THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
At The Conrad Clinic, we understand that privacy is deeply important to children, adolescents, and families. This Notice explains how we may use and disclose your protected health information (“PHI”), your rights regarding that information, and our legal responsibilities.
We are required by law to:
We may change the terms of this Notice at any time. Any updated Notice will apply to all protected health information we maintain and will be available in our office and on our website.
We may use and disclose your protected health information for the following purposes:
We may use and share your information to provide, coordinate, or manage your care. This may include communication with physicians, therapists, dietitians, hospitals, laboratories, pharmacies, and other professionals involved in your care or your child’s care.
We may use and disclose information to bill for services, collect payment, verify coverage, or carry out other payment-related activities.
We may use and disclose information for practice operations such as quality improvement, care coordination, staff training, auditing, licensing, accreditation, and business management.
We may contact you regarding appointments, scheduling, follow-up needs, care coordination, or other healthcare-related communications.
When appropriate and permitted by law, we may share relevant information with a parent, legal guardian, family member, caregiver, or another person involved in the patient’s care or payment for care.
We may disclose information when required or permitted for public health activities, to prevent or reduce a serious threat to health or safety, or to report abuse, neglect, or domestic violence when required or authorized by law.
We may disclose information when required by federal or state law, in response to lawful requests by health oversight agencies, or in connection with judicial or administrative proceedings, subpoenas, or law enforcement requests when permitted by law.
We may use or disclose information for research only when allowed by law and with appropriate protections in place.
We may disclose information for workers’ compensation, certain government functions, organ donation purposes, or to coroners, medical examiners, or funeral directors where permitted by law.
We will obtain your written authorization for uses and disclosures not otherwise permitted by law, including when required for:
If you give us authorization, you may revoke it in writing at any time, except to the extent we have already acted on it.
You have the right to:
You may request to inspect or obtain a copy of your medical record and certain other health information we maintain, subject to limited exceptions.
If you believe information in your record is incorrect or incomplete, you may request an amendment.
You may ask us to contact you in a certain way or at a certain location, and we will accommodate reasonable requests.
You may ask us to limit certain uses or disclosures of your information. We are not always required to agree, except where applicable law requires otherwise.
You may request a list of certain disclosures we have made of your information, as permitted by law.
You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.
If you have given someone medical power of attorney or if someone is the legal guardian of a minor patient or otherwise legally authorized to act for a patient, that person may exercise rights on the patient’s behalf, consistent with applicable law.
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be retaliated against for filing a complaint.
Because our practice cares for children and adolescents, some privacy rights may be exercised by a parent or legal guardian, while in other circumstances the minor patient may have privacy rights under applicable law. We handle these situations in accordance with federal and state law.
If you have questions about this Notice or wish to exercise your rights, please contact:
Privacy Officer
The Conrad Clinic
7970 E Thompson Peak Pkwy Suite 101
Scottsdale, AZ 85255
480-903-3337
info@theconradclinic.com
You may also file a complaint with:
U.S. Department of Health and Human Services
Office for Civil Rights
You may file electronically through the HHS OCR complaint portal or by mail. Current instructions are available through HHS.
