Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information.  Please review this notice carefully.

What Is This Notice And Who Will Follow It

The Gaudiani Clinic understands that information about you and your health is confidential. We are committed to protecting the privacy of this information. We use and share your health information only as permitted by federal and state laws.

We are required by law to maintain the privacy of your protected health information, to provide you with this Notice of our legal duties and privacy practices with respect to your health information, to notify affected individuals following a breach of unsecured protected health information, and to follow the terms of the Notice currently in effect.

This Notice applies to all of the records of your care generated at those covered programs and facilities, whether made by program personnel or your personal healthcare provider. Your personal healthcare provider may have different policies or notices regarding the use and disclosure of your health information created or maintained in the healthcare provider’s office or clinic.

How We May Use And Disclose Health Information About You

 The following categories are different ways that we may use and disclose health information. Not every possible use or disclosure in a category is described below.

·       For Treatment. We may use health information about you to provide you with therapy and other healthcare treatment or services. We may disclose health information about you to doctors, nurses, technicians, staff or other personnel who are involved in taking care of you and your health. For example, your health information may be shared with your personal physician, or, if a team of providers is treating you, we can share some of your health information with them so that the services you receive will be coordinated, such as phoning in prescriptions to your pharmacy, scheduling lab work and ordering x-rays. These are only some examples of how your health information may be used and disclosed.

·       For payment. We may use and disclose health information about you so that the treatment and services you receive at Gaudiani Clinic may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about a service you received here so your health plan will pay us for the service. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will pay for the treatment.

·       For Health Care Operations. We may use and disclose health information about you in order to help run our programs and make sure that you and our other patients receive quality care. For example, we may use your health information to evaluate the performance of our staff in caring for you. We may also use health information about all or many of our patients to help us decide what additional services we should offer, how we can become more efficient, or whether certain new treatments are effective.  We may also disclose your health information to health plans that provide you insurance coverage and other health care providers that care for you. Our disclosures of your health information to plans and other providers may be for the purpose of helping these plans and providers provide or improve care, reduce cost, coordinate and manage health care and services, train staff and comply with the law.

·       Business Associates. Some of our functions are accomplished by individuals or companies with whom we contract, called “business associates,” to perform certain specialized work for us. For example, we may use a billing service to submit your claim to the insurance company for payment. We may disclose your health information to our business associates so they can perform the tasks we have asked them to do.

Purposes That Do Not Require Your Written Authorization

Gaudiani Clinic may use and/or share your health information with others, for the following reasons, without your written authorization, subject to all applicable legal requirements and limitations:

·       To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

·       Required By Law. We will disclose health information about you when required to do so by federal and state laws and regulations.

·       Research. We may use and disclose health information about you for research projects that are subject to a special approval process. We will ask you for your permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the office.

·       Specialized Government Functions. If you are or were a member of the armed forces, or part of the national security or intelligence communities, we may be required by military command or other government authorities to release health information about you. We may also release information about foreign military personnel to the appropriate foreign military authority.

·       Workers’ Compensation. We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

·       Public Health Activities. We may disclose health information about you for public health reasons in order to prevent or control disease, injury or disability; or report births, deaths, suspected abuse or neglect, reactions to medications or problems with products, and the conduct of public health surveillance, public health investigations, and public health interventions.

·       Health Oversight Activities. We may disclose health information to a health oversight agency for audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the health care system, government programs, and compliance with civil rights laws.

·       Lawsuits and Disputes. We may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice to you) or to obtain an order protecting the information requested.

·       Law Enforcement. We may release health information if asked to do so by law enforcement in response to a court order, subpoena, warrant, summons or similar process, subject to all applicable legal requirements; for the purpose of identifying or locating a suspect, fugitive, material witness, or missing person. to alert law enforcement of the death of an individual from suspected criminal conduct; for reporting a crime on our premises; and reporting a crime in emergencies

·       Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official, if the release is necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

·       Coroners, Medical Examiners, Funeral Directors and Organ Procurement Organizations. We may release health information to coroners, medical examiners, funeral directors, or organ procurement organizations asnecessary to allow them to carry out their duties.

·       Multidisciplinary Personnel Teams. We may disclose health information to a government authority and/or multidisciplinary personnel team relevant to the prevention, identification, management or treatment of an abused child and the child’s parents, or elder abuse and neglect.

·       Note on Other Restrictions. Please be aware that certain federal or state laws may have more strict requirements on how we use and disclose your health information. If there are stricter requirements, even for the purposes listed above, we will not disclose your health information without your written permission, or as otherwisepermitted or required by such laws. For example, we will not disclose HIV test results without obtaining your written permission, except as permitted by state law. We may also be restricted by law to obtain your written permission to use and disclose your information related to treatment for certain conditions such as mental illness, or alcohol or drug abuse.

