Notice of Privacy Practice
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.
As our patient, you have rights
Get an electronic or paper 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. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
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.
• We will say “yes” to all reasonable requests.
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 our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
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.
• We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
• You can file a complaint if you feel we have violated your rights by contacting our office at 720-222-0550 and ask for our Executive Director, Sara Short.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.
As our patient, you have choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes
In the case of fundraising:
• We may contact you for fundraising efforts, but you can tell us not to contact you again.
Our uses and disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways:
We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Use of our website
Last updated: Jan 27, 2023 2:30 PM
What information might be collected
We may collect any and all information that you enter on this Website. This may include the following information about you:
|Category of information||Specific piece of information|
|Identifying information||Phone number|
|Identifying information||IP address|
|Identifying information||Email address|
|Identifying information||Device identifier|
|Identifying information||Online identifier|
|Identifying information||Account name|
|Commercial information||Products or services purchased, obtained or considered|
|Internet or other electronic activity||Browsing history|
|Internet or other electronic activity||Search history|
|Internet or other electronic activity||Information regarding your interaction with our website or application|
|Internet or other electronic activity||Information regarding your interactions with advertisements|
|Consumer profiling||Inferences drawn from any other information to create a profile about the consumer|
|Sensitive personal information||Geolocation information|
|Sensitive personal information||Keystroke patterns or rhythms|
How we may use your information
We may use the information that you provide us for the following:
- Enforcing our Terms of Service;
- Marketing and advertising;
- Participation in surveys and contests;
- Performing services;
- Providing customer service;
- Targeted advertising.
A cookie is a small piece of data sent from a website and stored on your device by your browser. This Website collects cookies. Please visit our cookies declaration page to learn more about what cookies we collect, why we collect them, and how to change your cookie settings.
This Website is intended for use by a general audience and does not offer services to children. Should a child whom we know to be under 18 send personal information to us, we will use that information only to respond to that child to inform him or her that they cannot use this Website.
This Website uses Google Analytics to collect information about you and your behaviors. If you would like to opt out of Google Analytics, please visit https://tools.google.com/dlpage/gaoptout/.
This Website may contain hyperlinks to websites operated by parties other than us. We provide such hyperlinks for your reference only. We do not control such websites and are not responsible for their contents or the privacy or other practices of such websites. It is up to you to read and fully understand their Privacy Policies. Our inclusion of hyperlinks to such websites does not imply any endorsement of the material on such websites or any association with their operators.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in
ways that contribute to the public good, such as public health and
research. We have to meet many conditions in the law before we can share
your information for these purposes. For more information see:
Help with public health and safety issues
We can share health information about you for certain situations such as:
• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it,
including with the Department of Health and Human Services if it wants
to see that we’re complying with federal privacy law.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
The Practice’s Responsibilities
• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know 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 and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may
change your mind at any time. Let us know in writing if you change your
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all
information we have about you. The new notice will be available upon
request, in our office, and on our web site.
Additional Information for Notice
• The Effective Date of this Notice is January 6, 2023
• The privacy contact is Sara Short. You can reach Sara via email at
firstname.lastname@example.org or by calling 720-222-0550 and asking for Sara
• Ballen Medical & Wellness will never market or sell personal information.
• Ballen Medical & Wellness will never share any substance abuse treatment records without your written permission.
• This notice also applies to Colorado Recovery Infusion Center which
practices under and within Ballen Medical & Wellness.