Notice of Privacy Practice for Protected Health Information

How We Use Your Patient Health Information

We use health information about you for treatment, to obtain payment, and for health care operations, including administrative purposes and evaluation of the quality of care that you receive. Under some circumstances we may be required to use or disclose the information even without your permission. Examples of Treatment, Payment and Health Care Operations


We will use and disclose your health information to provide you with medical treatment or services. For example, nurses, physicians and other members of your treatment team will record information in your record and use it to determine the most appropriate course of care. We may also disclose the information to other health care providers who are participating in your treatment, to pharmacists who are filling your prescriptions and to family members who are helping with your care.


We will use and disclose your health information for payment purposes. For example, we may need to obtain authorization from your insurance company before providing certain types of treatment. We will submit bills and maintain records of payments from your health plans.

Health Care Operations:

We will use and disclose your health information to conduct our standard internal operations, including proper administration of records, evaluation of the quality of treatment and to assess the care and outcomes of your case and others like it.

Special Uses

We may use your information to contact you with appointment reminders. We may also contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Other Uses and Disclosures

We may use or disclose identifiable health information about you for other reasons, even without your consent. Subject to certain requirements, we are permitted to give out health information without your permission for the following purposes:Required by Law:We may be required by law to report gunshot wounds, suspected abuse or neglect or similar injuries or events.


We may use of disclose information for approved medical research.

Public Health Activities:

As required by law, we may disclose vital statistics, diseases, information related to recalls of dangerous products and similar information to public health authorities.

Health oversight:

We may be required to disclose information to assist in investigations and audits, eligibility for government programs and similar activities.

Judicial and administrative proceedings:

We may disclose vital statistics, diseases, information related to recalls of dangerous products, and similar information to public health authorities.

Law enforcement purposes:

We may disclose information in response to an appropriate subpoena or court order.


We may report information regarding deaths to coroners, medical examiners, funeral directors and organ donation agencies.

Serious threat to health or safety:

We may use and disclose information when necessary to prevent a serious threat of your health and safety or the health and safety of the public or another person.

Military and Special Government Functions:

If you are a member of the armed forces, we may release information as required by military command authorities. We may also disclose information to correctional institutions or for national security purposes.

Workers Compensation:

We may release information about you for workers compensation or similar programs providing benefits for work-related injuries or illness.

Sign In Sheet:

We may use and disclose your health information by having you sign in when you arrive at our office. We may also call out your name when we are ready to see you.


If we maintain a website that provides information about our office, this Notice will be on the website.In any other situation, we will ask for your written authorization before using or disclosing any identifiable health information about you. If you chose to sign an authorization to disclose information, you can later evoke that authorization to stop any further uses and disclosures.

Individual Rights

You have the following rights with regard to your health information. Please contact the person listed below to obtain the appropriate form for exercising these rights.

Request Restrictions:

You may request restrictions on certain uses and disclosures of your health information. We are not required to agree to such restrictions, but if we do agree, we must abide by those restrictions.

Confidential Communications:

You may ask us to communicate with you confidentially by, for example, sending notices to a special address or not using postcards to remind you of appointments.Inspect and Obtain Copies:In most cases, you have the right to look at or get a copy of your health information. There may be a small charge for the copies.

Amend Information:

If you believe that information in your record is incorrect, or if important information is missing, you have the right to request that we correct the existing information or add the missing information.

Accounting of Disclosures:

You may request a list of instances where we have disclosed health information about you for reasons other than treatment, payment or health care operations.

Our Legal Duty

We are required by law to protect and maintain the privacy of your health information and to provide this Notice about our legal duties and privacy practices regarding protected health information, and to abide by the terms of the Notice currently in effect

Changes in Private Practices

We may change our policies at any time. Before we make a significant change in our policies, we will change our Notice and post the new Notice in the waiting room, you can also request a copy of our Notice at any time. For more information about our privacy practices, contact the person listed below.


If you are concerned that we have violated your privacy rights, or if you disagree with a decision we make about your records, you may contact the person listed below. You may also send a written complaint to the U.S Department of Health and Human Services. The person listed below will provide you with the appropriate address upon request. You will not be penalized in any way for filing a complaint.

Contact Person

If you have questions, requests, or complaints, please contact:
Kristina Calligan
Privacy Officer
1008 E. McDowell Rd. Suite-A
Phoenix, AZ 85006-2603
(602) 358-8588
Effective Date: July 1, 2010


To our patients. This notice describes how health information about you (as a patient of this practice) may be used and disclosed, and how you can get access to your health information. This is required by the Privacy Regulation created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Our Commitment to Your Privacy

Our practice is dedicated to maintaining the privacy to your health information. We are required by law to maintain the confidentiality of your health information:

Use and disclosure of your health information in certain special circumstances

The following circumstances may require us or disclosure health information

  1. To public health authorities and health oversight agencies that are authorized by law to collect information.
  2. Lawsuits and similar proceedings in response to a court or administrative order.
  3. If required to do by a law enforcement official.
  4. When necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. We will only make disclosures to a person or organization able to help prevent the threat.
  5. If you are a member of U.S. or foreign military forces (including veterans) and if required by the laws appropriate authorities.
  6. To federal officials for intelligence and national security activities authorized by the law.
  7. To correctional institutions or law enforcement officials if you are in inmate or under the custody of a law enforcement official.
  8. For Workers Compensation and similar programs