Your Information

We understand that health information about you and your health is personal.  This Notice describes how medical information about you may be used and disclosed by the San Felipe Pueblo Providers and our caregivers and how you can get access to this information.  This Notice also describes your rights and certain obligations and responsibilities we have regarding the use and disclosure of Protected Health Information (PHI).  The San Felipe Pueblo and all its health care providers and affiliates are required to comply with federal and state laws that offer additional privacy protections to a patient or plan member.  Please review this document carefully.

Your Rights

The following is a brief summary of your right as a patient of San Felipe Pueblo:

  • Obtain a paper copy of this “Notice of Health Information Privacy Practices” upon request.
  • Inspect and request a copy of your paper/electronic health information that we maintain, or direct us to send a copy of your health information to another person designated by you in writing.
  • Request correction or amendment of your paper/electronic health record if you think it is incorrect or incomplete.  If we deny your request, we are mandated by law to provide justification for denial within 60 days of receiving such request.
  • Request confidential communication of your health information by alternate means.
  • Request a restriction on certain uses and disclosures of your health information.  We are not mandated by law to agree to the request, except for request to limit disclosures to your health plan for purposes of payment or healthcare operations when you have paid for the item or service covered by the request out-of-pocket and in full and when the disclosure is not required by law.
  • Receive an accounting of disclosures we have made of your health information for the six (6) years prior to your request, except for disclosures we are not required by law to include.
  • If you believe your privacy rights have been violated, you have the right to file a complaint with the Secretary of the U.S. Department of Health and Human Services or with our Privacy Officer.

Our Responsibilities

This Notice Describes Our Practices and those of:

  • Any medical staff member and any healthcare professional who participates in your care;
  • Any volunteer we allow to help you while you are here; and
  • All employees any hospital, clinic, or laboratories affiliated with San Felipe Pueblo.

We Are Required by Law to:

  • Maintain the privacy of health information that identifies you;
  • Give you and other individuals this notice of our legal duties and privacy practices with respect to protected health information;
  • Follow the terms of the notice that is currently in effect; and
  • Notify affected individuals in the event of a breach involving unsecured protected health information (PHI).

How We May Use Your Information:

  • For Treatment.   We may use and disclose your health information to provide you with medical care treatment or services.  For example, a healthcare provider, such as a physician, a dental care provider, a nurse, or other person/s providing health services will access your health information to understand your medical condition and history.  Health care providers will also document and record actions taken by them in the course of your treatment and note how you respond to these actions.  This information is necessary for health care providers to determine what treatment you should receive and to coordinate your care.
  • For Payment.   We may use and disclose your health information for purposes of receiving payment for treatment and services that you received.  The information on our bill may contain information that identifies you, your diagnosis, treatment, and/or supplies used in the course of treatment.  We may also provide information to health entities that help us submit bills and collect amounts owed, such as a collection agency or third party billers.
  • For Health Care Operations.   We may use and disclose your health information for operational purposes.  For example, your health information may be used by, and disclosed to, members of the medical staff, risk or quality improvement personnel, and other employees of San Felipe Pueblo to evaluate the performance of our staff, to assess the quality of care and outcomes in your case and similar cases, to learn how to improve our services, and to determine how to continually improve the quality and effectiveness of the health care we provide.
  • Health Information Exchange.   We may participate in one or more health information exchanges and we may use and disclose your health information through these exchanges for certain purposes described in this notice.
  • Facility Directory.   Unless you object, we may include you in the facility directory.  This information may include your name, location in the facility, and general condition.  We may give your directory information to people who ask for you by name.
  • Others Involved in your Care.   We may disclose relevant health information to a family member, friend, or anyone else you designate in order for that person to be involved in your care or payment related to your care.  We may also disclose health information to those assisting in disaster relief efforts so that your relatives and loved ones can be notified of your condition, status, and location.
  • Fundraising.   We do not use or disclose health information for fundraising purposes.
  • Required by Law.   We may use and disclose information about you as required by law.  For example, we are required to disclose information about you to the U.S. Department of Health and Human Services if it requests such information to determine if we are complying with federal privacy laws.
  • Reporting Abuse, Neglect, or Domestic Violence.   We may disclose information to an appropriate government authority, protective service agencies, or our Tribal Council, if we believe an individual is a victim of abuse, neglect, or domestic violence.  We will only make such report if the patient agrees, if we believe that the patient will be in imminent danger, or if we are required by law to do so.
  • Public Health.   Your health information may be used and disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, of for other public health activities.
  • Law Enforcement Purposes.   Subject to certain restrictions, we may disclose information requested or needed by law enforcement officials.
  • Judicial and Administrative Proceedings.   We may disclose information in response to an appropriate subpoena, discovery request, or court order.
  • Health Oversight Activities.   We may disclose your health information to health oversight agencies for activities authorized by law such as audits, investigations, and inspections to monitor the health care system.
  • Decedents.   Health information may be disclosed to funeral directors, medical examiners, or coroners to enable them to carry out their lawful duties.
  • Organ and Tissue Donation.   Your information may be used and disclosed for cadaveric organ, eye, or tissue donation purposes.
  • Research.   We may use and disclose your health information for research purposes after a receipt of authorization from you or when an Institutional Review Board (IRB) or Privacy Board has waived the authorization requirements by its review of the research proposal and has established protocols to ensure the privacy of your health information.  We may also review your health information to assist in the preparation of the study and to ensure that only the “minimum necessary” information is disclosed.
  • Health and Safety.   Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.
  • Government and Tribal Functions.   Your health information may be disclosed for specialized government and/or tribal functions such as protection or public officials and tribal members.
  • Workers Compensation.   Your health information may be used or disclosed in order to comply with laws and regulations related to health compensation.
  • Business Associates.   We may disclose your health information to business associates provided they agree to safeguard your information.

Behavioral/Mental Health Information and Psychotherapy Notes:

Subject to compliance with limited exceptions, we will not use or disclose any behavioral or mental health information and psychotherapy notes without your written authorization, and/or authorization from your mental health caregiver and clinicians, or both.

Changes to this Notice:

We reserve the right to change the terms of this notice and make the new terms effective for all protected health information (PHI) kept and managed by the Health and Wellness Department and other programs of the San Felipe Pueblo.  We will post a copy of our current Notice in our facilities, program areas, and our website.  You may also get a current copy of this Notice by contacting our Privacy Officer (Contact information provided below).


If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer of the Health and Wellness Department of the San Felipe Pueblo or with the Secretary of the Department of Health and Human Services.  To file a complaint to the Privacy Officer, please submit your written complaint or ask to talk to the Privacy Officer.  You will not be penalized for filing a complaint.

Contact Information for Questions or to File a Complaint:

Compliance & Privacy Officer
Health & Wellness Department
3 Cedar Road
San Felipe Pueblo, NM 87001
Office: (505) 771-9908