Notice of Privacy Practice

NOTICE OF PRIVACY PRACTICES

Effective Date: January 1, 2026

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Who This Notice Applies To

This Notice applies to the independently licensed healthcare providers (“Covered Entity”) who provide your medical care.

Medical services are delivered by licensed Nurse Practitioners and/or Physician Assistants operating through separate professional entities.

LoDo Pain LLC is a healthcare management services organization (“MSO”) that provides non-clinical administrative, operational, and billing support services to the Covered Entity.

LoDo Pain LLC does not provide medical care and does not make medical decisions. LoDo Pain acts as a Business Associate to the Covered Entity and may access protected health information (PHI) solely to perform authorized administrative functions under a written Business Associate Agreement and in accordance with HIPAA.

Our Legal Duties

The Covered Entity is required by law to:

Maintain the privacy and security of your protected health information (PHI)
Provide you with this Notice of Privacy Practices
Abide by the terms of this Notice currently in effect
Notify you without unreasonable delay if a breach of unsecured PHI occurs

How We May Use and Disclose Your Information

The Covered Entity may use and disclose your PHI without your written authorization for the following purposes:

1. Treatment

We may use and disclose your PHI to provide, coordinate, or manage your healthcare, including:

Evaluating and managing pain conditions
Prescribing medications, including controlled substances
Reviewing Arizona Controlled Substances Prescription Monitoring Program (CSPMP) records as required by law
Coordinating care with pharmacies, laboratories, and other providers
Providing telemedicine services when appropriate
Consulting with other healthcare professionals

2. Payment

We may use and disclose PHI to:

Process payments for services rendered
Manage billing records
Respond to payment inquiries

Because services are provided on a self-pay basis, payment-related disclosures are limited to administrative processing and recordkeeping.

3. Healthcare Operations

We may use and disclose PHI for operational purposes, including:

Quality assessment and improvement
Compliance activities
Professional review
Risk management
Licensing and credentialing
Administrative management

LoDo Pain LLC may access PHI as necessary to perform these functions under its Business Associate Agreement.

Disclosures Required or Permitted by Law

We may disclose PHI without your authorization when required or permitted by law, including:

Public health reporting
Reporting suspected abuse or neglect
Health oversight activities (e.g., Arizona Medical Board, Arizona State Board of Nursing)
DEA or other law enforcement investigations
Court orders or subpoenas
To prevent a serious threat to health or safety

Uses and Disclosures Requiring Your Written Authorization

We will obtain your written authorization for:

Uses or disclosures not described in this Notice
Marketing communications as defined by HIPAA
The sale of protected health information
Most uses of psychotherapy notes (if applicable)

You may revoke your authorization at any time in writing, except to the extent action has already been taken.

The providers supported by LoDo Pain do not sell protected health information.

Your Rights Regarding Your Information

You have the following rights under HIPAA:

1. Right to Access Your Records

You have the right to inspect and obtain a copy of your medical records, including in electronic format if maintained electronically.

You may also direct us to transmit a copy of your records to a designated third party.

Requests must be made in writing. Reasonable cost-based fees may apply as permitted by law.

2. Right to Request an Amendment

If you believe information in your medical record is incorrect or incomplete, you may request an amendment in writing.

We may deny your request in certain circumstances but will provide a written explanation.

3. Right to an Accounting of Disclosures

You may request a list of certain disclosures of your PHI made in the past six (6) years, excluding disclosures for treatment, payment, and healthcare operations.

4. Right to Request Restrictions

You may request restrictions on certain uses or disclosures of your PHI.

We are not required to agree to all requested restrictions but will comply when required by law.

5. Right to Request Confidential Communications

You may request that we communicate with you in a specific way (e.g., at a specific phone number or mailing address). We will accommodate reasonable requests.

6. Right to a Paper Copy of This Notice

You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.

Business Associate Role of LoDo Pain LLC

LoDo Pain LLC performs administrative services on behalf of the Covered Entity and may access PHI only as necessary to perform those functions.

LoDo Pain is contractually obligated to safeguard PHI in accordance with HIPAA and applicable federal and state privacy laws.

LoDo Pain does not independently use or disclose PHI for purposes outside its authorized administrative functions.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with:

Privacy Officer
LoDo Pain
Email: info@lodopain.com

Phone: (602) 456-2860

You may also file a complaint with:

U.S. Department of Health & Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/ocr

You will not be retaliated against for filing a complaint.

Changes to This Notice

The Covered Entity reserves the right to revise this Notice at any time.

Any revised Notice will apply to all protected health information maintained by the Covered Entity.

Updated versions will be posted and made available upon request, with a revised effective date.