Effective January 1, 2022


It is our mission to profoundly improve your healthcare and aging experience. To do this, we intend to build a trusted and meaningful relationship with you and those family, friends and others you choose to participate in your care. We want you to understand and participate fully in your care, so we have set forth this Notice of Privacy Policy to describe how medical information about you may be used and disclosed, and your rights, under law, to get access to your health information.

Please review this Notice carefully, and if you have any questions, please contact your Care Team or Patina’s Privacy Officer Deborah Cohen, at 855-478-8208 or


1. 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.

A. You can 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. We may charge a reasonable, cost-based fee.

B. You can 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.

C. You can request confidential communications

  • 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.

D. You can 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.
  • 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 requires us to share that information.

E. You can 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.

F. You can 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.

G. You can 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.

H. You can file a complaint if you feel your rights are violated

  • You can complain if you feel we have violated your rights by contacting your Care Team or Patina’s Privacy Officer Deborah Cohen, at 855-478-8208 or
  • 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.


2. 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.

A. 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 interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

B. In these cases we never share your information unless you give us written permission:

  • Marketing purposes
  • Sale of your information
  • Most sharing of psychotherapy notes
  • We may contact you for fundraising efforts, but you can tell us not to contact you again.


3. PATINA’S USE OF YOUR INFORMATION. This is how we typically use and share your information as we:

A. 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.

B. Run our organization

  • We can use and share your health information to run our practice, improve your care, improve our technology and contact you when necessary.Example: We use health information about you to manage your treatment and services.C. 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.

D. Participate in Health Information Exchanges.

  • To provide better care to you, Patina participates in health information exchanges, Health Information Service Providers, and similar organizations, either directly or through a third-party vendor (each an “HIE”) to facilitate the exchange of your electronic health information through a secure network among health care providers or other health care entities for treatment, payment and other authorized purposes. This means we may share information we obtain or create about you with other providers or health care entities (such as hospitals, doctors offices, pharmacies, or insurance companies) or we may receive information they create or obtain about you (such as medication history, medical history, or insurance information) so each of us can provide better treatment and coordination of your healthcare services. As part of your consent for Patina to access your medical records and to make them available to other providers for treatment, payment and other authorized purposes, your information may be shared through an HIE and we may obtain your information from other providers or health care entities through an HIE. You specifically give us permission to collect, and give your pharmacy and health plan permission to disclose to us, information about your prescriptions that have been filled at any pharmacy or covered by any health insurance plan. This may include prescription medicines to treat AIDS/HIV and medicines used to treat mental health conditions, such as depression. Any other health care provider connected to an HIE may use your health information provided by us for treatment, payment and other authorized purposes to the extent permitted by law.
  • You have the right to “opt out” or decline to participate in having Patina share your information through an HIE. If you want to opt-out, please contact Patina and we will provide you with the appropriate form. We will still be able to access your electronic health information through other means.


4. 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:

A. 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

B. Do research

We can use or share your information for health research.

C. 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.

D. Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

E. Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

F. 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

G. Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.


5. 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 website.