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As required by the Privacy Regulations Promulgated Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
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.
This Notice of Privacy Practices explains how we may use and disclose your Protected Health Information (PHI) for treatment, payment, and health care operations, as well as other purposes required or permitted by law. It also describes your rights to access, amend, and control your PHI.
We may use and disclose your PHI to provide, coordinate, or manage your care. For example, we may share your PHI with another physician or a home health agency involved in your treatment.
Your PHI may be used to obtain payment for services. For example, we may disclose information to your health plan to secure approval for necessary medical equipment or services.
We may use or disclose your PHI to support daily business activities, such as quality assessment, staff reviews, licensing, or accreditation surveys. For example, accrediting agencies may review your PHI during a survey process.
We may use or disclose your PHI without your authorization in certain circumstances, including but not limited to:
As required by law
Public health activities
Communicable disease reporting
Health oversight activities
Abuse, neglect, or domestic violence reporting
FDA requirements
Legal proceedings and law enforcement requests
Criminal activity and national security
Military and veterans activities
Workers’ compensation claims
Required disclosures also include providing information to you and, when requested, to the Secretary of the Department of Health and Human Services.
Any uses or disclosures not described in this Notice will require your written authorization. You may revoke such authorization in writing at any time, except to the extent we have already relied on it.
Right to Inspect and Copy: You may request access to your PHI, with certain exceptions (e.g., psychotherapy notes, legal proceedings).
Right to Request Restrictions: You may request limitations on how your PHI is used or disclosed, though we are not required to agree if it conflicts with your care.
Right to Confidential Communications: You may request to receive communications through alternative means or locations.
Right to Amend: You may request an amendment to your PHI. If denied, you have the right to submit a statement of disagreement.
Right to an Accounting of Disclosures: You may request a record of certain disclosures made of your PHI.
Right to a Paper Copy: You may request a paper copy of this Notice, even if you have received it electronically.
We reserve the right to change this Notice and will provide an updated copy if significant changes occur.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of Health and Human Services. We will not retaliate against you for filing a complaint.
Contact: Privacy Officer / President
📞 844-349-0077
For more information about your HIPAA rights, visit:
https://www.hhs.gov/hipaa/for-individuals/notice-privacy-practices/index.html
PHI includes information about your health, medical treatment, or payment for services that can be used to identify you.
Your information may be used for your treatment, billing and payment, or to support healthcare operations like quality reviews and accreditation.
Yes. You have the right to request a copy of your health records, with limited exceptions such as psychotherapy notes or certain legal records.
You may contact our Privacy Officer at 844-349-0077 or file a complaint with the U.S. Department of Health and Human Services.
No. We will not retaliate against you for filing a complaint regarding your privacy rights.
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides resources. Visit their site for a detailed overview of patient rights.

Author & Editor: Adam Tomlinson
Clinically Reviewed by: Charee Marquez, LMFT
Clinical Contributor: Karynne Witkin, M.A. I/O Psychology
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