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 PRIVACY PRACTICES

Secure Draw Medical Services


Effective Date: July 9, 2025
Revision Date: July 9, 2025

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.

Our Commitment to Your Privacy

Secure Draw Medical Services is committed to protecting the privacy of your health information. We are required by federal and state law to maintain the privacy of your protected health information (PHI) and to provide you with this Notice of our legal duties and privacy practices with respect to your health information.
 

This Notice describes how we may use and disclose your protected health information to carry out treatment, payment, or healthcare operations and for other purposes that are permitted or required by law. It also describes your rights regarding your health information and how you may exercise those rights.

Definitions

Protected Health Information (PHI): Information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health condition and related healthcare services.


Use: The sharing, employment, application, utilization, examination, or analysis of PHI within our organization.


Disclosure: The release, transfer, provision of access to, or divulgence of PHI outside our organization.

How We May Use and Disclose Your Health Information
 

Uses and Disclosures for Treatment, Payment, and Healthcare Operations

Treatment: We may use and disclose your health information to provide, coordinate, or manage your healthcare and related services. This may include:
 

  • Communicating with other healthcare providers regarding your care

  • Coordinating medical services with laboratories and testing facilities

  • Providing medical information to healthcare providers involved in your care

  • Sharing information necessary for medical consultations or referrals


Example: We may share your test results with your primary care physician or the employer who requested the medical screening.


Payment: We may use and disclose your health information to obtain payment for services we provide to you. This may include:
 

  • Billing you, your insurance company, or third parties for services rendered

  • Collecting payment for services provided

  • Reviewing services provided to you to determine medical necessity

  • Pre-authorization activities and utilization review


Example: We may send your health information to your insurance company to obtain approval for payment of medical services.

Other Uses and Disclosures We May Make Without Your Authorization
 

As Required by Law: We will disclose your health information when required to do so by federal, state, or local law.

Other Uses and Disclosures We May Make Without Your Authorization
 

As Required by Law: We will disclose your health information when required to do so by federal, state, or local law.

Public Health Activities: We may disclose your health information for public health activities including:
 

  • Disease prevention and control

  • Injury and disability prevention

  • Vital statistics reporting

  • Public health surveillance, investigations, and interventions

  • FDA-regulated product monitoring and safety


Health Oversight Activities: We may disclose health information to health oversight agencies for oversight activities authorized by law, including audits, investigations, inspections, and licensure actions.
 

Judicial and Administrative Proceedings: We may disclose health information in response to:
 

  • Court orders, subpoenas, discovery requests, or other lawful process

  • Administrative tribunals and administrative proceedings

  • Arbitration and mediation proceedings
     

Law Enforcement: We may disclose health information to law enforcement officials for:
 

  • Legal processes and as otherwise required by law

  • Identification and location purposes

  • Victims of crime under certain limited circumstances

  • Suspicious deaths or criminal activity at our facility

  • Medical emergencies when a crime may have occurred


DOT and Regulatory Compliance: We may disclose health information to:
 

  • Department of Transportation (DOT) for commercial driver medical certification

  • Occupational Safety and Health Administration (OSHA) for workplace safety compliance

  • Other federal and state regulatory agencies as required by law

  • Employers when required by law or employment-related medical services
     

Workers' Compensation: We may disclose health information as authorized by and necessary to comply with workers' compensation laws.


Coroners, Medical Examiners, and Funeral Directors: We may disclose health information to coroners, medical examiners, and funeral directors to allow them to carry out their duties.
 

Organ and Tissue Donation: We may disclose health information to organ procurement organizations or other entities engaged in organ, eye, or tissue donation and transplantation.


Research: We may disclose health information for research purposes when:
 

  • An institutional review board or privacy board has reviewed the research proposal and established protocols to ensure the privacy of your health information

  • The research relates solely to decedents

  • As necessary for research preparation activities

  • When you have provided authorization
     

Serious Threat to Health or Safety: We may use or disclose your health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
 

Specialized Government Functions: We may disclose health information for:
 

  • Military and veteran activities

  • National security and intelligence activities

  • Protective services for the President and others

  • Medical suitability determinations for State Department employees

  • Correctional institutions and other law enforcement custodial situations
     

Employment-Related Services: When we provide medical services at the request of your employer, we may disclose health information to your employer as:
 

  • Required by occupational safety and health laws

  • Necessary for workplace medical surveillance

  • Required for employment-related medical determinations

  • Authorized by you or required by law

Uses and Disclosures That Require Your Authorization

Marketing: We will not use or disclose your health information for marketing purposes without your written authorization.
 

Sale of Health Information: We will not sell your health information without your written authorization.


