Infuse Ketamine Lounge
Notice of Privacy Practices (HIPAA)
This Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
1. Our Commitment to Your Privacy
Infuse Ketamine Lounge is committed to protecting the privacy and security of your Protected Health Information (PHI) in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Arizona state law, and applicable professional standards.
2. How We May Use and Disclose Your Health Information
Treatment: We may use and disclose PHI to provide, coordinate, or manage your healthcare, including ketamine infusions, wellness services, and telehealth encounters.
Payment: We may use PHI to bill and collect payment for services, including insurance submissions, self-pay arrangements, and third-party billing.
Healthcare Operations: We may use PHI for quality improvement, training, audits, credentialing, compliance, and business operations.
3. Telehealth Services
Infuse Ketamine Lounge may provide healthcare services via telehealth platforms. Telehealth may include secure video conferencing, electronic communications, patient portals, and remote monitoring technologies.
We take reasonable steps to protect the privacy of telehealth communications; however, electronic communications carry inherent risks. By participating in telehealth services, you acknowledge and accept these risks.
4. Other Permitted Uses and Disclosures
We may disclose PHI as permitted or required by law for public health activities, legal proceedings, law enforcement requests, health oversight activities, and to prevent a serious threat to health or safety.
5. Uses and Disclosures Requiring Authorization
We will not use or disclose PHI for marketing, sale of PHI, or psychotherapy notes without your written authorization. You may revoke authorization in writing at any time.
6. Your Rights
You have the right to access, amend, and receive copies of your health records; request confidential communications; request restrictions; receive an accounting of disclosures; and file a complaint without retaliation.
7. Our Responsibilities
We are required by law to maintain the privacy and security of PHI, provide this notice, notify you of breaches, and follow the terms of this notice.
8. Arizona-Specific Privacy Rights
Arizona law may provide additional privacy protections beyond HIPAA. Where state law provides greater protection, Infuse Ketamine Lounge will comply with Arizona law.
9. Changes to This Notice
We reserve the right to change this Notice. Changes will apply to all PHI we maintain and will be made available upon request.
10. Contact Information
Adrian Esparza, Privacy Officer
Infuse Ketamine Lounge
2158 N. Gilbert Rd.
Mesa, Arizona 85203
480-601-2941
Acknowledgment of Receipt
I acknowledge that I have received the Notice of Privacy Practices for Infuse Ketamine Lounge.