THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, HOW YOU CAN ACCESS THIS INFORMATION, AND HOW TO FILE A COMPLAINT. PLEASE REVIEW IT CAREFULLY.
This Notice applies to LoDo Pain, LLC (“LoDo Pain,” “we,” “our,” or “us”) and its workforce members who create, receive, maintain, transmit, or use protected health information on LoDo Pain’s behalf. LoDo Practice Management, LLC and other contracted service providers may perform administrative or operational functions for LoDo Pain under written agreements that require them to safeguard protected health information as required by law.
You have the right to receive a paper or electronic copy of this Notice and to discuss it with our Privacy Officer. Contact information appears at the end of this Notice.
YOUR RIGHTS
You have the rights described below regarding your health information. Certain rights may be subject to limits or exceptions permitted by law.
Get an Electronic or Paper Copy of Your Records
- You may ask to inspect or obtain an electronic or paper copy of your medical record and other health information we maintain about you.
- We generally will provide a copy or summary within 30 days after receiving your request. If additional time is permitted by law, we will tell you in writing why the delay is necessary and when we expect to respond.
- We may charge a reasonable, cost-based fee as permitted by federal and Arizona law.
- We may deny access in limited circumstances permitted by law. If we deny access, we will provide a written explanation and tell you whether the decision may be reviewed.
Ask Us to Correct or Amend Your Records
- You may ask us in writing to amend health information that you believe is incorrect or incomplete.
- We may deny the request in circumstances permitted by law, but we will explain the denial in writing, generally within 60 days, subject to any extension allowed by law.
Request Confidential Communications
- You may ask us to contact you in a particular way, such as only at a specified telephone number, or to send mail to a different address.
- We will accommodate reasonable requests. We may ask you to specify how or where you want to be contacted.
Ask Us to Limit What We Use or Share
- You may ask us not to use or disclose certain health information for treatment, payment, or healthcare operations. We are generally not required to agree, and we may decline a request if it could affect your care or our ability to operate lawfully.
- If you pay in full out of pocket for a healthcare item or service, you may ask us not to disclose information about that item or service to your health plan for payment or healthcare operations. We will honor the request unless disclosure is required by law.
- If we agree to another restriction, we will follow it except as permitted by law, including when information is needed for emergency treatment.
Get an Accounting of Certain Disclosures
- You may request a list of certain disclosures of your health information made during the six years before the date of your request.
- The accounting generally does not include disclosures for treatment, payment, or healthcare operations; disclosures made to you; disclosures you authorized; and certain other disclosures excluded by law.
- We will provide one accounting in any 12-month period without charge. We may charge a reasonable, cost-based fee for an additional accounting during the same period after telling you the cost in advance and giving you an opportunity to withdraw or modify the request.
Get a Copy of This Notice
You may request a paper copy of this Notice at any time, even if you previously agreed to receive it electronically. We will provide it promptly.
Choose Someone to Act for You
- If a person has legal authority to act as your personal representative, such as under a valid healthcare power of attorney or guardianship, that person may exercise your rights and make choices about your health information.
- We may verify the person’s identity and authority before acting on a request.
Receive Notice of a Breach
We will notify you as required by law if a breach occurs that may have compromised the privacy or security of your unsecured protected health information.
File a Complaint
- You may complain to our Privacy Officer if you believe your privacy rights have been violated. Contact information appears at the end of this Notice.
- You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by visiting https://www.hhs.gov/hipaa/filing-a-complaint, calling 1-877-696-6775, or writing to 200 Independence Avenue SW, Washington, DC 20201.
- We will not retaliate against you for filing a complaint or exercising any privacy right.
YOUR CHOICES
For certain health information, you may tell us your preferences about what we share. If you have a clear preference, tell us what you want us to do.
Family Members, Friends, and Others Involved in Your Care
- You may tell us whether we may share information relevant to your care or payment for your care with a family member, close friend, caregiver, or another person involved in your care.
- If you are unable to tell us your preference, such as during an emergency or incapacity, we may share relevant information when, using professional judgment, we believe doing so is in your best interest and is permitted by law.
Disaster Relief
We may share limited information with an authorized disaster-relief organization so that family or others responsible for your care can be notified about your location, general condition, or death, when permitted by law.
Uses Requiring Written Authorization
We will obtain your written authorization before using or disclosing your health information for purposes not described in this Notice unless another law permits or requires the use or disclosure. In particular:
- We will not use or disclose your health information for marketing purposes when HIPAA requires an authorization.
- We will not sell your protected health information.
- We will not use or disclose psychotherapy notes, if we maintain any, except as permitted by law or with the authorization required by law.
- LoDo Pain does not currently use protected health information for fundraising. If that practice changes, we will follow applicable notice, authorization, and opt-out requirements.
- You may revoke an authorization in writing at any time, except to the extent we already acted in reliance on it or another legal exception applies.
HOW WE TYPICALLY USE AND SHARE YOUR INFORMATION
Treatment
We may use and disclose your health information to provide, coordinate, or manage your healthcare. This may include evaluating and treating pain conditions; prescribing and managing medications, including controlled substances; reviewing prior records; ordering or reviewing laboratory tests and imaging; consulting with other professionals; coordinating with pharmacies; checking the Arizona Controlled Substances Prescription Monitoring Program as required or permitted by law; arranging referrals; and providing telemedicine services when appropriate.
Payment
We may use and disclose your health information to obtain payment for services. This may include verifying eligibility and benefits; obtaining referrals or prior authorization; submitting claims; coordinating benefits; responding to medical-necessity review; collecting lawful patient-responsibility amounts; appealing claim decisions; and communicating with Medicare, AHCCCS, Medicare Advantage plans, commercial health plans, supplemental insurers, and other responsible payers.
