Romanat Clinic, Inc. (“Romanat Clinic,” “we,” “us,” or “our”) is required by law to maintain the privacy of your protected health information (“PHI”), to give you this notice of our legal duties and privacy practices with respect to your PHI, and to follow the terms of the notice currently in effect.

We use and disclose PHI about you for treatment, payment, and health care operations, for example:

• Treatment — sharing information among the physicians, nurses, and medical assistants involved in your care, and with other providers you are referred to.
• Payment — sharing information with your insurance company or Clinic Service Corporation to obtain payment for services provided to you.
• Health care operations — using information for quality assessment, staff training, and running the clinic.
• Appointment reminders and scheduling — contacting you by phone, email, or text about an appointment you requested or already have, including the self-service reschedule link sent after a booking.

We may also be required or permitted to disclose PHI without your authorization for public health activities, health oversight, law enforcement purposes, to avert a serious threat to health or safety, and as otherwise required by law.

Other than as described above, we will not use or disclose your PHI without your written authorization. This includes most uses and disclosures of psychotherapy notes, uses for marketing purposes, and any sale of PHI. You may revoke an authorization at any time, in writing, except to the extent we have already acted on it.

• Right to inspect and copy. You may request access to your medical record and billing records maintained by the clinic.
• Right to amend. You may ask us to amend your health information if you believe it is incorrect or incomplete.
• Right to an accounting of disclosures. You may request a list of certain disclosures we made of your PHI.
• Right to request restrictions. You may ask us to limit how we use or disclose your PHI for treatment, payment, or operations.
• Right to request confidential communications. You may ask us to contact you in a specific way or at a specific location.
• Right to a paper copy. You may request a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Right to be notified of a breach. We will notify you if there is a breach of your unsecured PHI, as required by law.

To exercise any of these rights, contact us using the information below. We may ask you to submit your request in writing.

We are required by law to maintain the privacy of your PHI, provide you with this notice of our legal duties and privacy practices, and abide by the terms of the notice currently in effect. We reserve the right to change the terms of this notice and to make the revised notice effective for PHI we already have as well as PHI we receive in the future. The current notice is always available on this page and posted at our office.

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.

[Privacy Officer name and title]
Romanat Clinic, Inc.
11275 E Mississippi Ave #2E2, Aurora, CO 80012
303-364-1422