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928 756 7987
This notice describes how medical information about you may be used and disclosed by Amber Bahm Family Practice PLLC and how you can get access to this information. Please review this document carefully.
The following is a brief summary of your rights. A more detailed description of each right is also included in this document.
You have some choices in the way that Amber Bahm Family Practice PLLC uses and shares information as we:
Amber Bahm Family Practice PLLC may use and share your information as we:
Amber Bahm Family Practice PLLC may use, process, and disclose your medical information in accordance with U.S. law. U.S. federal and state laws require Amber Bahm Family Practice PLLC to protect your medical information and federal law requires us to describe to you how we handle that information. When federal and state privacy laws are different and conflict, and the state law is more protective of your information or provides you with greater access to your information, then we will follow state law. For example, where we have identified specific state law requirements in this notice, the referenced Amber Bahm Family Practice PLLC location will follow the more protective state law requirements.
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. 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.
You can ask us to correct health information about you that you think is incorrect or incomplete. We may say "no" to your request, but we will tell you why in writing within 60 days.
You can ask us to contact you in a specific way or to send mail to a different address. We will say "yes" to all reasonable requests.
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, except when you pay out-of-pocket in full.
You can ask for a list (accounting) of the times we have shared your health information for six years prior to the date you ask. We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
You can ask for a paper copy of this notice at any time.
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights.
You can complain by contacting us or file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you.
We may contact you about your healthcare using the phone numbers and email addresses that you provide us. You will be given the opportunity to opt out of receiving similar communications going forward. If you do not wish to receive these types of text or email messages, please let us know.
We typically use or share your health information to treat you and coordinate your care, run our organization, and bill for your services.
We are also allowed or required to share your information for public health and safety issues, research, to comply with the law, organ donation, medical examiner/funeral director needs, workers’ compensation, law enforcement, and legal actions.
Amber Bahm Family Practice PLLC can change the terms of this notice. The new notice will be available upon request, in our office, and on our website at www.bahmfamilypractice.com.
This notice applies to Amber Bahm Family Practice PLLC at 203 S Candy Lane Suite 9B, Cottonwood, AZ 86326.
Special federal protections apply to substance use disorder records. Generally, such information cannot be disclosed without written patient consent, court order, or in a medical emergency.
Certain information (mental health, HIV/AIDS, genetic testing) may have additional protections under state law.
If you want to file a complaint, express concerns, or inquire further, please contact us at (928) 756-7987 or amber@bahmfamilypractice.com.
Effective Date: July 1, 2026
Amber Bahm Family Practice PLLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, creed, religion, gender, marital status, sex stereotypes, sex characteristics, sexual orientation, gender identity or expression, veteran status, status with regard to public assistance, national origin, disability, or age.
We provide free aids/services for disabilities and language services. Contact the front desk if you need assistance.
To file a grievance: Livy Madrid, Practice Manager at livy@bahmfamilypractice.com or mail to Amber Bahm Family Practice PLLC, PO BOX 1175, Cottonwood, AZ 86326.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.