THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
 

If you have any questions about this notice, please contact:

Dr. Andi Woodbury 970-239-3010
 

Pledge Regarding Personal Health Information (PHI)

I understand that personal health information (information about you and your health or "PHI") is deeply personal and I am committed to maintaining the confidentiality of your health information. I create and maintain a record of the care and services that you receive from me. This record is necessary to treat you and to comply with certain legal requirements. This notice applies to all of the records of your care with me, whether made by me or by other personnel within my office and/or facilities.
 

This notice advises you about the ways in which I may use and disclose health information about you. It also describes your rights to access and control your health information. 'Health Information' (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. This notice also describes your rights and explains certain obligations I have regarding the use and disclosure of health information.

I am required by law to:

• Make sure that health information that identifies you is kept private.

• Provide you with this notice of my legal duties and privacy with respect to health information about you.

• Follow the terms described in this notice.

I may change the terms of this notice at any time. The new notice will be effective for all protected health information that I maintain at that time. Upon your request, I will provide you with any revised Notice of Privacy Practices by calling my office and/or facilities and requesting that a revised copy be sent to you in the mail, by asking for one at the time of your next visit, or by accessing my website.
 

How We May Use and Disclose Health Information About You

The following categories describe different ways that I may use and disclose health information. 
 

Treatment - I may use health information about you to provide you with health treatment or services. I may disclose health information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in your health care and treatment. Areas of my office also may share health information about you in order to coordinate the different things you need, such as prescriptions or lab work. I also may disclose health information about you to people outside the office and/or facilities who may be involved in your health care after you leave my office and/or facilities for continuity of care to assist in caring for you.
 

Payment - I may use and disclose health information about you so that the treatment and services which I provide to you at my office and/or facilities, or other site may be billed to and payment may be collected from you and/or your insurance company or other responsible third party. For example, I may need to provide to your health insurance plan information about the services which I provided to you at my office and/or facilities, so that your health plan will pay or reimburse you for the services. I may also advise your health insurance plan about a treatment you are going to receive in order to obtain prior approval or to determine whether your plan will cover treatment.
 

Health Care Operations - I may use and disclose health information about you for my office operations. These uses and disclosures are necessary to operate my office and/or facilities and make sure all of my patients receive quality care. 
 

Appointment Reminders - I may use and disclose health information in to send reminders or confirmations about upcoming appointments.  
 

Treatment Alternatives - I may use and disclose health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you. 
 

Health-Related Benefits and Services - I may use and disclose health information to tell you about health-related benefits or services that may be of interest to you.

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Research - Occasionally, I may use and disclose general health information about patients (without PHI) for research purposes. If PHI is involved, I will ask for individual and specific permission prior to disclosing PHI for research purposes. 
 

SPECIAL SITUATIONS
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object:

Emergencies - I may use or disclose your health information in an emergency treatment situation. If this happens, your healthcare provider shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If your provider, or another provider in the office and/or facilities is required by law to treat you and the provider has attempted to obtain your consent but is unable to obtain your consent, he or she may still use or disclose your health information in order to treat you.
 

As Required By Law - I will disclose your health information when required to do so by federal, state or local law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.
 

Legal Proceedings - If you are involved in a lawsuit or a dispute, I may disclose health information about you in response to a court or administrative order. I may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if required by law or if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
 

Public Health - I may disclose health information about you for public health activities. These activities generally include the following: :

• To prevent or control disease, injury or disability.

• To report births and deaths.

• To report child abuse or neglect.

• To report reactions to medications or problems with products.

• To notify people of recalls of products they may be using.

• To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.

• To notify the appropriate government authority if I believe a patient has been the victim of abuse, neglect or domestic violence. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
   

To Avert a Serious Threat to Health or Safety - I may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
 

Law Enforcement - I will disclose health information when required to do so for law enforcement purposes. These law enforcement purposes include:

1. Legal processes and otherwise required by law.

2. Limited information requests for identification and location purposes.

3. Pertaining to victims of a crime.

4. Suspicion that death has occurred as a result of criminal conduct.

5. In the event that a crime occurs on the premises of the practice.

6. Medical emergency (not on the practice's premises) and it is likely that a crime has occurred.
    

Criminal Activity - Consistent with applicable federal and state laws, I may disclose your health information, if I believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. I may also disclose health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

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National Security and Intelligence Activities - I may release health information about you to authorized federal officials for intelligence, counterintelligence, protection of the President, other authorized persons or foreign heads of state, for the purpose of determining your own security clearance and other national security activities authorized by law.
 

