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Ketamine West of Western Colorado Notice of Privacy

Notice Of Privacy:

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Effective Date: 4/20/2025

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At Ketamine West, your privacy is important to us. This Privacy Policy describes how we may use and share your health information and outlines your rights under the Health Insurance Portability and Accountability Act (HIPAA).

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How We May Use or Share Your Health Information

We may use or share your Protected Health Information (PHI) in the following ways:

1. To Treat You

We can use your health information and share it with other healthcare professionals who are treating you.
Example: A doctor treating you for an injury may consult another provider about your overall condition.

2. To Run Our Organization

We use your health information to operate our clinic, improve your care, and communicate with you.
Example: We use information about you to manage your treatment and services.

3. To Bill for Services

We can use and share your health information to bill and receive payment from health plans or other payers.
Example: We send information to your insurance plan so it will cover your treatment costs.

Your Rights Regarding Your Health Information

You have the right to:

  • Get a Copy of Your Medical Records
    Request to see or receive an electronic or paper copy of your medical record.

  • Request Corrections
    Ask us to correct information you think is inaccurate or incomplete.

  • Request Confidential Communications
    Request that we contact you in a specific way (e.g., phone or email) or send mail to a different address.

  • Limit What We Use or Share
    Ask us not to use or share certain health information. We’ll comply when legally possible.

  • Get a List of Disclosures
    Request an accounting of disclosures of your health information made in the last six years (excluding treatment, payment, and healthcare operations).

  • Get a Paper Copy of This Policy
    Request a paper copy of this notice at any time.

  • Choose Someone to Act for You
    If you have a medical power of attorney or legal guardian, that person may exercise your rights and make choices about your PHI.

  • File a Complaint
    You can file a complaint if you believe your rights have been violated. We will not retaliate.

Our Responsibilities

We are required by law to:

  • Maintain the privacy and security of your protected health information.

  • Inform you promptly if a breach compromises your information.

  • Follow the duties and privacy practices described in this policy.

  • Not use or share your information other than as described here unless you provide written permission. You may revoke permission at any time.

For more details, visit: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to This Privacy Policy

We may change the terms of this policy at any time, and changes will apply to all information we have about you. The new policy will be posted on our website and available in our office.

Contact Information – Privacy Official

If you have questions or want to file a complaint, contact:

Stryder Reilly, NP
Privacy Officer – Ketamine West
📍 1212 Bookcliff Ave, Suite 1, Grand Junction, CO 81501
📞 970 427 4400
📧 info@ketaminewest.com

You may also contact:
U.S. Department of Health and Human Services, Office for Civil Rights
📍 200 Independence Avenue, S.W., Washington, D.C. 20201
📞 1-877-696-6775
🌐 www.hhs.gov/ocr/privacy/hipaa/complaints/

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