HIPAA Notice of Privacy Practices

Your rights

Inspect or receive a copy of your records

You may ask to inspect or receive an electronic or paper copy of your medical record and other health information we maintain about you. We will ordinarily respond within the period required by law and may charge a reasonable, cost-based fee when permitted.

Request a correction

You may ask us to correct health information you believe is inaccurate or incomplete. We may deny the request in certain circumstances, but we will explain the reason in writing.

Request confidential communications

You may ask us to contact you in a particular way or at a different address. We will accommodate reasonable requests.

Request limits on use or disclosure

You may ask us not to use or share certain information for treatment, payment, or health care operations. We are not always required to agree. If you pay in full out of pocket for a service, you may ask us not to disclose information about that service to your health plan for payment or operational purposes unless disclosure is required by law.

Receive an accounting of certain disclosures

You may request a list of certain disclosures made during the six years before your request. The list does not include every type of disclosure, such as many disclosures for treatment, payment, or health care operations.

Receive a copy of this notice

You may request a paper copy at any time, even if you previously agreed to receive it electronically.

Choose a representative

A person with legal authority to act for you may exercise your privacy rights. We may verify that authority before acting on a request.

File a complaint

You may contact our Privacy Officer if you believe your privacy rights were violated. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at hhs.gov/hipaa/filing-a-complaint, by calling 1-877-696-6775, or by writing to 200 Independence Avenue SW, Washington, DC 20201. We will not retaliate against you for filing a complaint.

Your choices

In certain situations, you may tell us whether and how to share information—for example, with family members, close friends, or others involved in your care or payment for care. If you cannot communicate your preference, we may share information when we believe it is in your best interest or necessary to prevent a serious and imminent threat.

We will obtain your written authorization before using or disclosing your health information for most marketing purposes, selling your health information, or disclosing most psychotherapy notes. You may revoke an authorization in writing, except to the extent we have already acted on it.

How we may use and disclose your information

Treatment

We may use and share your health information to provide, coordinate, or manage your care and to communicate with other professionals involved in your treatment.

Health care operations

We may use and share information to operate the practice, improve quality, train staff, manage services, conduct compliance activities, and contact you when necessary.

Payment

We may use and share information to bill and collect payment for services, including processing self-pay transactions and coordinating payment-related matters when applicable.

Other uses permitted or required by law

Subject to legal conditions and safeguards, we may use or disclose health information for public health and safety activities, health oversight, research, organ and tissue donation, workers’ compensation, law-enforcement or government requests, judicial or administrative proceedings, and work with coroners, medical examiners, or funeral directors. We may disclose information when federal or Arizona law requires it.

Some categories of information may receive additional protection under federal or Arizona law. We will follow any stricter law that applies.

Our responsibilities

• We must protect the privacy and security of your protected health information.
• We will notify affected individuals as required if a breach may have compromised protected information.
• We must follow the privacy practices described in the notice currently in effect.
• We will not use or disclose your information in ways not described here unless you authorize us in writing or the law permits or requires it.

Changes to this notice

We may change this notice and apply the revised terms to health information we already maintain as well as information received in the future. The current notice will be available on this website, upon request, and at the practice.

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