Notice of Privacy Practices

How we use and share your health information

Treatment

We use and share your health information with other professionals who are treating you. Example: we send your general dentist a report of your diagnosis and treatment.

Payment

We use and share your health information to bill and get payment for your care. Example: we give information about you to your dental or health plan so it will pay for your services.

Health care operations

We use and share your health information to run our practice and improve your care. Example: we use your information to manage your treatment and send appointment reminders.

To the extent that we have your substance use disorder patient records, subject to 42 CFR part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.

Other uses and disclosures permitted without your authorization

In all cases, including those listed below, if we have substance use disorder patient records about you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.

• Family and others involved in your care: we may share information with family, close friends or others involved in your care or payment for your care, and in disaster relief situations. You can tell us not to; if you are unable to tell us your preference, we may share if we believe it is in your best interest.
• As required by law, including to the Department of Health and Human Services to show we are complying with HIPAA.
• Public health and safety: preventing disease, product recalls, reporting adverse reactions, reporting suspected abuse, neglect or domestic violence, and preventing a serious threat to health or safety.
• Health oversight activities authorized by law.
• Lawsuits and legal actions: in response to a court or administrative order or a subpoena.
• Law enforcement purposes.
• Coroners, medical examiners and funeral directors.
• Organ and tissue donation requests.
• Research, subject to the conditions the law places on research.
• Special government functions, such as military, national security and presidential protective services.
• Workers’ compensation claims.

State law

Where Arizona law gives certain information more protection than federal law (for example, communicable disease information such as HIV), we follow the more protective law.

Uses that require your written authorization

We will not use or share your health information for marketing, sell your health information, or share most psychotherapy notes without your written authorization. Other uses and disclosures not described in this notice will be made only with your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already acted on it.

Your rights

To exercise any of these rights, contact us using the information at the end of this notice.

• Request restrictions: you may ask us to limit how we use or share your health information. We are not required to agree, except that we must agree not to share information with your health plan about a service you paid for out-of-pocket in full, unless the law requires it.
• Confidential communications: you may ask us to contact you in a certain way or at a certain location.
• Access: you may inspect and get a copy of your health information, including an electronic copy if we keep it electronically.
• Amendment: you may ask us to correct your health information.
• Accounting of disclosures: you may get a list of certain disclosures we have made of your health information.
• Paper copy: you may get a paper copy of this notice on request, even if you agreed to receive it electronically.

Our duties

• We are required by law to maintain the privacy of your health information, to give you this notice of our legal duties and privacy practices, and to notify you following a breach of your unsecured health information.
• We must follow the terms of the notice currently in effect.
• We reserve the right to change the terms of this notice and to make the new terms effective for all health information we maintain. A revised notice will be available on request, in our office and on our website.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us by contacting the person listed below, and with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Contact

For more information about this notice or our privacy practices, contact: