Notice of Privacy Practices

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I.  We are legally required to:

A. Maintain the privacy of your private health information (PHI).

B. Provide you with a written notice that outlines your rights relating to your private health information.

C. To assist you in designating how your private health information will be used & to whom it may be disclosed.

II. We do not need your authorization to release your PHI if it is released to:

A. Provide treatment to you.

B. Obtain payment for having treated you.

C. Operate this facility.

D. Any agency or authority that has a right to demand our PHI by law.

III. You have the following rights regarding your PHI:

A. Inspect and copy your PHI.  To copy your PHI, there will be a fee.

B. Amend your PHI.

C. To restrict certain uses and releases of information of your PHI.

Complaints:  If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Federal Department of Health &  Human Services.  We will not retaliate against you for filing a complaint.

We reserve the right to change our privacy practices in the future.

**You must make any requests in writing**

Contact:
Office Manager

Address:
130 E. Virginia St.
Gunnison, CO 81230

Phone: (970) 641-2241
Fax: (970) 641-1268

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