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
The Privacy of Your Health Information is Important to Us.
OUR LEGAL DUTY
We are required by applicable federal and state law to maintain the privacy of your health information. We are also
required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health
information. We must follow the privacy practices that are described in this Notice while it is in effect. This Notice
takes effect August 24, 2023 and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes
are permitted by applicable law. We reserve the right to make changes in our privacy practices and the new terms of
our Notice effective for all health information that we maintain, including health information we created or received
before we made the changes. Before we make a significant change in our privacy practices, we will change this
Notice and make the new Notice available upon request.
You may request a copy of our Notice at any time. For more information about our privacy practices, or for
additional copies of this Notice, please contact us using the information listed at the end of this Notice.
USES AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose health information about you for treatment, payment, and healthcare operations. For example:
Treatment: We may use or disclose your health information to a physician or other healthcare provider providing
treatment to you.
Payment: We may use and disclose your health information to obtain payment for services we provide to you.
Healthcare Operations: We may use and disclose your health information in connection with our healthcare
operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence
or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training
programs, accreditation, certification, licensing or credentialing activities.
Your Authorization: In addition to our use of your health information for treatment, payment or healthcare
operations, you may give us written authorization to use your health information or to disclose it to anyone for any
purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect
any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written
authorization, we cannot use or disclose your health information for any reason except those described in this
To Your Family and Friends: We must disclose your health information to you, as described in the Patient rights
section of this Notice. We may disclose your health information to a family member, friend or other person to the
extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may
Persons Involved In Care: We may use or disclose health information to notify, or assist in the notification of
(including identifying or locating) a family member, your personal representative or another person responsible for
your care, of your location, your general condition, or death. If you are present, then prior to use or disclosure of
your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event
of your incapacity or emergency circumstances, we will disclose health information based on a determination using
our professional judgment disclosing only health information that is directly relevant to the person’s involvement in
your healthcare. We will also use our professional judgment and our experience with common practice to make
reasonable inferences of you best interest in allowing a person to pick up health information.
Marketing Health-Related Services: We will not use your health information for marketing communications
without your written authorization.
Required by Law: We may use or disclose your health information when we are required to do so by law.
Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that
your child is a possible victim of abuse, neglect, domestic violence or the possible victim of other crimes. We may
disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health
or safety of others.
National Security: We may disclose to military authorities the health information of Armed Forces personnel under
certain circumstances. We may disclose to authorized federal official’s health information required for lawful
intelligence, counterintelligence, and other national security activities. We may disclose to law enforcement official
having lawful custody of protected health information under certain circumstances.
Appointment Reminders: We may use or disclose your health information to provide you with appointment
reminders (such as voicemail messages, postcards, or letters).
Access: You have the right to look at or get copies of your health information, with limited exceptions. You may
request that we provide copies in a format other than photocopies. We will use the format you request unless we
cannot practicable do so. (You must make a request in writing to obtain access to your health information. You may
obtain a form to request access by using the contact information at the end of this Notice. We may charge you a
reasonable cost-based fee for expenses such as copies and staff time. You may also request access by sending us a
letter to the address at the end of the Notice. Contact us using the information listed at the end of this Notice for an
estimate of any costs we may charge.
Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates
disclosed your health information for purposes other than treatment, payment, healthcare operations and certain
other activities. If you request this accounting more than once in a 12-month period, we may charge you a
reasonable, cost-based fee for responding to these additional requests.
Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your
health information. We are not required to agree to these additional restrictions, but we do, we will abide by our
agreement (except in an emergency).
Alternative Communication: You have the right to request that we communicate with you about your health
information by alternative means or to alternative locations. (You must make your request in writing.) Your request
must specify the alternative means or location, and provide satisfactory explanation how payments will be handled
under alternative means or locations you request.
Amendment: You have the right to request that we amend your health information. (Your request must be in
writing, and explain why the information should be amended.) We may deny your request under certain
Electronic Notice: If you receive this Notice on our website or by electronic mail (e-mail), you are entitled to
receive this Notice in written form.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have questions or concerns, please contact us.
If you are concerned that we may have violate your privacy rights, or disagree with a decision we made about access
to your health information or in response to a request you made to amend or restrict the use or disclosure of your
health information or to have us communicate with you by alternative means or at alternative locations, you may
complain to us using the contact information listed at the end of this Notice. You also may submit a written
complaint to the U.S. Department of Health and Human Services. https://ocrportal.hhs.gov/ocr/smartscreen/
We support your right to privacy of your health information. We will not retaliate in any way if you choose to file a
complaint with us or with the U.S. Department of Health and Human Services.
Contact Officer: Maureen Rohde
Director of Operations
8922 Cuming St. Omaha NE, 68114