Clinica's Notice of Privacy Practices

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.


Each time you visit our community health center, a record of your visit is created. This record usually contains your name and other information that may identify you, your symptoms, examination and test results, diagnoses, treatment, plan for future health care, and financial information. This record is sometimes referred to as your “medical record” or “medical chart.” This record allows:

  • Doctors, nurses, and other health professionals to plan your treatment;
  • Our community health center to obtain payment for services we provide to you, such as from health plans, Medicaid, or you; and
  • Our community health center to measure the quality of care provided to you.

As we have in the past, we are committed to keeping your health information confidential. We will not use or give to others your health information without your written permission, except as stated in this Notice.



We will use and give out your health information to provide you with health care treatments, to get paid for our services, and to help us operate our community health center. For example:

  • We will give your health information to health care professionals not on our staff, such as other doctors and hospital staff, who help care for you. This information may be shared via fax, paper or electronic formats.
  • Clinica Family Health endorses, supports, and participates in an electronic Health Information Exchange (HIE) as a means to improve the quality of your health and healthcare experience. The Colorado Regional Health Information Organization (CORHIO) HIE provides us with a way to securely and efficiently share patients’ clinical information electronically with other physicians and health care providers that participate in the HIE network. Using HIE helps your health care providers to more effectively share information and provide you with better care. The HIE also enables emergency medical personnel and other providers who are treating you to have immediate access to your medical data that may be critical for your care. Making your health information available to your health care providers through the HIE can also help reduce your costs by eliminating unnecessary duplication of tests and procedures. However, you may choose to opt-out of participation in the CORHIO HIE, or cancel an opt-out choice, at any time. To opt-out of the CORHIO HIE, please request the necessary paperwork from a front desk employee at any of our clinics.

  • The Colorado Immunization Information System (CIIS) is a confidential, computerized, population-based system that collects and consolidates immunization data for Coloradans of all ages from a variety of sources and provides tools for designing and sustaining effective immunization strategies to prevent disease and reduce healthcare costs. Clinica Family Health participates in CIIS so that we are able to see the vaccines that you/your child received in the past as well as any vaccines recommended for you/your child at the time of the visit. Clinica Family Health can print immunization forms needed for child care, school and camp enrollment directory from the secure CIIS web application. However, you may choose to opt-out of participation in CIIS, or cancel an opt-out choice, at any time. To opt-out of CIIS, please request the necessary paperwork from a front desk employee at any of our clinics.
  • We have formed an organized health care arrangement (OHCA) with Mental Health Partners and Dental Aid to better address your health care needs. The OHCA members will use your health information in an integrated care setting where you may receive health care services from more than one provider. The OHCA members will work together in utilization review, quality activities, and/or payment activities.
  • We may send a bill to your health insurance plan or to you; and
  • Our community health center may use your medical record to review our performance and make sure you receive quality health care.


We may use or give out your health information for the following purposes under limited circumstances:

  • To people who are involved in your care or who help pay for your care, such as your family, your close personal friends, or any other person chosen by you, to notify them of your location, general health, and to assist you in your health care (such as to pick-up medicine or help with follow-up care);
  • To government agencies that oversee our community health center (such as license and certification inspectors);
  • To government agencies that have the right to receive and collect health information (such as to control disease outbreaks);
  • When we are ordered by a court or judge;
  • To workers’ compensation programs when your health problem is from a work-related injury;
  • When law enforcement requests information (such as to prevent danger or injury);
  • To coroners and funeral directors to allow them to carry out their duties;
  • To organ donor agencies (subject to applicable laws);
  • To avoid a serious threat to the health or safety of others;
  • To contact you about new treatments or medicines that may help you.
  • For the purpose of research, only under limited circumstances.
  • To business associates of the community health center that help us perform required tasks, such as our accountants, computer consultants, and billing companies (only if the business associate agrees in writing to keep your health information confidential as required by law); and
  • For any other purpose required or allowed by law.


Except as stated above, we will use or give out your health information only after getting your written permission on an Authorization form. You may revoke your authorization at any time by notifying us in writing that you wish to do so.