Healthcare Operations
We may use and disclose your health information to operate the practice and improve care. Activities may include quality assessment and improvement; clinical governance; patient-safety and risk-management activities; professional review; compliance review; auditing; licensing and credentialing; staff training; business planning; customer service; legal and accounting services; information-system administration; and other activities permitted as healthcare operations.
Administrative and operational functions may be performed by LoDo Practice Management, LLC or other contractors under written business associate agreements when required by HIPAA.
OTHER USES AND DISCLOSURES PERMITTED OR REQUIRED BY LAW
We may use or disclose health information in the circumstances described below only when the applicable legal requirements and safeguards are satisfied. When required, we will limit information to the minimum necessary for the purpose.
Public Health and Safety
We may use or disclose health information for purposes including:
- Preventing or controlling disease, injury, or disability;
- Reporting adverse events, product defects, or product recalls;
- Reporting suspected abuse, neglect, or domestic violence when authorized or required by law; and
- Preventing or lessening a serious and imminent threat to a person or the public, when disclosure is permitted by law and consistent with professional standards.
Health Oversight
We may disclose information to legally authorized health-oversight agencies for audits, inspections, investigations, disciplinary matters, licensing, credentialing, and other activities necessary for oversight of the healthcare system and government benefit programs.
Research
We may use or disclose health information for research when the research is approved or otherwise permitted under federal and Arizona law, such as through an institutional review board or privacy-board waiver, a valid authorization, or use of a limited or de-identified data set.
Compliance With Law
We will disclose health information when federal or Arizona law requires us to do so. This includes disclosures to the U.S. Department of Health and Human Services when it requests information to evaluate our compliance with federal privacy law.
Organ and Tissue Donation
We may disclose health information to organ-procurement organizations or other entities engaged in procuring, banking, or transplanting organs, eyes, or tissue when permitted by law.
Coroners, Medical Examiners, and Funeral Directors
We may disclose health information to a coroner, medical examiner, or funeral director when permitted or required by law.
Workers’ Compensation
We may disclose health information as authorized by and to the extent necessary to comply with workers’ compensation laws and similar programs.
Law Enforcement and Special Government Functions
We may disclose health information to law-enforcement officials only in circumstances permitted or required by law and subject to applicable conditions, such as in response to qualifying legal process, to report certain wounds or injuries, to report a crime on our premises, to locate specified persons, or to address a serious and imminent threat.
We may also disclose information for lawful military, national-security, protective-service, correctional-institution, or other special government functions when applicable.
Judicial and Administrative Proceedings
We may disclose health information in response to a court or administrative order. We may respond to a subpoena, discovery request, or other lawful process only when the conditions and safeguards required by federal and Arizona law have been satisfied. A request, subpoena, or investigation does not by itself authorize every disclosure.
SUBSTANCE USE DISORDER PATIENT RECORDS
Some substance use disorder patient records may receive additional protection under 42 U.S.C. § 290dd-2 and 42 C.F.R. Part 2. LoDo Pain does not represent through this Notice that it is a federally assisted Part 2 program. However, to the extent LoDo Pain receives or maintains records that remain subject to Part 2, the following additional protections apply:
- Part 2 records will not be used or disclosed in any civil, criminal, administrative, or legislative investigation or proceeding against you unless you provide written consent or the use or disclosure is authorized by a qualifying Part 2 court order and accompanied by a subpoena or other legal mandate when required.
- Part 2 records disclosed with consent for treatment, payment, or healthcare operations may be redisclosed by a recipient subject to HIPAA as permitted by HIPAA, but they still may not be used in a proceeding against you except as permitted by Part 2.
- If LoDo Pain ever uses Part 2 records for fundraising, we will give you clear and conspicuous advance notice and an opportunity to elect not to receive those communications.
- Additional Part 2 restrictions, consent requirements, and rights will be followed whenever they apply.
ARIZONA CONFIDENTIALITY PROTECTIONS
Arizona law generally treats medical records and payment records as privileged and confidential. LoDo Pain will comply with Arizona laws that provide additional protection for particular information, including applicable laws concerning behavioral-health records, communicable-disease and HIV-related information, genetic-testing information, and other specially protected records.
When Arizona law is more protective than HIPAA, we will follow the more protective requirement.
OUR RESPONSIBILITIES
- We are required by law to maintain the privacy and security of your protected health information.
- We must follow the duties and privacy practices described in the Notice currently in effect.
- We will notify you as required by law if a breach may have compromised the privacy or security of your unsecured protected health information.
- We will not use or disclose your health information other than as described in this Notice unless you authorize us in writing or the law permits or requires the use or disclosure.
- We will provide this Notice to you and make the current Notice available on our website, at our facilities, and upon request.
CHANGES TO THIS NOTICE
We may change the terms of this Notice. A revised Notice may apply to all health information we maintain, including information created or received before the revision.
The current Notice will be available upon request, at our facilities, and on our website at https://www.lodopain.com/nopp. A revised Notice will state its effective date.
QUESTIONS, REQUESTS, AND COMPLAINTS
Contact the LoDo Pain Privacy Officer to ask questions, request a copy of this Notice, exercise a privacy right, or submit a complaint:
Privacy Officer LoDo Pain, LLC P.O. Box 770 Carefree, Arizona 85377 Phone: (602) 456-2860 Fax: (602) 922-2302 Email: info@lodopain.com Website: https://www.lodopain.com
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. LoDo Pain will not retaliate against you for filing a complaint or exercising a privacy right.