REVISED – NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that requires that all medical and dental records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This law gives you, the patient, important rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse Protected Health Information (PHI).
This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information (PHI) to carry out treatment, payment, or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information and our legal duties with respect to your protected health information.
“Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.
Our Legal Duties
We are required by law to:
- Maintain the privacy of your protected health information
- Provide you with this Notice of Privacy Practices
- Abide by the terms of this Notice currently in effect
- Notify you following a breach of unsecured protected health information
Uses and Disclosures of Protected Health Information
Your protected health information may be used and disclosed by your physician, our office staff, and others outside of our office who are involved in your care and treatment for the purpose of providing health care services to you, to receive payment for services, to support the operation of the practice, and for other purposes permitted or required by law.
We may use or disclose your protected health information without your authorization in the following situations, including but not limited to:
- As required by law
- Public health activities
- Communicable disease reporting
- Health oversight activities
- Abuse or neglect reporting
- Food and Drug Administration requirements
- Legal proceedings
- Law enforcement activities
- Coroners, funeral directors, and organ donation
- Research, in accordance with applicable laws
- Criminal activity
- Military activity and national security
- Workers’ compensation
- Inmates and correctional institutions
Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with HIPAA.
Uses and Disclosures Requiring Authorization
Other uses and disclosures of protected health information not described in this Notice will be made only with your written authorization, unless otherwise permitted or required by law.
You may revoke an authorization at any time, in writing, except to the extent that we have already taken action in reliance on the authorization.
Your Rights
You have the following rights with respect to your protected health information:
- Right to Inspect and Copy
You have the right to inspect and obtain a copy of your protected health information, except for certain records such as psychotherapy notes, information compiled in reasonable anticipation of litigation, or information restricted by law. - Right to Request Restrictions
You have the right to request restrictions on certain uses or disclosures of your protected health information. We are not required to agree to all requested restrictions. However, we must agree to a request to restrict disclosure of protected health information to a health plan if the disclosure is for payment or health care operations and you have paid for the service in full out of pocket. - Right to Request Confidential Communications
You have the right to request to receive communications in a certain way or at a certain location. - Right to Amend
You have the right to request an amendment of your protected health information. If we deny your request, you have the right to submit a written statement of disagreement. - Right to an Accounting of Disclosures
You have the right to receive an accounting of certain disclosures of your protected health information. - Right to a Paper Copy of This Notice
You have the right to obtain a paper copy of this Notice upon request, even if you have agreed to receive this Notice electronically. - Right to Be Notified of a Breach
You have the right to be notified if a breach of your unsecured protected health information occurs.
Fundraising
We do not use your protected health information for fundraising purposes. If this changes, you will be provided the opportunity to opt out of such communications.
Changes to This Notice
We reserve the right to change the terms of this Notice at any time. Any changes will apply to all protected health information we maintain. The revised Notice will be made available upon request and will be posted on our website.
Effective Date: 02-10-2026
Complaints
You may complain to us or to the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with us by contacting our Privacy Officer. We will not retaliate against you for filing a complaint.
Contact Information
If you have questions about this Notice or our privacy practices, please contact:
Privacy Officer
Beth Markwalder
600 W. Ray Road, Suite C-2
Chandler, AZ 85225
Phone: 480-577-3150
Email: [email protected]