    • Psychotherapy Notes – Although we do not anticipate maintaining your psychotherapy notes, in the extent that we do maintain such psychotherapy notes, use and disclosures of such notes, with limited exception.
    • Marketing – Uses and disclosures of your protected health information for marketing purposes.
    • Sale of Protected Health Information – Any disclosure of your protected health information that would result in remuneration to us. Such disclosures will be made only in accordance with your authorization.


Subject to certain legal limits, you have rights regarding the use and disclosure of your health information, including the rights to:

  • Request limits on uses of your health information
  • Receive confidential communications of your health information
  • Inspect and copy your health information
  • Request a change to your health information
  • Receive a record of how we have used and given out your health information
  • Obtain a copy of this Notice of Privacy Practices
  • Right to Receive an Electronic Copy or your Electronic Protected Health Information - If you request an electronic copy of your protected health information (including electronically linked information) that we maintain in an electronic designated record set, you have the right to be provided with access to that electronic information in the form or format that you request, if it is readily producible by us in the requested form or format. If the electronic information is not readily producible in your requested form or format, we will provide the electronic information in a form or format to which we agree. If you reject the form or format of electronic information that we are able to produce, we will provide a hard copy of the information to you. If we maintain your information in mixed media format (electronic and hard copies), we will provide you with a copy of your information in that same mixed media format. If you request that we provide your electronic information in an unencrypted format (e.g. unsecure email), we will require your agreement to the risks of such transmission. If you so request, we will transmit your electronic information to a third party designated by you. A fee will be charged for the costs of providing copies of your medical record.
  • Right to Receive Notice of Breach - You have the right to receive notice from us of a breach of your unsecured protected health information.
  • If you are deceased, we may disclose information after your death to your next of kin.
  • Right to Request Restrictions - You have the right to request a restriction or limitation of the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a clinic visit you had. We are required to agree to your request only if 1) except as otherwise required by law, the disclosure is to your health plan and the purpose is related to payment or health care operations (and not treatment purposes), and 2) your information pertains solely to health care services for which you have paid in full, out of pocket. However, we are not required to comply with your request if your payment is not honored, or for other services that may be related to or in follow up to the services for which you have paid in full, if you did not also pay for these additional services in full. For other requests, we are not required to agree. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to the clinic’s Privacy Officer. In your request, you must tell us: (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
  • Fundraising Activities - We may use medical information about you to contact you in an effort to raise money for the clinic and its operations. We may disclose medical information to the “Clinica Family Health Foundation” so that the Foundation may contact you in raising money for the clinic. Some of the information we may release for fundraising purposes includes contact information (such as your name, address and phone number) the dates you received treatment or services at the clinic, your health insurance information, and outcome information. If you are contacted in our fundraising efforts, you will have the opportunity to opt out of receiving further fundraising communications from us; we will provide information regarding opting out of such communications in any written fundraising communication sent to you, as well as in verbal communications we have with you, if any.
  • Health Plans or Health Insurer’s may not use or disclose genetic information for underwriting purposes. There is an exception for underwriting performed by issuers of long-term care policies.


If you have any questions or want to talk about any of the information in this Notice of Privacy Practices, please contact the HIPAA Privacy Officer at 1345 Plaza Court N. Suite 1A, Lafayette, CO. (303) 650-4460.

If you believe your privacy rights have been violated, you may file a complaint with our community health center or with the Secretary of the Department of Health and Human Services. To file a complaint with our community health center, submit it to the HIPAA Privacy Officer at 1345 Plaza Court N. Suite 1A, Lafayette, CO 80026. All complaints must be submitted in writing. We will not retaliate against you for filing a complaint.

We may change our Notice of Privacy Practices in the future. Such changes will apply to your health information that we created or received before the effective date of the change. We will notify you of any changes to our Notice of Privacy Practices by posting the changed notice at our community health center. In addition, at any time you visit the clinic, you may request a copy of the most recent privacy notice, and it will be provided to you.