Notice of Privacy Practices

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.

Brian Lewis, LCMHC ("we," "our," "the practice") is required by the Health Insurance Portability and Accountability Act (HIPAA) and applicable state law to maintain the privacy of your protected health information (PHI), give you this Notice of our legal duties and privacy practices concerning your PHI, follow the terms of the Notice currently in effect, and notify you following a breach of unsecured PHI.

How we may use and disclose your PHI

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your mental-health care and any related services, including consulting with or referring you to other providers.

Payment

We may use and disclose your PHI so we can bill for services and receive payment from you, an insurance company, or a third party. This may include verifying coverage and providing information about services rendered.

Health care operations

We may use and disclose your PHI for our internal operations, such as quality assessment, training, licensing, and administrative activities.

Other permitted or required uses and disclosures

• Required by law — including public-health reporting and responses to court orders or subpoenas.
• Abuse, neglect, or domestic violence — reports required by law.
• Health oversight activities — audits, investigations, inspections, and licensure.
• Serious threat to health or safety — to prevent or lessen a serious and imminent threat.
• Coroners, medical examiners, and funeral directors, workers' compensation, and specialized government functions where permitted by law.

Uses and disclosures that require your written authorization

Most uses and disclosures of psychotherapy notes, uses and disclosures for marketing purposes, and any sale of PHI require your written authorization. You may revoke a written authorization at any time, in writing, except to the extent we have already relied on it.

Your rights

• Right to inspect and copy your PHI (with limited exceptions).
• Right to request an amendment to PHI you believe is incorrect or incomplete.
• Right to an accounting of disclosures we have made, subject to legal exceptions.
• Right to request restrictions on certain uses or disclosures. We are not required to agree, except that we must agree to restrict disclosures to a health plan for services you paid for out of pocket in full.
• Right to confidential communications at an alternative location or by an alternative means.
• Right to a paper copy of this Notice, even if you agreed to receive it electronically.
• Right to be notified of a breach of your unsecured PHI.

Our responsibilities

We are required by law to maintain the privacy and security of your PHI, notify you if a breach occurs that may compromise the privacy or security of your PHI, follow the terms of the Notice currently in effect, and make this Notice available to you.

Changes to this Notice

We reserve the right to change the terms of this Notice at any time. Any change will apply to PHI we already have and to information we receive in the future. The revised Notice will be posted at this URL and available on request.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the practice using the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights, at hhs.gov/hipaa/filing-a-complaint. You will not be retaliated against for filing a complaint.

Contact

Brian Lewis, LCMHC — Midvale, Utah. Reach the practice via the contact page (non-PHI only). For private matters, use the secure client channel provided to you when care begins.

This Notice is provided as a template. Clients should also receive and acknowledge the practice's current Notice of Privacy Practices at intake.