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Notice of Privacy Practices

Effective September 23, 2026


This Notice describes how medical information about you may be used or disclosed and how you can get access to this information. Please review it carefully.
 

Our Responsibility


Maverick Sports Medicine, Inc. ("Practice", "We", or "Us";) is committed to protecting the privacy of your medical information. Your care and treatment are recorded in a medical record that is considered protected health information ("PHI").


Our privacy obligations:

 

  • We are required by law to maintain the privacy and security of your PHI.

  • 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 PHI in ways other than as described here unless you tell us we can. If you tell us we can, you may change your mind at any time.

 

How We Use and Share Your Information

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  • We typically use and share your PHI for your treatment — including sharing it within our offices and with the professionals who are treating you. 

  • We also use your PHI for running our Practice: billing for our services and getting payment from health plans and other entities, improving your care, and contacting you.

  • We will share your PHI if state or federal law requires it, including with the Department of Health and Human Services if it wants to review our compliance with federal privacy laws.

  • We will share your PHI to address workers's compensation, law enforcement, health oversight agencies, and special government functions such as military, national security, and presidential protective services.

  • We will share your PHI in response to a court or administrative order, or in response to a subpoena.

  • We will never share your information for marketing or sales purposes unless you provide us with written permission to do so.

  • 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 proceedings against you without your written consent or a court order, following notice and an opportunity for you to be heard.

  • If we have psychotherapy notes or behavioral health records, we cannot use or share information in those records without your specific consent or a court order.

  • Any other use or disclosure not described in this Notice will be made only with your authorization, which you may revoke in writing at any time, to the extent we have not already acted in reliance on it.

  • Information disclosed under this Notice may be subject to redisclosure by the recipient and may no longer be protected by the HIPAA Privacy Rule, unless another law applies.

 

Your Rights


When it comes to your medical record, you have the right to:

 

  • Get a copy. Request an electronic or paper copy of your medical record by submitting a Medical Record Authorization form. We will provide it within the timeframe permitted under state law.

  • Ask for corrections. Request that we correct information you believe is incorrect or incomplete. We'll let you know within 60 days whether the change has been made.

  • Opt out of the Health Information Exchange. You may opt out of having your records shared with the statewide Health Information Exchange.

  • Choose how we contact you. Ask us to contact you in a specific way (home, office, or cell phone) or send mail to a different address.

  • Request restrictions. Ask us not to use or share certain information for treatment, payment, or operations. We are not required to agree if your provider determines it would negatively affect your care, but we will honor your request otherwise unless the law requires disclosure. 

  • Get a list of disclosures. Request an accounting of the times we've shared your health information, with whom, and why (excluding treatment, payment, and operations disclosures).

  • Get a paper copy of this notice, at any time, even if you've agreed to receive it electronically.

  • Choose your communication method, including email or phone call.

  • Name a representative. If you've given someone medical power of attorney, or if someone is your legal guardian, that person can exercise these rights on your behalf once we've confirmed their authority.

  • Involve others in your care. Tell us how you'd like us to share information with family, a close friend, or another person involved in your care, or in a disaster relief situation — we will follow your instructions. If you're unable to tell us your preference (for example, if you're unconscious), we may share information if we believe it's in your best interest, or when needed to lessen a serious or imminent threat to your health or safety.

 

Questions, Concerns, or Complaints


If you have questions about this notice, want to exercise your rights, or feel your privacy
rights have not been respected, contact:


Jarrod Harrall, DO
(719) 230-0258


You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights:
Mail: 200 Independence Avenue S.W., Washington, D.C. 20201
Web: www.hhs.gov/ocr/privacy/hipaa/complaint.html
Phone: 1-877-696-8775


You will not be retaliated against for filing a complaint.

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