Notice of Privacy Practices
Rights and Responsibilities of the Patient and Organization and Notice of Privacy Practices.
PLEASE READ IT CAREFULLY
This notice describes how your health information may be used and disclosed, and how you can access this information.
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
You have the right to be treated fairly and respectfully, recognizing your dignity and respect.
You have the right to receive information in a non-discriminatory manner.
You have the right to have a desirability and right to receive information in an alternative way set forth in the Americans with Disabilities Act.
Patients and their legal guardians have the right to receive information to consent to services.
Patients and their legal guardians have the right to select a third party who can participate in making decisions.
Get an electronic or paper copy of your medical records
1. You can ask to be shown or given an electronic or paper copy of your medical records and other medical information we have about you. Ask us how to do it.
2. We will give you a copy or summary of your medical information, usually within 30 days of your request. We may charge a reasonable fee based on cost.
Ask us to correct your medical records
1. You can ask us to correct medical information about you that you think is incorrect or incomplete. Ask us how to do it.
2. We may say “no” to your request, but we will give you a reason in writing within 60 days.
Request Confidential Communications
1. You can ask us to contact you in a specific way (e.g., by home or work phone) or to send correspondence to a different address.
2. We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
1. You can ask us not to use or share certain health information for treatment, payment, or for our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
2. If you pay for a health care service or item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our dealings with your health insurer. We will say “yes” unless a law requires us to share such information.
Receive a list of those with whom we have shared information
3. You can request a list (report) of the times we have shared your health information during the six years prior to the date of your request, with whom we have shared it, and why.
4. We will include all disclosures except those about treatment, payment, and health care operations, and certain other disclosures (such as any disclosures you have asked us to make). We will provide you with one free report per year but charge a reasonable fee based on cost if you request another one within 12 months.
Obtain a copy of this Privacy Notice
You may request a paper copy of this notice at any time, even if you agreed to receive the notice electronically. We will provide you with a paper copy right away.
Choosing someone to act on your behalf
1. If you have given someone medical representation or if someone is your legal guardian, that person can exercise your rights and make decisions about your health information.
2. We will make sure that the person has this authority and can act on your behalf before taking any action.
File a complaint if you think your rights have been violated.
1. To file your complaint if you think your rights have been violated, please contact us at: www.lcdfnm.org
2. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to: 200 Independence Avenue, S.W., Washington, D.C. 20201, Tel: 1-877-696-6775, or by visiting the website: http://www.hhs.gov/ocr/privacy/hipaa/complaints
3. There will be no retaliation from us if you file a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, please contact us.
Tell us what you want us to do, and we’ll follow your instructions.
In these cases, you have both the right and the option to ask us to:
1. Share information with your family, close friends, or others involved in your care. • Let’s share information in a situation of relief in the event of a una catástrofe.
1. Include your information in a hospital directory.
If you are unable to tell us your preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is for your own benefit. We may also share your information when necessary to reduce a serious and imminent threat to health or safety.
In these cases, we will never share your information unless you give us written permission:
1. Marketing Purposes.
2. Sale of Your Information.
3. Most cases in which psychotherapy notes are shared.
In the case of fundraising:
We may contact you about fundraising, but you can ask us not to contact you again.
Your Responsibilities
1. Treat the employees of La Clinica de Familia, Inc. with dignity and respect.
2. Respect the facilities and property of La Clinica de Familia, Inc.
3. Patients are not permitted to demonstrate aggressive behavior such as obscene or abusive language, sexual language toward others, threats, physical assault, or bringing weapons of any kind into our facility.
Use of Your Information and Disclosure
How do we generally use or share your health information? We generally use or share your health information in the following ways.
Treatment
We may use your health information and share it with other professionals who are treating you.
Example: A doctor who is treating you for an injury consults another doctor about your general health.
Lead our organization
We may use and disclose your information to conduct our practice, improve your care, and communicate with you when necessary.
Example: We use medical information about you
to administer your treatment and
services.
Invoice for your services
We may use and share your information to bill and obtain payment from health plans and other entities.
Example: We give information about you to your health insurance plan so that it pays for your services.
How else may we use or share your health information?
We are permitted or required to share your information in other ways (usually in ways that contribute to the public good, such as public health and medical research). We have to meet many legal conditions before we can share your information for such purposes. For more information, please visit: www.hhs.gov/ocr/privacy/hipaa/
understanding/consumers/index.html.
Assist with public health and safety issues
1. We may share your health information in certain situations, such as:
2. Disease prevention.
3. Help with product recalls.
4. Report of adverse drug reactions.
5. Report suspected abuse, neglect, or domestic violence.
6. Preventing or reducing a serious threat to someone’s health or safety.
Conduct medical research
We may use or share your information for health research.
Comply with the law
We may share your information if required by federal or state law, including sharing the information with the Department of Health and Human Services if it wants to verify that we comply with the Federal Privacy Act.
Respond to requests for organ and tissue donation
We may share your health information with organ procurement organizations.
Work with a medical examiner or funeral director
We may share medical information with a coroner’s investigation officer, medical examiner, or funeral director when an individual passes away.
Dealing with workers’ compensation, law enforcement, and other government requests
We may use or share your health information:
1. In workers’ compensation claims.
2. For the purposes of law enforcement or law enforcement personnel. • With health oversight agencies for activities autorizadas por ley.
1. In the case of special government functions, such as servicios de
presidential protection, national security, and military services.
Respond to lawsuits and legal actions
We may share your health information in response to an administrative or court order or in response to a subpoena.
Reproductive Rights
We are dedicated to safeguarding your reproductive health information, including details about family planning, contraception and other related services that are lawful where provided.
• For example, we will not disclose your PHI to law enforcement investigating a patient for seeking an abortion that is lawful in the State of New Mexico
• If a court orders the release of reproductive health information, we require an attestation that the request is not for a prohibited reason and only disclose the specific PHI allowed by the order.
Substance Use and Disorder Services
• For more detailed information on how we protect your information, please review the Notice of Privacy Practices Part 2 SUDS Program located on our website
Our Responsibilities
1. We are required by law to maintain the privacy and security of your protected health information.
2. We will let you know immediately if a breach occurs that may have compromised the privacy or security of your information.
3. We must follow the privacy duties and practices described in this notice and provide you with a copy of this notice.
4. We will not use or share your information other than as described here, unless you tell us in writing that we can do so. If you tell us we can, you can change your mind at any time. Let us know in writing if you change your mind.
For more information, see: www.hhs.gov/ocr/privacy/hipaa/
understanding/consumers/noticepp.html
Changes to the Terms of This Notice
We may change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.
For more information about this notice and its contents, please contact us:
LA CLINICA DE FAMILIA, INC.
Administrative Office
385 Calle de Alegra, Building A Las Cruces, NM 88005
Karen Dawson, Director of Quality & Risk Mgmt.
Telephone: (575) 526-1105
FAX: (575) 524-4266
Email: Karen.dawson@lcdfnm.org
Treat Everyone with Respect
La Clinica de Familia, Inc. is committed to the physical, mental, and emotional well-being of our patients, staff, and visitors. Individuals who demonstrate aggressive or dangerous behavior will be removed or expelled from our premises and may be reported to the authorities.
Patient Signature: ____________________________________
Patient Name: _______________________________________
Name of Guardian: ____________________________________
Date: _______________________________________________
LCDF Witness: _ _______________________________________
Effective Date of this Notice
February 15, 2026