Notice of Privacy Practices

Purpose

Federal and Arizona law require that we protect the privacy of your personal health information. This Notice of Privacy Practices explains how your medical information may be used and disclosed, and how you can access this information.

We are required by law to provide you with a copy of this Notice and to obtain your acknowledgment that you received it. This Notice describes your rights under:

• The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
• A.R.S. Title 12, Chapter 13, Article 7.1 (Medical Records Access & Privacy)
• The Arizona Administrative Code, Title 9, Chapter 10, which governs patient rights and confidentiality in healthcare settings

How We May Use and Disclose Your Health Information

Sage & Stem Wellness may use and disclose your protected health information (PHI) for the following purposes:

• Treatment: To provide, coordinate, or manage your healthcare and related services.
• Payment: To obtain payment for services rendered, including billing and collections.
• Healthcare Operations: For quality assessment, training, licensing, and other operational activities necessary to run our practice.
• As Required by Law: When required by federal, state, or local law.
• Public Health Activities: To report diseases, injuries, or vital statistics as required by law.

All other uses and disclosures of your PHI require your written authorization, which you may revoke at any time in writing.

Your Rights

You have the right to:

• Access and request copies of your medical records (A.R.S. § 12-2293)
• Request restrictions on the use or disclosure of your health information (45 C.F.R. § 164.522)
• Request confidential communications (45 C.F.R. § 164.522(b))
• Request corrections or amendments to your health information
• Receive an accounting of disclosures of your PHI
• File a complaint if you believe your privacy rights have been violated, without fear of retaliation

How to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with:

• Sage & Stem Wellness directly at tasia@sageandstemwell.com
• The U.S. Department of Health and Human Services Office for Civil Rights at www.hhs.gov/ocr

You will not be retaliated against for filing a complaint.

Changes to This Notice

Sage & Stem Wellness reserves the right to change this Notice and to make the revised Notice effective for medical information we already have about you as well as any information we receive in the future. The current Notice will always be available on this website.

Contact

For questions regarding this Notice of Privacy Practices, please contact:

Tasia Kurland, DNP, AGNP-C
Sage & Stem Wellness
tasia@sageandstemwell.com
(602) 935-5385