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 LoDo Pain, LLC and its licensed healthcare professionals who provide your medical care.

LoDo Pain, LLC is a healthcare provider and Covered Entity under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

LoDo Practice Management, LLC provides administrative and operational support services to LoDo Pain, LLC pursuant to written agreements and may access protected health information (PHI) as a Business Associate in accordance with HIPAA.

Our Legal Duties

LoDo Pain 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

We may use and disclose your PHI without your written authorization for the following purposes:

1. Treatment

We may use and disclose 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) data 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 necessary administrative processing and recordkeeping.

3. Healthcare Operations

We may use and disclose PHI for healthcare operations, including:

Quality assessment and improvement
Clinical governance and compliance review
Professional review activities
Risk management
Licensing and credentialing
Administrative management

Administrative services may be performed by LoDo Practice Management, LLC or other contracted Business Associates pursuant to written agreements requiring HIPAA compliance.

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.

LoDo Pain does 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 (for example, at a particular 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.

Complaints

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

Privacy Officer
LoDo Pain, LLC
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

LoDo Pain reserves the right to revise this Notice at any time.

Any revised Notice will apply to all protected health information maintained by LoDo Pain.

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