HIPAA Notice of Privacy Practices

Our Commitment to Your Privacy

[Your Practice Name] is committed to protecting the privacy of your health information. This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information (PHI) to carry out treatment, payment, or healthcare operations, and for other purposes permitted or required by law. It also describes your rights regarding your health information.

How We May Use and Disclose Your Health Information

Treatment

We may use your health information to provide you with mental health treatment and services. We may disclose your information to other healthcare providers involved in your care.

Example: We may share information with your primary care physician if you sign a release of information.

Payment

We may use and disclose your health information to bill and collect payment for services provided, including submitting claims to your health insurance company.

Example: We may submit a claim to your insurance company that includes your diagnosis and treatment information.

Healthcare Operations

We may use and disclose your health information for our healthcare operations, such as quality assessment, training, and business management.

Example: We may review records to improve the quality of services we provide.

Other Uses and Disclosures Requiring Authorization

Other uses and disclosures of your health information will be made only with your written authorization. You may revoke your authorization in writing at any time, except to the extent that we have already taken action based on your authorization.

We will not sell your information or use it for marketing purposes without your specific authorization.

Disclosures Without Your Authorization

We may use or disclose your health information without your authorization in the following situations:

As Required by Law

When required by federal, state, or local law.

Public Health Activities

For public health activities such as disease prevention, reporting abuse, or FDA monitoring.

Victims of Abuse or Neglect

When we reasonably believe that an individual is a victim of abuse, neglect, or domestic violence.

Health Oversight Activities

To authorized health oversight agencies for activities such as audits, investigations, and licensing.

Judicial and Administrative Proceedings

In response to a court order, subpoena, or other lawful process.

Law Enforcement

To law enforcement officials as required by law or in response to a valid subpoena or court order.

Serious Threat to Health or Safety

To prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Workers' Compensation

For workers' compensation or similar programs that provide benefits for work-related injuries.

Your Rights Regarding Your Health Information

Right to Inspect and Copy

You have the right to inspect and obtain a copy of your health information. We may charge a reasonable fee for copying and mailing costs.

Right to Amend

If you believe your health information is incorrect or incomplete, you may ask us to amend it. We may deny your request in certain circumstances.

Right to an Accounting of Disclosures

You have the right to request an "accounting of disclosures," which is a list of certain disclosures we have made of your health information.

Right to Request Restrictions

You have the right to request restrictions on certain uses and disclosures of your health information. We are not required to agree to your request, except in certain limited circumstances.

Right to Request Confidential Communications

You have the right to request that we communicate with you about your health information by alternative means or at alternative locations.

Right to a Paper Copy of This Notice

You have the right to receive a paper copy of this Notice upon request.

Right to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. You will not be retaliated against for filing a complaint.

Our Responsibilities

We are required by law to:

• Maintain the privacy of your health information
• Provide you with this Notice of our legal duties and privacy practices
• Follow the terms of the Notice currently in effect
• Notify you if we are unable to agree to a requested restriction
• Accommodate reasonable requests for confidential communications

Changes to This Notice

We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. A copy of the current Notice will be available at our office and on our website.

Business Associate - Ensora Mental Health

We use Ensora Mental Health, a HIPAA-compliant practice management and electronic health records system, to store and manage your protected health information. Ensora Mental Health is our "Business Associate" under HIPAA and is required to protect the privacy and security of your information in accordance with our agreement and applicable law.

Important: This website (hosted on Google Cloud Storage) does NOT store any Protected Health Information. All clinical records, session notes, and sensitive health data are maintained exclusively in our secure, HIPAA-compliant Ensora system.

Questions and Complaints

If you have questions about this Notice or wish to exercise any of your rights, please contact:

To file a complaint with the federal government: