NOTICE OF PRIVACY PRACTICES Your Information. Your Rights. Our Responsibilities. Effective Date: July 15, 2018 Privacy Officer: Natalie Gates, 720-436-1966, email@example.com 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. This notice of is a requirement by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPPA). It describes how we may use and disclose your protected health information (PHI) as permitted or required by law. It also describes your right to access and control your PHI. PHI refers to 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. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION Your PHI may be used and disclosed for the purpose of providing health care services to you, paying your health care bills, supporting the operation of our practice, and any other use required by law. Listed below are the different categories of our uses and disclosures along with some examples. 1. FOR TREATMENT: We can disclose your PHI to physicians and other healthcare providers or lactation support providers who provide you with health care services or are involved in your care. For example, we can disclose your PHI to your baby's pediatrician in order to coordinate your care. 2. TO OBTAIN PAYMENTS: Your PHI may be used, as needed, to obtain payment for your health care services. For example, providing PHI to billing companies, and others that process health care claims. 3. FOR ADMINISTRATIVE PURPOSES: We can use and share your health information to run our practice, improve your care, and contact you when necessary. We may also provide your PHI to accountants, attorneys, consultants, or others to make sure we are complying with applicable laws. For example, your PHI may be disclosed by contacting you via unsecured text or email. 4. OTHER DISCLOSURES: You may provide written authorization to use your health information or to disclose it to anyone for any purpose. If you give me an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosure permitted by your authorization while it was in effect. Unless you submit written authorization, I cannot use or disclose your health information for any reason except those described in this Notice. We will never sell your information, or disclose PHI for marketing purposes. USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR CONSENT We can use and disclose your PHI without your consent or authorization for the following reasons: 1. CHILD ABUSE: I can report PHI to the appropriate authorities when there is reasonable ground to believe that a minor is or has been the victim of neglect or abuse. 2. JUDICIAL AND ADMINISTRATIVE PROCEEDINGS: When judicial or administrative proceedings or law enforcement requires disclosure. For example, we may make a disclosure to applicable official when a law requires me to report information to government agencies and law enforcement personnel about victims of abuse or neglect; or when ordered in a judicial or administrative proceeding. 3. COMPLY WITH THE LAW: We will share information about you if local, state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law. PATIENT RIGHTS You have certain rights that are protected by law, including: 1. ACCESS AND LIMITS: You have the right to look at or obtain copies of your health information, with limited exceptions. You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. 2. DISCLOSURE ACCOUNTING: You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). 3. ALTERNATIVE COMMUNICATION: You have the right to request that we communicate with you about your health information by alternative means. You must make your request in writing. You can ask us to contact you in a specific way, such as avoiding unsecured email and text in favor of phone calls and the patient portal. We will say “yes” to all reasonable requests. 4. AMENDMENT: You can ask us to correct health information about you that you think is incorrect or incomplete. Your request must be in writing and it must explain why the information should be amended. We may say “no” to your request under certain circumstances, but it will be explained in writing. OUR RESPONSIBILITIES We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and offer you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. We reserve the right change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request. QUESTIONS AND COMPLAINTS If you have any questions about this notice, or any complaints about our privacy practices please contact us directly or submit a written complaint to the U.S. Department of Health and Human Services. We support your right to privacy of your healthcare information and will not retaliate for filing a complaint.