Notice of Privacy Practices

1. Treatment

We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. This includes sharing information with other providers involved in your care — such as your referring physician, primary care provider, OB/GYN, or psychiatrist — when relevant to your treatment.

2. Payment

We may use and disclose your PHI to obtain payment for services rendered, including submitting claims to insurance companies and processing prior authorization requests (particularly relevant for Spravato / esketamine, which is billed as a covered pharmaceutical benefit).

3. Healthcare Operations

We may use your PHI for internal operations, including quality improvement activities, staff training, compliance audits, and business management.

4. As Required by Law

We will disclose PHI when required by federal, state, or local law, including mandatory public health reporting, reporting of abuse or neglect, and compliance with court orders or subpoenas.

5. Serious Threats to Health or Safety

We may disclose PHI to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, consistent with applicable law and professional ethical standards.

6. To Business Associates

We may share PHI with third-party vendors ("business associates") who perform services on our behalf, such as our electronic health record and scheduling platform. These parties are contractually required to protect your PHI in accordance with HIPAA.

7. Uses Requiring Your Written Authorization

Any use or disclosure of your PHI not described in this Notice — including most marketing uses and sale of PHI — requires your written authorization. You may revoke an authorization at any time in writing; revocation does not apply to actions already taken in reliance on the authorization.

Right to Access Your PHI

You have the right to inspect and obtain a copy of your medical records held by Innerbloom Medical. Requests must be submitted in writing. We will respond within 30 days. We may charge a reasonable, cost-based fee for copies.

Right to Request an Amendment

If you believe information in your record is inaccurate or incomplete, you may request an amendment in writing. We may deny a request if the record was not created by us, is not part of our designated record set, or is accurate and complete.

Right to an Accounting of Disclosures

You may request a list of certain disclosures we have made of your PHI during the prior six years. This right does not apply to disclosures for treatment, payment, or operations, or disclosures you authorized. The first accounting in any 12-month period is free.

Right to Request Restrictions

You may request that we limit how we use or disclose your PHI for treatment, payment, or operations. We are not required to agree to all requests. We are required to agree to a request to restrict disclosures to a health plan if the PHI pertains solely to a service you paid for entirely out of pocket.

Right to Request Confidential Communications

You may request that we communicate with you through alternative means or at an alternative location (for example, contact you only by email, or only at a specific phone number). We will accommodate all reasonable requests. We will not ask you to explain the reason for the request.

Right to Receive a Paper Copy of This Notice

You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically. Contact us at the address or phone number below.

Right to Be Notified Following a Breach

You have the right to receive notice in the event of a breach of your unsecured PHI, as required by the HIPAA Breach Notification Rule (45 CFR Part 164, Subpart D).

File with Innerbloom Medical:

Attn: Privacy Officer
4388 N. Civic Center Plaza, Suite #101
Scottsdale, AZ 85251
Phone: (623) 343-3466

File with the U.S. Department of Health and Human Services:

Office for Civil Rights, U.S. Department of Health and Human Services
200 Independence Avenue, S.W., Washington, D.C. 20201
Toll-free: 1-877-696-6775
www.hhs.gov/ocr/privacy