Disclosures We May Make Unless You Object

Unless you instruct us otherwise, we may disclose your information as described below:

·       Family and Friends. We may disclose health information about you to your family members, relatives, friends, or other person identified by you and who are involved in your health care or payment for your health care if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection.  We may also disclose health information to your family or friends if we can infer from the circumstances, based on our professional judgment that you would not object.  For example, we may assume you agree to our disclosure of your personal health information to your spouse when you bring your spouse or your parent with you into a group, therapy session, or other program activity during treatment, or while treatment is discussed.

In situations where you are not capable of giving consent (because you are not present or due to your incapacity or medical emergency), we may, using our professional judgment, determine that a disclosure to your family member or friend is in your best interest.  In that situation, we will disclose only health information relevant to the person’s involvement in your care.  We may also use our professional judgment and experience to make reasonable inferences that it is in your best interest to allow another person to act on your behalf to pick up, for example, filled prescriptions or medical supplies.

·       Disaster Relief. We may disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

Uses And Disclosures Only with Your Authorization. For any category of use or disclosure that is not described above or authorized by law, we must obtain your written authorization. This includes (i) most uses and disclosures of psychotherapy notes; (ii) uses and disclosures of health information for marketing purposes; (iii) disclosures that constitute a sale of health information. If you give us your written authorization, you may revoke (cancel) it at any time by submitting a written revocation to the office or location that originally received your authorization, or to the Privacy Officer at the address listed below. Your revocation will be effective except to the extent that we have already acted upon your authorization.

Your Rights Regarding Health Information About You. You have the following rights regarding health information we maintain about you. To exercise the rights in this section, except for requesting a copy of this Notice, you must submit a written request. You may obtain additional information and instructions for exercising these rights by contacting us as indicated below.

·       Right to Inspect and Copy. You have the right to inspect and copy records that are used to make decisions about your care or payment for your care (including an electronic copy if we maintain the records electronically). Your right to inspect and copy PHI will be denied if we determine that access would cause serious harm to you or if the information contains psychotherapy notes. We may also deny your request to inspect and copy in certain other limited circumstances. We may charge you a reasonable cost-based fee for providing the records. If you are denied access to health information, you may request that the denial be reviewed. Another licensed health care professional chosen by Gaudiani Clinic will review your request and the denial. The person conducting the review will not be the person who denied your request.

·       Right to Amend. If you believe health information we have about you is incorrect or incomplete, you may ask us to amend the information.  You have the right to request an amendment as long as the information is kept by the Gaudiani Clinic program where you were treated. To request an amendment, please contact us using the contact information provided later in this Notice. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if your request is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

o    We did not create, unless the person or entity that created the information is no longer available to make the amendment

o    Is not part of the health information that we keep

o    You would not be permitted to inspect and copy

o    Is accurate and complete

If we deny your request for amendment, you have the right to submit a statement of disagreement (not to exceed 250 words) with respect to any item or statement in your record you believe is incomplete or incorrect, and request your statement be made a part of your medical record.

We have the right to file a rebuttal responding to your statement in your medical record.

Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.”  This is list of the disclosures we made of health information about you for purposes other than treatment, payment, health care operations or any disclosures that have been specifically authorized by you and a limited number of special circumstances involving national security, correctional institutions and law enforcement. To obtain this list, you must submit your request in writing using the contact information provided later in this Notice. It must state a time period, which may not be longer than six years. The first list you request within a 12-month period will be free.  For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.  We are not required to agree to your request, except to the extent that you request us to restrict disclosure to a health plan or insurer for payment or health care operations purposes if you, or someone else on your behalf (other than the health plan or insurer), has paid for the item or service out of pocket in full. Even if you request this special restriction, we can disclose the information to a health plan or insurer for purposes of treating you. If we agree to another special restriction, we will comply with your request unless the information is needed to provide you emergency treatment.

·       To request restrictions, you must make your request in writing using the contact information provided later in this Notice. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply.

Right to Request Confidential Communications. You have the right to request that we communicate with you in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must submit the request in writing using the contact information provided later in this Notice. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice.  You have the right to a paper copy of this Notice even if you have agreed to receive it electronically.  To obtain a paper copy, contact us using the contact information provided later in this Notice.

Changes To This Notice. We reserve the right to change our Notice of Privacy Practices from time to time, and to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. If we make a material change to our Notice, we will have the revised Notice available upon request to the Gaudiani Clinic administrative office as indicated below on or after the effective date of the revision, and will make the revised Notice available and posted at the program location.

Complaints. If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, contact us as indicated below. All complaints must be submitted in writing. We will take no action against you and you will not be penalized for filing a complaint.

Privacy Contact Information.

If you have any questions about this Notice, wish to request a copy of the current Notice, or if you want to file a privacy complaint, please contact the Gaudiani Clinic Privacy & Security Manager, Aimee Becker, 4700 Hale Pkwy. Suite 380, Denver, CO 80222, aimee@gaudianiclinic.com