improved knowledge for  providers. You may choose to not have your mental health information shared through health  information exchanges by completing the CPC HIE opt-out form. At this time, we do not have  the technology capability to share some but not all of your health and mental health information. If  you do not want your mental health information shared, you will need to opt-out of the CPC HIE,  and none of your health information will be shared through the HIEs.

As Required by Law. We will disclose Health Information when required to do so by law.

To Prevent a Serious Threat to Health or Safety. We may use and disclose Health Information  when necessary to prevent a serious threat to your health and safety or the health and safety of  the public or another person. We will only disclose information to someone who may help prevent  the threat. 

Business Associates. We may disclose Health Information to our business associates that  perform services for us if the information is necessary for these services. For example, we may  use another company for our billing services. All of our business associates are required to protect  the privacy of your information and are not allowed to use or disclose any information except as  stated in our contract. 

Organ and Tissue Donation. If you are an organ donor, we may use or release Health  Information to organizations that handle any part of the organ donation process.

Military and Veterans. If you are a member of the armed forces, we may release Health  Information as required by military authorities. If you are a member of a foreign military, we may  also release Health Information to that foreign military authority. 

Workers’ Compensation. We may release Health Information for workers’ compensation or  similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks. We may disclose Health Information for public health activities. These  activities include preventing or controlling disease, injury, or disability; reporting births and deaths;  reporting child abuse or neglect; reporting abuse or neglect of a person in your care; reporting reactions to medications or problems with products; notifying people of recalls of products they  may be using; informing a person who may have been exposed to a disease or may be at risk for  contracting or spreading a disease; and reporting to the appropriate government authority if we  believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make  this disclosure if you agree or when required by law. 

Health Oversight Activities. We may disclose Health Information to a health oversight agency  for activities authorized by law. These oversight activities include, for example, audits,  investigations, inspections, and licensure. These activities are necessary for the government to  monitor the health care system, government programs, and compliance with civil rights laws. 

Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose Health  Information in response to a court or administrative order. We may also disclose Health  Information in response to a subpoena, discovery request, or other lawful process by someone  else involved in the dispute, but only if efforts have been made to tell you about the request or to  obtain an order protecting the information requested.

All other uses and disclosures will be made only with your consent unless required by law. Without your  permission, we are prohibited from using or disclosing your protected health information for marketing purposes. We may not sell your protected health information without your permission. We will not use or  disclose any of your protected health information that contains genetic information that will be used for  underwriting purposes. You may take back your permission, at any time, in writing, except if your provider has taken an action that relies on the use indicated in your permission. 

You have the following rights regarding Health Information we have about you: 

Right to View and Copy. You have the right to view and copy the Health Information that Bread  for the City creates and may be used to make decisions about your care. This includes your  medical and billing records. To inspect and copy this Health Information, you must submit a  request to your provider using our Release of Information form. Requests must be made in person  or in writing. 

Right to Change. If you feel that Health Information we have is incorrect or incomplete, you may  ask us to change the information. You have the right to request a change for as long as our office  keeps your information. To request a change, you must make your request in writing to your  provider. 

Right to a List of Disclosures. You have the right to request a list of the ways we shared your  Health Information for purposes other than treatment, payment, and health care operations or for  which you provided written permission. To request a list of disclosures, you must make your  request in writing to your provider 

Right to Request Restrictions. You have the right to request a limit on the Health Information  we use or disclose for treatment, payment, or health care operations. You also have the right to  request a limit on the Health Information we share with someone involved in your care, like a  family member or friend. For example, you can ask that we not share information about a  particular diagnosis with your spouse. We will honor all requests for restrictions, unless the  information is needed to provide you with emergency treatment. 

Right to Request Confidential Communication. You have the right to request that we  communicate with you about your care in a certain way or at a certain location. For example, you  can ask that we contact you only by mail or at work. To request confidential communication, you  must make a request in person or in writing to your provider. Your request must state how or  where you wish to be contacted. We will accommodate all reasonable requests. 

Right to Receive Notice of a Breach. We will notify you if your unsecured protected health  information has been breached. 

Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You  may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this  notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of  this notice at our website, www.breadforthecity.org. To obtain a paper copy of this notice, contact the Privacy Officer.

We reserve the right to change this notice and make the new notice apply to Health Information we  already have as well as information we receive in the future. We will post a copy of our current notice at  our office. The notice will contain the effective date on the first page.

If you believe your privacy rights have been violated, you may file a complaint with our office or with the  Secretary of the Department of Health and Human Services. To file a complaint with our office, contact:  Privacy Officer, Bread for the City, 1525 7th St., N.W., Washington, D.C. 20001. All complaints must be  made in writing. You will not be penalized for filing a complaint.