Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed, and how you can get access to that information. Please review it carefully.
Who this notice applies to
This notice covers the medical practice of David Shockey, M.D., located at Brown Road Family Medicine, 2310 E. Brown Rd, Mesa, AZ 85213 (“the practice”). Desert Premier Wellness Program is a trade name; the practice operates as a professional limited liability company, identified in full in the membership agreement. In this notice, “medical information” means protected health information as defined by federal law (HIPAA).
Our duties
The practice is required by law to maintain the privacy and security of your medical information, to give you this notice of its legal duties and privacy practices, to follow the terms of the notice currently in effect, and to notify you if a breach occurs that may have compromised the privacy or security of your information.
How we may use and disclose medical information
For treatment
We use your medical information to provide your care and may share it with other physicians, laboratories, imaging facilities, pharmacies and health professionals involved in that care — for example, sending an order to a laboratory, or records to a specialist you are referred to.
For payment
We may use and disclose your information to bill and collect payment for services — for example, submitting a claim to Medicare or your health plan, or confirming that your plan covers a service before it is performed.
For health care operations
We may use and disclose your information to run the practice — for example, quality review, training, scheduling, and administrative work that supports your care.
Appointment reminders and care communications
We may contact you to remind you of an appointment, to share test results, or to tell you about treatment options or health-related services relevant to your care.
People involved in your care
With your agreement, or when you are unable to agree and it is in your best interest, we may share information relevant to their involvement with a family member, close friend or caregiver you have involved in your care.
Other uses and disclosures permitted or required by law
We may use or disclose your medical information without your authorization in circumstances that federal and state law permit or require, including: when required by law; for public-health activities such as disease reporting and adverse-event reporting; to report suspected abuse, neglect or domestic violence; to health-oversight agencies for audits and inspections; in judicial and administrative proceedings in response to a court order, or in some cases a subpoena; to law enforcement in limited circumstances; to coroners, medical examiners and funeral directors; for organ and tissue donation; for certain research approved under legally required protections; to avert a serious and imminent threat to health or safety; for specialized government functions such as military and national-security purposes; and for workers’ compensation as authorized by law. These disclosures are subject to the conditions and limits set by the applicable law.
Uses and disclosures that require your written authorization
Most uses and disclosures of psychotherapy notes, uses and disclosures of your information for marketing purposes, and any sale of your information require your written authorization. Other uses and disclosures not described in this notice will be made only with your written authorization. You may revoke an authorization at any time, in writing; the revocation applies to information not yet used or disclosed under it.
Your rights
You have the right, generally exercised by a written request to the office, to: inspect and receive a copy of the medical information we maintain about you, in the form and format you request where readily producible; ask us to amend information you believe is incorrect or incomplete (we may deny the request in certain cases, and will tell you why in writing); receive an accounting of certain disclosures we have made of your information; request restrictions on how we use or disclose your information for treatment, payment or operations — we are not required to agree, except that we must honor a request not to disclose information to your health plan about a service you have paid for in full out of pocket; request that we communicate with you in a certain way or at a certain location, which we will accommodate when the request is reasonable; receive a paper copy of this notice on request, even if you agreed to receive it electronically; and name a personal representative with legal authority to act for you in these matters. You will also be notified in the event of a breach involving your unsecured medical information, as described above.
Changes to this notice
We may change this notice, and the change will apply to information we already hold as well as information we receive in the future. The current notice is posted on this page and available at the office; the effective date appears at the foot of this page.
Complaints
If you believe your privacy rights have been violated, you may complain to the practice by calling 480-649-9000 or writing to staff@desertpremierwellness.com, and you may file a complaint with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue S.W., Washington, D.C. 20201, 1‑877‑696‑6775, or at hhs.gov/ocr/complaints. You will not be penalized or retaliated against for filing a complaint.
Information submitted through this website
This website collects no personal information. There is no form anywhere on it; prospective members contact the office directly by phone or email. How the site itself handles information is described in the website privacy notice.
Questions
For questions about this notice or your privacy rights, contact the office at 480-649-9000 or staff@desertpremierwellness.com.