Privacy Notice

Cottonwood Clinical Services, Inc.

Notice of Privacy Practices


  1. Uses and Disclosures of Protected Health Information

Following are examples of the types of uses and disclosures of your protected health care information that the provider is permitted to make.  These examples are not meant to be exhaustive, but to describe the types of uses and disclosures.

Treatment:  With your written consent only, we will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services.  For example, your protected health information may be provided to a doctor to whom you have been referred to ensure that the doctor has the necessary information to diagnose or treat you.

Payment:  Your protected health information will be used, as needed, in activities related to obtaining payment for your health care services.  For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to your health insurance company to obtain approval for the hospital admission.

Business Associates:  We may share your protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services).  Whenever an arrangement between us and a business associate involves the use or disclosure of your protected health information, we will have a written contract from them that contains terms that will protect privacy of your protected health information.

Marketing:  We may use or disclose certain health information in the course of providing you with information about treatment alternatives, and health-related services.  For example, we may mail a brochure about marital enrichment weekend workshops.  You may contact us to request that these materials not be sent to you.

Written Authorization:  Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by Law as described below.  You may revoke this authorization at any time in writing.

Opportunity to Object:  We may use and disclose your protected health information in the following instances.  You have the opportunity to object.  If you are not present or able to object, then your provider may, using professional judgment, determine whether the disclosure is in your best interest.

Others Involved in Your Healthcare:  Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care.

Emergencies: In an emergency treatment situation, your provider shall try to provide you a Notice of Privacy Practices as soon as reasonably practicable after the delivery of treatment.

Communication Barriers:  We may use and disclose your protected health information if your provider attempts to obtain acknowledgment from you of the Notice of Privacy Practices but is unable to do so due to substantial communication barriers and the provider determines, using professional judgment, that you would agree.

Without Opportunity to Object:  we may use or disclose your protected health information in the following situations without your authorized opportunity to object: Health Oversight: to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.  Abuse or Neglect: to an appropriate authority to report child abuse or neglect if we believe that you have been a victim of abuse, neglect or domestic violence.  Food and Drug Administration: as required by the Food and Drug Administration to track products.  Legal Proceedings: in the course of legal proceedings.  Law Enforcement:  for law enforcement purposes, such as pertaining to victims of a crime or to prevent a crime.  Coroner or Funeral Director and Organ Donation:  for the coroner, medical examiner, or funeral director to perform duties authorized by law for organ donation purposes.  Research:  to researchers where their research has been approved by an Institutional Review Board.  Soldiers, Inmates and National Security:  to military supervisors of Armed Forces personnel or to custodians of inmates, as necessary.  Preserving national security may also necessitate sharing protected health information.  Worker’s Compensation:  to comply with worker’s compensation laws.  Compliance:  to the NM Department of Behavioral Health Examiners to investigate our compliance with their regulations.

As Required by Law: In general, we may use or disclose your protected health information as required by law and limited to the relevant requirements of the law.

You May Obtain Your Records: The records by this office are available to you.  It is unlikely that a client would desire to obtain their file.  However, the method for obtaining your file is to submit any type of written request with your name address and signature.


  1. Area describing the rights you have:

Inspect and copy your protected health information:  However, we may refuse to provide access to certain psychotherapy notes or information for a civil or criminal proceeding.

Request a restriction of your protected health information:  You may ask us not to use or disclose certain parts of your protected health information for treatment, payment or healthcare operations.  You may also request that the information not be disclosed to family members or friends who may be involved in your care.  Your request must state the specific restriction requested and to whom you want the restriction to apply.  We are not required to agree to a restriction that you may request, but if we do agree, then we must behave accordingly.

Request to receive confidential communications from us by alternative means or at an alternative location:  We will accommodate reasonable requests.  We may also condition this accommodation by asking you for information as to how payment will be handled or specification as to the basis for the request.

Ask your provider to amend your protected health information:  You may request an amendment of protected health information about you.  If we deny your request for amendment you have the right to file a statement of disagreement with us, and your medical record will note the disputed information.

Receive an accounting of certain disclosures we may have made:  This right applies to disclosures for purposes other than treatment, payment or healthcare operations.  It excludes disclosures we may have made to you, for facility director, to family members or friends involved in your care, or for notification purposes.  You have the right to receive specific information regarding these disclosures.  The right to receive this information is subject to certain exceptions, restrictions and limitations

Obtain a paper copy of this notice from us:  upon request, even if you have agreed to accept this notice electronically.