NOTICE OF PRIVACY PRACTICES

Effective Date: 4/14/03
This notice describes how medical information about you may be used and disclosed and how you get access to this information. Please review it carefully!
Contact Information
If you have any questions about this notice, please contact our Privacy Officer at (602) 298-1188 and/or 15830 North 35th Avenue, Phoenix, Arizona 85053.
Our duties regarding your medical information
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of your medical information.

We are required by law to:

Take reasonable steps to protect medical information that identifies you from unauthorized disclosure;
Give you this notice of our legal duties and privacy practices with respect to medical information about you; and
Follow the terms of our notice that is currently in effect.
How we may use and disclose medical information about you
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories:

Treatment means providing, coordinating, or managing health care and related services by one of more health care providers. An example of this would include forwarding your records to your primary care physician and/or providing laboratory studies and pre-operative testing to a surgical facility and/or anesthesiologist to facilitate a surgical procedure.
Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review. An example of this would be sending a bill for your visit to your insurance company for payment or providing your insurance company information about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
Health Care Operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service. An example would be an internal quality assessment review. We may also create and distribute de-identified health information by removing all references to individually identifiable information to promote study in health care and health care delivery.
Appointment Reminders include the use and disclosure of medical information to contact you as a reminder that you have an appointment for treatment or medical care by letter, telephone including the utilization of answering machines and voice mail.
Other Uses and Disclosures include: Treatment Alternatives to tell you about or recommend possible treatment options or alternatives that may be of interest to you, Health-Related Benefits & Services to tell you about health-related benefits or services that may be of interest to you, Research only under special circumstances and we will almost always ask for your specific permission for participation in a research program, Individuals Involved In Your Care Or Payment For Your Care like a friend or family member who is involved in your medical care, As Required By Law when required by federal, state or local law, and To Avert A Serious Threat To Health Or Safety when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Special Situations include: Organ & Tissue Donation if you are an organ donor, Military & Veterans if you are a member of the armed forces, Workers’ Compensation to provide care under the benefit programs for work-related injuries or illness, Public Health Risks to prevent or control disease, injury or disability; to report births & deaths; to report child abuse or neglect; to report reactions to medications or problems with products; to notify people of recalls of products they may be using; to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence, Health Oversight Activities for activities authorized by law including audits, investigations, inspections, licensure and disciplinary actions, Lawsuits & Disputes in response to a court or administrative order including response to a subpoena, discovery request or other lawful process, Law Enforcement as required by law; in response to a court order, subpoena, warrant, summons; to identify or locate a suspect, fugitive, material witness, or mission person; about the victim of a crime; about a death we believe may be the result of criminal conduct; about criminal conduct in the office; and in emergency circumstance to report a crime, the location of the crime or victims, or the identify, description or location of the person who committed the crime, Coroners, Medical Examiners & Funeral Directors to carry out their duties, National Security & Intelligence Activities for intelligent, counterintelligence and other national security activities as authorized by law, Inmates for the institution to provide health care or protect inmates health, safety and security, and Protective Services For The President & Others so authorized federal officials may provide protection to the President or other authorized persons including foreign heads of state.
Other uses of medical inforamtion
Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
Your rights regarding medical information about you
You have the following rights with respect to your protected health information that you can exercise by presenting a written request to the Privacy Officer:

The right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations including those related to disclosures to family members, other relatives, close personal friends or any other person identified by you. However, we are not required to agree to your request. If we do agree, we will comply unless the information is needed to provide emergency treatment.
The right to reasonable request to receive confidential communications of health information from us by alternative means or at alternative locations such as to ask we only contact you at work or by mail. We will accommodate all reasonable requests.
The right to inspect and copy your health information. This does not include psychotherapy notes or information compiled in anticipation of a legal proceeding. We may charge a fee for the costs of copying, matting, postage or other supplies associated with your request and we will provide you with access and/or copies within 30 days of the receipt of your request. We may deny your request under very limited circumstances. * The right to request an amendment of your medical information if you feel that your medical information is incorrect or incomplete. We may deny your request if you ask us to amend information that:
Was not created by us;
Is not part of the medical information kept by or for this office;
Is not part of the information that you would be permitted to inspect or copy;
Is accurate and complete.
The right to receive an accounting of disclosures of protected health information excluding disclosures for treatment, payment or other health care operations. The first list you request within a 12-month period of time will be free. For additional lists, we may charge you for the costs of providing the list.
The right to obtain a paper copy of this notice from us upon your request at any time.
Changes to this notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the lobby of our office. The notice will contain the effective date on the first page.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with this office or with the Secretary of the Department of Health and Human Services. To file a complaint with this office contact the Privacy Officer at 15830 North 35th Avenue, Phoenix, Arizona, 85053. All complaints must be submitted in writing. You will not be penalized for filing a complaint.