Notice of Privacy Practices

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.

This notice applies to Denver Ketamine Clinic, a trade name of TMS Therapy Centers of Colorado.

We are required by law to maintain the privacy and security of your protected health information, to give you this notice of our legal duties and privacy practices, to follow the terms of the notice currently in effect, and to notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

• Treatment — to provide, coordinate, and manage your care, including with other clinicians involved in your treatment.
• Payment — to bill and obtain payment from you, your health plan, or another payer, including prior authorization and benefit verification.
• Health care operations — for quality assessment, staff review, care coordination, business management, and administrative activities.
• Appointment reminders and treatment alternatives — to contact you about appointments or other treatment options and health-related services.
• As required or permitted by law — including public health activities, reporting abuse or neglect, health oversight, judicial and administrative proceedings, law enforcement requests, coroners and funeral directors, organ donation, research permitted by law, workers' compensation, and to avert a serious threat to health or safety.

Other uses and disclosures — including most uses of psychotherapy notes, marketing, and any sale of your information — require your written authorization, which you may revoke in writing at any time.

• Inspect and obtain a copy of your medical and billing records, including an electronic copy where available.
• Request an amendment to information you believe is incorrect or incomplete.
• Request an accounting of certain disclosures we have made.
• Request restrictions on certain uses and disclosures, including a restriction on disclosure to a health plan for services you pay for in full out of pocket.
• Request confidential communications at an alternative address or by an alternative means.
• Receive a paper copy of this notice, even if you agreed to receive it electronically.
• Choose someone to act for you, such as a personal representative or someone with medical power of attorney.

We may change the terms of this notice, and the changes will apply to all information we hold. The revised notice will be available at our office and on this page.

To exercise a right, ask a question, or file a complaint, contact us at (720) 221-8560 or at Denver Ketamine Clinic, 66 S Logan St, Denver, CO 80209. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.