• This notice describes how your health information may be used and disclosed. Please Review it carefully.

    YOUR RIGHTS. You have certain rights with respect to your health information, subject to legal limitations, including: - Obtaining an electronic or paper copy of your record or a summary, usually within 30 days. We may charge a reasonable fee. - Requesting correction of incorrect or incomplete information. If we say “no,” we’ll tell you why in writing within 60 days. - Requesting confidential or specific contact methods (e.g., home or office phone). We will say “yes” to reasonable requests. - Asking us to limit what we use or share for treatment, payment, or operations. We are not required to agree, and we may say “no.” If, however, you pay for a services or item out-of-pocket in full, you can request that we not share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information. - Obtaining a list of those with whom we’ve shared your information for six years prior to the request and why. The list will not include disclosures for treatment, payment, and health care operations, and certain other disclosures (e.g. made at your request). We’ll provide one free accounting a year, but will charge a reasonable, cost-based fee if you ask 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 (e.g., a medical power of attorney or legal guardian), to 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. - Filing a complaint by contacting: Privacy Officer, 3810 N. Grant Avenue, Loveland, CO 80538, 970-221-9451; or HHS, 200 Independence Ave, S.W., Washington, DC 20201, www.hhs.gov/ocr/privacy/hipaa/complaints, 1-877-696-6775. We will not retaliate against anyone for filing a complaint.

    YOUR CHOICES - You have the right to have us share information with family, friends, or others involved in your care; share information in a disaster situation; or include your information in a directory. - We will not sell your information or share it for marketing unless you give us written permission. We may, however, contact you for fundraising efforts, but you can tell us not to contact you again. - We will not share psychotherapy notes for unless you give us written permission.

    If you are not able to choose, we may share information if we believe it is in your best interest. We may also share information when needed to lessen a serious and imminent threat to health or safety.

    OUR USES AND DISCLOSURES - 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, 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; - Incidental uses or disclosures (e.g., listing your name on a sign-in sheet, etc.); - Legal compliance (including reports of adverse reactions, suspected abuse, neglect or violence); - Providing information to the Physician Drug Monitoring Program; - Providing information to law enforcement correctional institutions; - Providing information to a coroner, medical examiner, funeral director, or for organ procurement; - Responding to health oversight agencies or public health authorities or the FDA. - 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 affairs, veterans affairs, national security, intelligence, Department of State, or presidential protective service activities;

    - 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 protected health 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.

    OUR RESPONSIBILITIES - We are required to maintain the privacy and security of your protected health information and to let you know promptly if a breach occurs that may compromise such privacy or security. - 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 here unless you tell us in writing that we can. If you tell us we can, you may change your mind at any time, but please let us know in writing if you change your mind.

    CHANGES TO THE TERMS OF THIS NOTICE. We reserve the right to change the terms of this notice. The newly effective notice will be posted in our office, on our website, and will be available upon request. This Notice is effective November 15, 2015.

    For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.