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

New West Physicians has always considered physician-patient confidentiality an integral part of patient care.

As part of the Balanced Budget Act of 1997, new legislation regarding the privacy of your protected health information (PHI) will become effective April 14, 2003.

The law, known as HIPAA (Health Insurance Portability and Accountability Act), requires that all healthcare providers maintain the privacy of protected health information and provide individuals with notice of its legal duties and privacy practices with respect to protected health information. This office is required to follow the terms of the notice currently in effect.

We use health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. Continuity of care is part of treatment and your records may be shared with other healthcare providers to whom you are referred. Information may be shared by paper mail, electronic mail, fax, or other methods.

In addition, we may disclose identifiable personal health information about you without your authorization for several reasons. Subject to certain requirements, we may give out health information without your authorization for public health purposes such as reporting of communicable diseases, birth, death, injury and child abuse or neglect; for auditing purposes; for research studies; and for emergencies. We may provide information when otherwise required by law, such as for law enforcement or by court order in specific circumstances. Contact with you may also take place in the form of appointment reminders, prescription refills, referrals, test results, etc.

In any other situation, we will ask for your written authorization before using or disclosing any identifiable personal health information about you. If you choose to sign an authorization to disclose information, you may later request to revoke either all or part of the authorization to limit or stop any future uses or disclosures.

You have the right to request to see and receive a copy of all information that is contained in your medical record or chart at this office by alternate means or at alternate locations. All such requests must be submitted in writing. This includes information that other providers may have sent to this office. If you request a copy of your medical record, we will charge you only normal photocopy fees. Exceptions to this right of access include psychotherapy notes, information complied in reasonable anticipation of, or for use in, civil, criminal, or administrative proceedings: and protected health information maintained by New West that is subject to the Clinical Laboratory Improvements Amendments of 1988, 42 U.S.C., 263a, to the extent the provision of access would be prohibited by law or exempt from the Clinical Laboratory Improvements Amendments of 1988, pursuant to 42 C.F. R., 493.3(a)(2).

New West may deny your access request provided that you are given the right to have such a denial reviewed in the following circumstances:

1. A licensed health care professional has determined that the access requested is reasonably likely to endanger the life or physical safety of you or another person;
2. The protected health information refers to another person and a licensed health care professional has determined that the access requested is reasonably likely to cause substantial harm to that person; or
3. The request for access is made by your personal representative and a licensed health care professional has determined that the provision of access is reasonably likely to cause substantial harm to you or another person.

We may also deny you access without providing an opportunity for review in the following circumstances:

1. The protected health information is excepted from the right of access;
2. Access to the protected health information is contained in records that are subject to the Privacy Act, 5 U.S.C., 552a or
3. Access may be denied if the protected health information was obtained from someone other than a health care provider under a promise of confidentiality and the access requested would be reasonably likely to reveal the source of the information.

New West will have 30 days to act on a written request for access to your records unless the requested information is not maintained or accessible on site in which case we may take up to 60 days to act on your request. We will respond in writing to your request and provide you with the anticipated date we will complete our action on your request. If access is granted, we will provide whatever access was requested including inspection, obtaining a copy, or both. If access is denied, we will inform you in writing and provide you with the reasons or basis for the denial, a statement regarding your right to request a review of the decision and information on how to issue such a request. We will also give you access to any other protected health information after excluding the portion of the information for which access is denied.

If you believe that information contained in your medical record is incorrect or if important information is missing, you have the right to request that we correct the existing information or amend the missing information. This request must be submitted in writing and must include a reason to support the requested amendment. New West must act on a request for amendment within 60 days of the receipt of the request. The acceptance or denial of a request to amend your protected health information will follow the same process as requests for access described above. Should you request and receive approval for an amendment to your personal health information from another physician, we will also amend our records to reflect any changes made to your medical record at the other physician's office.

You have the right to an accounting of disclosures of all protected health information that was released by this office in the past six years EXCEPT for disclosures for purposes of treatment, payment and healthcare operations; to individuals of protected health information about them; for a facility directory or to persons involved in your care; or other notification purposes; for national security or intelligence purposes; to correctional institutions or law enforcement officials; or that occurred prior to the compliance date of April 14, 2003. You have the right to a paper copy of this notice regardless of whether you have received a prior copy either in printed or electronic format.

The accounting will include the date of the disclosure, the name of the person who received the protected health information and their address; a copy of the written request for disclosure; a brief description of the PHI disclosed and brief statement of the purpose of the disclosure that reasonably informs you of the basis for the disclosure. If we have made disclosure of PHI for a particular research purpose for 50 or more patients, the accounting will provide additional information about the disclosure and the research purposes.

You have the right to request a restriction on the use and disclosure of some information, even those disclosures or uses related to treatment, payment or health care operations. This request must be submitted in writing. However, New West is not required to automatically agree to such a restriction request. If New West does agree to a restriction of PHI, we will document the specific requested restriction. Please be advised that New West may still disclose the restricted information if the individual who requested the restriction is in need of emergency treatment and the restricted health information is needed to provide that treatment. In those circumstances, we may use restricted information or may disclose the information to a health care provider to provide emergency treatment for you. If we disclose or use restricted information in this manner, we will request that the provider not further use or disclose that information beyond the emergency treatment.

We may also terminate our agreement to a restriction if:

1. You agree to or request the termination in writing;
2. You verbally agree to the termination and the verbal agreement is documented;
3. New West informs you that we are terminating our agreement to a restriction, except that such termination is only effective with respect to protected health information created, received or obtained after the date of the termination notice to you.

New West will keep on file the titles of the persons or offices responsible for receiving and processing requests for access and amendments from all patients and will retain appropriate documentation of any and all requests.

Any and all documentation relating to requests for access, requests for restrictions, requests for amendments, and requests for accounting disclosures will be maintained in the New West offices for 6 years from the date it was created or the date it was last in effect, whichever is later.

Finally, you have the right to complain about any perceived privacy violations or if you disagree with a decision we made about access to your records. You may contact the Practice Manager at this office, the New West Privacy Officer, Mary Murphy, R.N., at (303) 716-8020, and/or the Secretary of the Department of Health and Human Services at 200 Independence SW, Washington D.C., 20201. Be assured that the law also prohibits retaliation in any form to any person who exercises this right.

We may change our policies at any time. Before we make significant change/s to our policies, we will modify this notice to reflect the changes and post the new notice in the waiting area. You can also request a copy of our notice at any time. For more information about our Privacy Practices, contact the New West Practice Manager at this office.

We are required by law to protect the privacy of your personal health information, provide this notice about our information practices, follow the information practices that were described in this notice, and obtain your written acknowledgement that you have read this notice, been given the opportunity to ask any questions regarding the notice, and have been given a copy of the notice if you requested one.

Again, if you have any questions or concerns that cannot be answered by the Practice Manager regarding this notice, please contact the New West Privacy Officer,
Mary Murphy, RN, at (303) 716-8020
or 1707 Cole Blvd., Suite 250, Golden, CO 80401