Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES

I. OUR PLEDGE REGARDING HEALTH INFORMATION:

Fortifying Wellness Integrative Psychiatry Clinic, PLLC (“Fortifying Wellness”, “we”, “our”, or “us”) understands that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by us. This Notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you and describe certain obligations we have regarding the use and disclosure of your health information. We are required by law to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.
• Give you this Notice of our legal duties and privacy practices with respect to health information.
• Follow the terms of the Notice that is currently in effect.
• Provide you with adequate notice of your rights and our legal duties if we create or maintain records protected by 42 C.F.R. Part 2.
• Provide notice if we change the terms of this Notice; such changes will apply to all information we have about you. The new Notice will be available upon request, in our office, and on our website.
• Notify you following a breach of unsecured PHI as required by law.

II. HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:

The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

Treatment. We may use and disclose your PHI to provide, coordinate, or manage your health care and related services. For example, we may disclose information to another health care provider involved in your treatment.

Payment. We may use and disclose your PHI to bill and collect payment for services we provide to you. For example, we may provide information to your health plan to obtain payment for services or determine coverage.

Health Care Operations. We may use and disclose your PHI for activities necessary to operate our practice, such as quality assessment and improvement, reviewing the competence and qualifications of health care professionals, training, compliance activities, and business management.

If your records are protected under 42 C.F.R. Part 2, additional requirements apply to the use and disclosure of those records. You may provide a single consent for future uses and disclosures of Part 2 records for treatment, payment, and health care operations. When Part 2 records are disclosed pursuant to such consent to a HIPAA-covered entity or business associate, the recipient may generally use and redisclose the records as permitted by HIPAA, subject to applicable restrictions under Part 2, including restrictions on the use and disclosure of Part 2 records in legal proceedings against you.

Disclosures for treatment purposes are not limited to the minimum necessary standard because health care providers need access to complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

Lawsuits and Disputes: We may disclose your PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process only to the extent permitted or required by applicable federal and Colorado law. Mental health records and communications may be subject to additional confidentiality and privilege protections under Colorado law. Where applicable, we will disclose such information only with your authorization, pursuant to a valid court order, or as otherwise permitted or required by law. Records protected by 42 C.F.R. Part 2 are subject to additional restrictions on their use and disclosure in civil, criminal, administrative, and legislative proceedings.

Other Uses and Disclosures. Other uses and disclosures of your PHI not described in this Notice will be made only with your written authorization, unless otherwise permitted or required by law. If you provide authorization, you may revoke it in writing at any time, except to the extent Fortifying Wellness has already relied on the authorization.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

1. Psychotherapy Notes. We do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your authorization unless the use or disclosure is:
   • For our use in treating you.
   • For our use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
   • For our use in defending our practice or practitioners in legal proceedings instituted by you.
   • For use by the Secretary of Health and Human Services to investigate our compliance with HIPAA.
   • Required by law and the use or disclosure is limited to the requirements of such law.
   • Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
   • Required by a coroner who is performing duties authorized by law.
   • As permitted or required by applicable law to prevent or lessen a serious threat to the health or safety of you or another person, including disclosures permitted or required under Colorado law.
2. Substance Use Disorder (SUD) Counseling Notes. We may also maintain “SUD counseling notes,” which are notes recorded by a substance use disorder provider documenting the contents of a counseling session. Any use or disclosure of these notes requires your separate written authorization, which cannot be combined with a consent for other types of records. You can revoke your consent at any time except to the extent that we have already acted upon it to disclose these notes in accordance with your initial authorization.
3. Marketing Purposes. We will not use or disclose your PHI for marketing purposes except as permitted by law or with your authorization.
4. Sale of PHI. We will not sell your PHI except as permitted by law or with your authorization.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION:

Subject to certain limitations in the law, we can use and disclose your PHI without your authorization for the following reasons:

1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
2. For public health and safety activities, including disclosures required or permitted by Colorado law concerning suspected child abuse or neglect, mistreatment or exploitation of an at-risk adult, or a serious threat to health or safety.
3. For health oversight activities, including audits and investigations.
4. For judicial and administrative proceedings, to the extent permitted or required by applicable federal and Colorado law, as described above.
5. For law enforcement purposes, including reporting crimes occurring on our premises.
6. To coroners or medical examiners, when such individuals are performing duties authorized by law.
7. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
8. Specialized government functions, including ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or helping to ensure the safety of those working within or housed in correctional institutions.
9. For workers’ compensation purposes. Although our preference is to obtain an authorization from you, we may provide your PHI in order to comply with workers’ compensation laws.
10. Appointment reminders and health-related benefits or services. We may use and disclose your PHI to contact you to remind you that you have an appointment with us. We may also use and disclose your PHI to tell you about treatment alternatives or other health care services or benefits that we offer.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT:

1. Disclosures to family, friends, or others. We may disclose PHI relevant to your care or payment for your care to a family member, friend, or other person involved in your care when you agree, when we reasonably infer from the circumstances that you do not object, or when otherwise permitted by applicable law.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and we may say “no” if we believe it would affect your health care.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for in Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full. If you request that a health plan pay for the treatment, we may disclose information as necessary to submit and process the claim.
3. The Right to Request Confidential Communications. You have the right to ask us to contact you in a specific way (for example, home or office phone), or to send mail to a different address, and we will agree to all reasonable requests.
4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes” and other information excluded from the right of access by applicable law, you have the right to get an electronic or paper copy of your medical record and other information that we have about you. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and we may charge a reasonable, cost-based fee for doing so.
5. The Right to Get a List of the Disclosures We Have Made. You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided us with an authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a reasonable cost-based fee for each additional request. You also have the right to request an accounting of disclosures specifically for your substance use disorder records protected under 42 C.F.R. Part 2.
6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. We may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request.
7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice, and you have the right to get a copy of this Notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.
8. The Right to Information under Colorado Law. You may also have additional rights regarding access to and copies of your records under Colorado law. We will provide access to records in accordance with HIPAA and other applicable federal and Colorado law.
9. The Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with Fortifying Wellness or with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against or penalized for filing a complaint.
10. The Right to Choose Someone to Act for You. If you have given someone medical power of attorney or if someone is your legal guardian or otherwise authorized by law to act for you, that person may exercise your rights and make choices about your PHI as permitted by applicable law. We will verify that the person has appropriate authority before acting.

COLORADO LAW

Colorado law may provide additional confidentiality and privilege protections for mental health records and communications beyond those provided by HIPAA. Where Colorado law provides greater privacy protection or imposes additional restrictions on the use or disclosure of your information, we will comply with applicable Colorado law.

Questions or Complaints

If you have questions about this Notice or wish to exercise your rights or file a complaint, contact:

Privacy Officer
Fortifying Wellness | Integrative Psychiatry Clinic PLLC
7345 S Pierce Street, Suite 205, Littleton, CO 80128
Phone: (720) 432-0958
Email: [email protected]

ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information.

By signing below, I acknowledge that I have received a copy of Fortifying Wellness's Notice of Privacy Practices.