Military and Veterans - If you are a member of the armed forces, I may release health information about you as required by military command authorities. I may also release health information about foreign military personnel to the appropriate foreign military authority. If you are a member of the Armed Forces, I may disclose health information about you to the Department of Veterans Affairs upon your separation or discharge from military services. This disclosure is necessary for the Department of Veterans Affairs to determine whether you are eligible for certain benefits.

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Health Oversight Activities - I may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. Under the law, I must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine my compliance with the requirements of Section 164.500 et. seq.
 

Your Rights Regarding Health Information About You

You have the following rights regarding health information we maintain about you:

Right to Inspect and Copy - You have the right to inspect and copy health information that may be used to make decisions about your care. Usually, this includes health and billing records and any other records that your provider and the office and/or facilities use for making decisions about you. I may deny your request to inspect and copy in certain limited circumstances. Under federal law, you may not inspect or copy:

1. Psychotherapy notes.

2. Information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding.

3. Health information that is subject to law that prohibits access to health information.

If you are denied access to health information, you may request that the denial be reviewed. Another licensed health care professional chosen by the practice will review your request and the denial. The person conducting the review will not be the person who denied your request. I will comply with the outcome of the review.

To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing to the Office Administrator / Privacy Contact. If you request a copy of the information, I may charge a fee as permitted by state law for the costs of copying, mailing or other supplies associated with your request.  I request that
 

Right to Amend - If you feel that health information I have about you is incorrect or incomplete you have the right to request an amendment for as long as the information is maintained the practice. Your request must be made in writing to the Office Administrator / Privacy Contact, and you must provide a reason that supports your request. I may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, I may deny your request if you ask me to amend information that:

• Was not created by us, unless the person or entity that created the information is no longer available to make the amendment.

• Is not part of the health information maintained by the practice.

• Is not part of the information which you would be permitted to inspect and copy.

• Is accurate and complete.
   

Right to Request Restrictions - You have the right to request a restriction or limitation on the health information I use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information I disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that I not use or disclose information about a surgery that you had. Your request must be made in writing to my Office Administrator / Privacy Contact and you must tell me:

1. What information you want to limit.

2. Whether you want to limit our use, disclosure or both.

3. To whom you want the limits to apply, for example, disclosures to your spouse.

I am not required to agree to your request. If I believe it is in your best interest to permit the use and disclosure of your health information, then your health information will not be restricted. If I do agree, I will comply with your request unless the information is needed to provide you with emergency treatment. With this in mind, please discuss any restriction you wish to request with your healthcare provider.
 

Right to an Accounting of Disclosures - You have the right to request an "accounting of disclosures." This is a list of the disclosures I made of health information about you. This right applies to disclosures other than purposes of treatment, payment or health care operations as described in this Notice of Privacy. It excludes disclosures I may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. Your request must be made in writing to my Office Administrator / Privacy Contact and must indicate a time-period that may not be longer than six years and may not include dates prior to September 1, 2025 (practice start). Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be provided at no cost to you. For additional lists, I may charge you for the costs of providing the list. I will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
 

Right to Request Confidential Communications - You have the right to request that I communicate with you about health matters in an alternative way or at an alternative location. For example, you can ask that I only contact you at work or by mail. I will accommodate reasonable requests and I will not request an explanation for your request. Please make this request in writing to my Office Administrator / Privacy Contact.
 

Right to a Paper Copy of This Notice - You have the right to a paper copy of this notice, even if you have agreed to receive this notice electronically. You may print a copy of this notice or ask me to provide you with a copy of this notice at any time.
 

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the practice or with the Secretary of the Department of Health and Human Services. All complaints must be made in writing. You will not be penalized for filing a complaint.

To file a complaint with the practice, contact:

Andi Woodbury, DO  (970) 239-3010
 

Other Uses of Health Information

Other uses and disclosures of health information not covered by this notice or the laws that apply to me will be made only with your written permission. If you provide me permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, I will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that I am unable to take back any disclosures I have already made with your permission, and that I am required to retain my records of the care that I provided to you.
 

This notice was published and becomes effective on September 1, 2025.