Your Information. Your Rights. Our Responsibilities. 

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. This notice is effective as of June 9th, 2026. 

Your Rights 

You have the right to: 

• Get a copy of your paper or electronic medical record 

• Correct your paper or electronic medical record 

• Request confidential communication 

• Ask us to limit the information we share 

• Get a list of those with whom we’ve shared your information 

• Get a copy of this privacy notice 

• Choose someone to act for you 

• File a complaint if you believe your privacy rights have been violated.

Your Choices 

You have some choices in the way that we use and share information as we:  

• Tell family and friends about your condition 

• Provide mental health care 

• Inform you of our scheduling and services 

Our Uses and Disclosures 

We may use and share your information as we:  

• Treat you 

• Run our organization 

• Bill for your services 

• Do research 

• Comply with the law 

• Address workers’ compensation, law enforcement, and other government 

requests 

• Respond to lawsuits and legal actions 

To the extent that we have your substance use disorder patient records, subject to 42 CFR 

part 2, we will not share that information for investigations or legal proceedings against 

you without (1) your written consent or (2) a court order and a subpoena. 

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. 

Get an electronic or paper copy of your medical record 

• You can ask to see or get an electronic or paper copy of your medical record and other health 

information we have about you. Ask us how to do this.  

• We will provide a copy or a summary of your health information, usually within 30 days of your 

request. We may charge a reasonable, cost-based fee. 

Ask us to correct your medical record 

• You can ask us to correct health information about you that you think is incorrect or 

incomplete. Ask us how to do this. 

• We may say “no” to your request, but we’ll tell you why in writing within 60 days. 

Request confidential communications 

• You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to 

send mail to a different address.  

Ask us to limit what we use or share 

• You can ask us not to use or share certain health information for treatment, payment, or our 

operations. We are not required to agree to your request, and we may say “no,” for example, if 

it could affect your care. If we agree to your request, we may still share this information in the 

event that you need emergency treatment. 

• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that 

information for the purpose of payment or our operations with your health insurer. We will say 

“yes” unless a law requires us to share that information. 

Get a list of those with whom we’ve shared information 

• You can ask for a list (accounting) of the times we’ve shared your health information for six 

years prior to the date you ask, who we shared it with, and why. 

• We will include all the disclosures except for those about treatment, payment, and health care 

operations, and certain other disclosures (such as any you asked us to make). We’ll provide one 

accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one 

within 12 months. 

Get a copy of this privacy notice 

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice 

electronically. We will provide you with a paper copy promptly. 

Choose someone to act for you 

• If someone has authority to act as your personal representative, such as if someone has your 

medical power of attorney or if someone is your legal guardian, that person can exercise your 

rights and make choices about your health information. 

• We will make sure the person has this authority and can act for you before we take any action. 

File a complaint if you feel your rights are violated 

• You can complain if you feel we have violated your rights by contacting us using the information 

on page 1. 

• 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, calling 1

877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html. 

• We will not retaliate against you for filing 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, report this on your 

intake paperwork and or talk to us. Tell us what you want us to do, and we will follow your instructions. 

In these cases, you have both the right and choice to tell us to: 

• Share information with your family, close friends, or others involved in your care or payment for 

your care 

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead 

and share your information if we believe it is in your best interest. We may also share your 

information when needed to lessen a serious and imminent threat to health or safety. 

In these cases we never share your information unless you give us written permission: 

• Marketing purposes including photos & testimonies. 

• Most sharing of psychotherapy notes 

If we have your substance use disorder patient records, subject to 42 CFR part 2, we will give you clear 

and obvious notice in advance and a choice about whether to receive fundraising communications that 

use your Part 2 information. 

Our Uses and Disclosures 

How do we typically use or share your health information? 

We typically use or share your health information in the following ways. 

Treat you 

We can use your health information and share it with other professionals who are treating you. 

Example: A doctor treating you for an injury asks another doctor about your overall health condition. 

Run our organization 

We can use and share your health information to run our practice, improve your care, and contact 

you when necessary. 

