HIPPA Notice

Updated: 01/21/2026

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.

Who We Are

This Notice applies to all Iowa Ketamine Clinic locations (1701 48th St., Suite 260, West Des Moines, IA 50266 and 1960 SW Magazine Road, Ankeny, IA, 50023). The notice also applies to all health care professionals, employees, staff, and business associates who provide services on our behalf.

Our Pledge Regarding Your Health Information

We understand that medical information about you and your health is personal. We are committed to protecting the privacy of your protected health information ("PHI"). We are required by law to:

  • Maintain the privacy of your PHI
  • Give you this notice of our legal duties and privacy practices
  • Follow the terms of the notice currently in effect

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 communications
  • Ask us to limit the information we share
  • Get a list of those with whom we've shared your PHI
  • 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

Our Uses and Disclosures

We may use or share your PHI for:

  • Treatment — Provide and coordinate your health care (e.g., SPRAVATO/esketamine administration, consultations, referrals)
  • Payment — Bill and collect for services (e.g., insurance claims, eligibility verification)
  • Health Care Operations — Run our practice, improve quality, conduct training, comply with accreditation

Other Allowed Uses and Disclosures (without your authorization)

We may use or disclose your PHI without your written permission for:

  • Public health activities (e.g., reporting adverse events for SPRAVATO under REMS)
  • Health oversight activities (e.g., audits by government agencies)
  • Judicial and administrative proceedings
  • Law enforcement purposes (as required by law)
  • To avert a serious threat to health or safety
  • Specialized government functions (e.g., military, national security)
  • Workers' compensation
  • Research (under strict protections)
  • To coroners, medical examiners, funeral directors
  • Organ/tissue donation
  • As otherwise required by law

Uses and Disclosures Requiring Your Authorization

We will obtain your written authorization before using or disclosing your PHI for purposes not listed above, such as:

  • Most marketing communications
  • Sale of your PHI
  • Psychotherapy notes (separate, heightened protection if we maintain them)

You may revoke authorization in writing at any time (except for actions already taken in reliance).

Additional Uses and Disclosures

  • Appointment Reminders, Treatment Alternatives, Health-Related Benefits — We may contact you to remind you of appointments, provide refill reminders, or tell you about treatment options or health-related benefits/services.
  • Fundraising — We may use limited contact information for fundraising communications (you can opt out).
  • Family/Friends — We may share PHI with family members or others involved in your care if it is in your best interest (you can object).

Your Rights (Detailed)

  • Right to Inspect and Copy — You may inspect or get a copy of your PHI (we may charge reasonable fees). We may deny access in limited cases (e.g., psychotherapy notes, certain compiled data).
  • Right to Amend — Request corrections if PHI is inaccurate or incomplete.
  • Right to an Accounting — Get a list of disclosures (for 6 years prior; certain exceptions apply).
  • Right to Request Restrictions — Ask us not to use/disclose PHI for treatment/payment/operations or to certain persons (we are not required to agree except for disclosures to health plans for paid-out-of-pocket services).
  • Right to Confidential Communications — Request communications in a specific way or at a specific location (e.g., alternate address).
  • Right to a Paper Copy — Get this notice in paper form upon request.

Changes to This Notice

We reserve the right to change our privacy practices and this notice. Changes will apply to PHI we already have. The new notice will be posted on our website (iowaketamine.com) and available upon request.

Complaints

If you believe your privacy rights have been violated, contact:

Privacy Officer Iowa Ketamine Clinic
1701 48th St., Suite 260
West Des Moines, IA 50266
Phone: 515-401-4774
Email: info@iowaketamine.com

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights: https://www.hhs.gov/hipaa/filing-a-complaint/index.html

Filing a complaint will not affect your treatment here.

Acknowledgment

We will ask you to acknowledge receipt of this notice at your first visit or as soon as practicable.

This Notice complies with HIPAA Privacy Rule requirements and Iowa law where applicable. For questions, contact our Privacy Officer.