HIPPA Notice of Privacy Practices


– We will take reasonable efforts to maintain the privacy and security of protected health information (PHI) in compliance with state and federal law.
– 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 unless you consent in writing. If you authorize a disclosure, you may change your mind at any time by letting us know in writing.


You have rights with respect to your health information, subject to legal limitations, including:


– The right to inspect and receive copies (electronic or paper) of your health information, usually within 30 days.
– Asking us to correct or amend information. If we say “no,” we will notify you in writing within 60 days.
– Requesting confidential communications in a specific way (e.g., cell phone). We’ll honor reasonable requests.
– Asking to limit what we use or share for treatment, payment, or operations. We are not required to agree except for requests that we not share information with your health insurer when you pay out-of-pocket in full.
– Obtaining a list (accounting) of those with whom we have shared your information for the prior six years.The list will not include disclosures for treatment, payment, or health care operations; disclosures made to or authorized by you; and certain other disclosures allowed by law. We will provide one accounting each year for free, but will charge a reasonable, cost-based fee for additional accountings.
– Obtaining a paper copy of this Notice at any time, even if you agreed to receive it electronically.
– Designating someone to act for you. If you have a 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 on your behalf before we take any action.
– You have the right and choice to have us share information with family, friends, or others involved in your care; and to share information in a disaster situation. If you are not able to choose, we may share information if we believe it is in your best interest or when needed to lessen a serious and imminent threat to health or safety.
– We will not sell your information or share it for marketing unless you give us written permission.
– We will not share psychotherapy notes unless you give us written permission.


You may file a complaint or make requests by contacting:

Charlie Stine, Privacy Officer
4740 Flintridge Dr. Ste 130, Colorado Springs CO 80918

You may also contact HHS, 200 Independence Ave, S.W., Room 509F HHH Bldg., Washington, DC 20201,
OCRComplaint@hhs.org www.hhs.gov/ocr/privacy/hipaa/complaints, 1-877-696-6775. We will not retaliate
against anyone for filing a complaint.


– We can use or disclose your health information for treatment, payment, and health care operations. This includes sharing information with others who are treating you or assisting us in care (e.g. residents, technical representatives), to bill and get paid, and to run our practice and improve care.

– We are also allowed or required to share your information in other ways, such as:
– Providing you with information related to your health;
– Contacting you regarding appointments, treatment alternatives, or other health related services (we may leave detailed messages on the primary contact number that you provide, unless you request in writing that we not do so);
– Incidental uses or disclosures (e.g., sign-in sheet, in office discussion, etc.);
– Legal compliance (including reports of adverse reactions, suspected abuse, neglect or violence);
– Providing information to law enforcement or correctional institutions;
– Providing information to a coroner, medical examiner, funeral director, or for organ procurement;
– Public health activities when requested by a public health authority or the FDA.
– Responding to health oversight agencies;
– Responding to court or administrative orders, subpoenas, discovery requests or lawful process;
– Research activities;
– When necessary to avert a serious threat to health or safety;
– Military/veteran affairs, national security, intelligence, State Department, or presidential protection;
– Providing information regarding your location, general condition or death to disaster relief agencies;
– Providing information for workers’ compensation claims; or
– Informing a family member, other relative, or close personal friend when:
– Information is relevant to the individual’s involvement with your care;
– Notification of your location, general condition or death;
– To assist in your care (pick-up prescriptions or documents, follow-up care instructions, etc.).
– Our practice will make other uses and disclosure of your information only after obtaining your written
authorization. If you authorize a use not contained in this notice, you may revoke your authorization at
any time by notifying us in writing.



We reserve the right to change the terms of this notice. The newly effective notice will be in our offices, on
our website, and available upon request.

For more information see: https://www.hhs.gov/hipaa

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