Example: We use health information about you to manage your treatment and services. 

Bill for your services 

We can use and share your health information to bill and get payment from health plans or other 

entities. 

Example: We give information about you to your health insurance plan so it will pay for your 

services. 

How else can we use or share your health information? 

We are allowed or required to share your information in other ways – usually in ways that 

contribute to the public good, such as public health and research. We have to meet many conditions 

in the law before we can share your information for these purposes. 

In all cases, including those listed below, if we have substance use disorder patient records about 

you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, 

administrative, or legislative investigations or proceedings against you without (1) your consent or 

(2) a court order and a subpoena. 

Help with public health and safety issues 

We can share health information about you for certain situations such as: 

• Preventing disease 

• Helping with product recalls 

• Reporting adverse reactions to medications 

• Reporting suspected abuse, neglect, or domestic violence 

• Preventing or reducing a serious threat to anyone’s health or safety 

Do research 

We can use or share your information for health research. 

Comply with the law 

We will share information about you if state or federal laws require it, including with the 

Department of Health and Human Services if it wants to see that we’re complying with federal 

privacy law. 

Work with a medical examiner or funeral director 

We can share health information with a coroner, medical examiner, or funeral director when an 

individual dies.  

Address workers’ compensation, law enforcement, and other government requests 

We can use or share health information about you: 

• For workers’ compensation claims 

• For law enforcement purposes or with a law enforcement official  

• With health oversight agencies for activities authorized by law 

• For special government functions such as military, national security, and presidential protective 

services 

Respond to lawsuits and legal actions 

• We can share health information about you in response to a court or administrative order, or in 

response to a subpoena.  

Our Responsibilities 

• We are required by law to maintain the privacy and security of your protected health 

information. 

• We will let you know promptly if a breach occurs that may have compromised the privacy or 

security of your information. 

• We must follow the duties and privacy practices described in this notice and give you a copy of 

it. 

• We will not use or share your information other than as described in this notice unless you tell 

us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in 

writing if you change your mind. 

SMS Communications and Mobile Privacy / Terms and Conditions 

By providing your mobile phone number you are opting in to receive text messages from 3D Integrated 

Medical. You consent to receive SMS communications related to our services, including appointment 

reminders, account notifications, customer support messages, and other service-related 

communications. 

Personal health information (PHI) will not be communicated via SMS.  

Consent to Receive Text Messages 

Your consent to receive text messages is not a condition of purchase. Message frequency may vary. By 

providing your number to the office you are choosing to opt in to SMS messages. Standard message and 

data rates may apply depending on your mobile carrier and service plan. 

Opt-Out Instructions 

You may opt out of receiving SMS messages at any time by replying STOP to any text message. After 

opting out, you will receive a confirmation message and will no longer receive SMS communications 

from us unless you opt in again. 

For assistance, reply HELP to any message or contact our office directly via phone at 480-456-3703 or via 

email at admin@3dintegratedmedical.com 

Use of Mobile Information 

3D Integrated Medical uses your mobile phone number and SMS consent information solely for the 

purpose of delivering requested communications and providing our services. We implement reasonable 

safeguards to protect your information from unauthorized access, disclosure, or misuse.  

No Sharing of Mobile Opt-In Data 

No mobile opt-in data, text messaging originator opt-in data, consent records, or mobile phone 

numbers collected for SMS communications will be shared, sold, rented, or disclosed to third parties 

or affiliates for marketing or promotional purposes. 

Information may be shared only with service providers that assist 3D Integrated Medical in delivering 

SMS messages and operating our business, and solely for the purpose of providing those services. Such 

service providers are prohibited from using your information for their own marketing purposes. 

Data Retention 

We may retain SMS consent records and related communication information for as long as necessary to 

comply with applicable legal requirements, resolve disputes, enforce agreements, and maintain business 

records. 

Contact Information 

If you have questions regarding this Privacy Policy or our SMS communications practices, please contact 

the office via phone at 480-456-3703 or via email at admin@3dintegratedmedical.com