OUR LEGAL RESPONSIBILITIES
We are required by law to give you this notice. It provides you on how we may use and disclose protected health information about you and describes your rights and our obligations regarding the use and disclosure of that information. We shall maintain the privacy of protected health information and provide you with notice of our legal duties and privacy practices with respect to your protected health information.

Address: 4425 E. Agave Rd, Phoenix, AZ 85044 

Notice of Privacy Practices

Effective Date: 10/9/23
Clinic Name: Cactus Canyon Medical LLC
Address: 4425 E. Agave Rd, Phoenix, AZ 85044
Phone: 626-621-1710
Email: patientinformation@cactuscanyonmedical.com

Your Information. Your Rights. Our Responsibilities.

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

Your Rights

You have the right to:

• Get a copy of your medical record
  You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.
• Request a correction
  You can ask us to correct health information you think is incorrect or incomplete.
• Request confidential communications
  You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• Ask us to limit what we use or share
  You can ask us not to use or share certain health information for treatment, payment, or operations.
• Get a list of those with whom we’ve shared information
  You can ask for an accounting of disclosures made of your health information during the past six years.
• Get a copy of this privacy notice
  You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Choose someone to act for you
  If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• File a complaint if you feel your rights are violated
  You can complain directly to us or to the U.S. Department of Health and Human Services (HHS).
• To file with us: Contact Paul Goldman at 626-621-1710
• To file with HHS: Visit https://www.hhs.gov/ocr/privacy/hipaa/complaints/
  We will not retaliate against you for filing a complaint.

Your Choices

You have some choices in the way we use and share information when it comes to:

• Sharing information with family, friends, or others involved in your care.
• Sending appointment reminders or information about treatment alternatives and health-related benefits.
• Including you in a clinic directory (if applicable).

If you are unable to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest.

Our Uses and Disclosures

We typically use or share your health information in the following ways:

Treat You

We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for weight-related conditions asks another healthcare provider for your lab results.

Run Our Clinic

We can use and share your health information to run our clinic, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.

Bill for Services

We can use and share your health information to bill and receive payment from health plans or other entities.
Example: We give information to your health insurance plan so it will pay for your services.

Other Permitted or Required Disclosures

We may share your information for other reasons — usually to meet legal or public health obligations — including:

• Preventing or controlling disease, injury, or disability
• Reporting births and deaths
• Reporting adverse reactions to medications
• Responding to court or legal orders
• Assisting with product recalls
• Reporting abuse, neglect, or domestic violence
• Complying with laws related to workers’ compensation or law enforcement requests

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice.
• We will not use or share your information other than as described here unless you tell us we can in writing. You may change your mind at any time by letting us know in writing.

Contact Information

If you have questions or want more information, contact:
Privacy Officer: Paul Goldman
Phone: 626-621-1710
Email: Patientinformation@CactusCanyonMedical.com