To our Patients:

This notice describes how health information about you, as a patient of this practice, may be used and disclosed, and how you can get access to your Health Insurance portability and Accountability Act of 1996 (HIPAA).

Our Commitment to your privacy

Our practice is dedicated to maintaining the privacy of your health information.  We are required by law to maintain the confidentiality of your health information.

We realize that these laws are complicated, but we must provide you with the following important information:
Use and disclosure or your health information in certain special circumstances.

The following circumstances may require us to use or disclose your health information:

Your rights regarding your health information

1. Communications.  You can request that our practice communicate with you about your health and related issues in a particular manner or at a certain location.  For instance, you may ask that we contact you at home, rather than work.  We will accommodate reasonable requests.
2. You can request a restriction in our use of disclosure of your health information for the treatment, payment, or health care operations.  Additionally, you have the right to request that we restrict our disclosure of your health information to only certain individuals involved in your care such as family members and friends.  We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.
3. You have the right to inspect and obtain a copy of the health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes.  You must submit your request in writing and submit it to Boojum Obstetrics & Gynecology, David N Kells, M.D. at 655 South Dobson Rd. Suite 101 Chandler, Arizona 85224..
4. You may ask us to amend your health information if you believe it is incorrect or incomplete, and as long as the information is kept by or for our practice.  To request an amendment, you request must be made in writing and submitted to Boojum Obstetrics & Gynecology, David N Kells, M.D. at 655 South Dobson Rd. Suite 101 Chandler, Arizona 85224.  You must provide us with a reason that supports your request for amendment.
5. Right to a copy of this notice.  You are entitled to receive a copy of this Notice of Privacy Practices.  You may ask us to give you a copy of this Notice at any time.  To obtain a copy of this notice, contact our office at Boojum Obstetrics & Gynecology, David N Kells, M.D. at 655 South Dobson Rd. Suite 101 Chandler, Arizona 85224 (tel. (480)855-5900).
6. Right to file a complaint.  If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services.  To file a complaint with our practice, contact the office of David N Kells, MD at (480)855-5900.  All complaints must be submitted in writing.  You will not be penalized for filing a complaint.
7. Right to provide an authorization for other uses and disclosures.  Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.

If you have any questions regarding this notice or our health information privacy policies, please contact Boojum Obstetrics & Gynecology, David N Kells, M.D. at 655 South Dobson Rd. Suite 101 Chandler, Arizona 85224 (tel. (480)855-5900).