Psychotherapy Notes: We do not maintain psychotherapy notes, but if we did, we would need your authorization to use or disclose them except in very limited circumstances.


Other Uses: Any other use or disclosure of your health information not described in this Notice will be made only with your written authorization. You may revoke your authorization at any time by providing written notice to our Privacy Officer, except to the extent we have already relied on your authorization.

Your Rights Regarding Your Health Information

Right to Inspect and Copy

You have the right to inspect and obtain a copy of your health information that may be used to make decisions about your care. This includes medical and billing records.

How to Request: Submit a written request to our Privacy Officer using our medical records request form.


Response Time: We will respond to your request within 30 days. We may extend this time by 30 days if we notify you in writing of the delay.


Fees: We may charge a reasonable fee for copying, mailing, and supplies associated with your request.


Denial: We may deny your request in certain circumstances. If we deny your request, we will provide you with written reasons for the denial and explain your right to have the denial reviewed.
 

Right to Amend
 

You have the right to request that we amend health information about you that you believe is incorrect or incomplete.


How to Request: Submit a written request to our Privacy Officer and provide the reason for your request.

 

Response: We will respond within 60 days. We may extend this time by 30 days if we notify you in writing.

 

Denial: We may deny your request if the health information:
 

  • Was not created by us

  • Is not part of the medical information kept by us

  • Is not information you would be permitted to inspect and copy

  • Is accurate and complete


Right to an Accounting of Disclosures
 

You have the right to request an accounting of disclosures of your health information made by us for the six years prior to your request.
 

What's Included: The accounting will include:

  • Date of disclosure

  • Name and address of the person or entity who received the information

  • Description of the information disclosed

  • Reason for the disclosure
     

What's Not Included:

  • Disclosures for treatment, payment, and healthcare operations

  • Disclosures authorized by you

  • Disclosures for facility directory or to family members

  • Disclosures for national security or intelligence purposes

  • Disclosures to correctional institutions or law enforcement
     

How to Request: Submit a written request to our Privacy Officer.

Fees: The first accounting in a 12-month period is free. We may charge a reasonable fee for additional accountings.
 

Right to Request Restrictions
 

You have the right to request restrictions on how we use or disclose your health information for treatment, payment, or healthcare operations. You also have the right to request restrictions on disclosures to family members or others involved in your care.
 

How to Request: Submit a written request to our Privacy Officer specifying:
 

  • What information you want to limit

  • Whether you want to limit our use, disclosure, or both

  • To whom you want the limits to apply
     

Our Response: We are not required to agree to your request except in one situation: if you pay out of pocket in full for a healthcare item or service, you can ask us not to share information about that item or service with your health insurer for payment or healthcare operations purposes, and we must honor that request.
 

Right to Request Confidential Communications
 

You have the right to request that we communicate with you about your health information in a certain way or at a certain location.

Examples:
 

  • Requesting that we contact you at work instead of home

  • Asking that we send mail to a different address

  • Requesting that we communicate by phone instead of mail

​

How to Request: Submit a written request to our Privacy Officer. We will accommodate reasonable requests.
 

Right to a Paper Copy of This Notice
 

You have the right to a paper copy of this Notice even if you have received it electronically. You may request a copy at any time.
 

Right to File a Complaint
 

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services.


Filing a Complaint with Us: Contact our Privacy Officer at the address listed below. All complaints must be submitted in writing.
 

Filing a Complaint with HHS: You may file a complaint with the Secretary of the Department of Health and Human Services at:
 

  • Online: www.hhs.gov/ocr/privacy/hipaa/complaints/

  • Mail: Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue S.W., Washington, D.C. 20201

  • Phone: 1-877-696-6775
     

No Retaliation: We will not retaliate against you for filing a complaint.
 

Changes to This Notice
 

We reserve the right to change this Notice at any time. We reserve the right to make the revised or new Notice effective for health information we already have about you as well as any information we receive in the future.
 

How We Will Notify You of Changes:
 

  • We will post the current Notice in our facility

  • We will make the current Notice available on our website

  • We will provide you with a copy of the revised Notice upon your next visit

  • For material changes, we may also notify you by mail or email


Contact Information


Privacy Officer
Secure Draw Medical Services
211 W 19th St Ste 103
Cheyenne, WY 82001
Phone: [Insert Phone Number]
Email: info@securedrawmedical.com


For Medical Records Requests:

Medical Records Department
Secure Draw Medical Services
211 W 19th St Ste 103
Cheyenne, WY 82001
Phone: [Insert Phone Number]
Email: info@securedrawmedical.com


For Complaints or Privacy Questions:
Privacy Officer
Email: info@securedrawmedical.com
Phone: [Insert Phone Number]

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