Notice of Privacy Practices
Effective Date: [Insert Date]
This Notice describes how medical and mental health information about you may be used and disclosed and how you can access this information. Please review it carefully.
Evermore Therapy & Wellness Group is required by law to maintain the privacy of your Protected Health Information (PHI) and to provide you with this Notice of our legal duties and privacy practices under the Health Insurance Portability and Accountability Act (HIPAA).
What Is Protected Health Information (PHI)?
Protected Health Information (PHI) includes information about your mental health condition, treatment, and identifying information such as your name, address, or other details that could identify you.
How We May Use and Disclose Your Information
For Treatment
We may use and share your information to provide, coordinate, or manage your mental health treatment. For example, we may consult with another healthcare provider involved in your care.
For Payment
We may use your information to bill and receive payment from you or your insurance provider.
For Healthcare Operations
We may use your information for administrative, quality assurance, and internal practice management purposes.
Other Situations Where We May Disclose Information
We may disclose your information without your written authorization in certain circumstances required or permitted by law, including:
If there is suspected abuse or neglect
If there is a serious threat to your safety or the safety of others
In response to a court order or subpoena
For certain public health activities
For law enforcement purposes as required by law
Uses and Disclosures Requiring Authorization
We will obtain your written authorization before:
Releasing psychotherapy notes (with limited exceptions)
Using your information for marketing purposes
Selling your health information
You may revoke your authorization at any time in writing.
Your Rights Regarding Your Health Information
You have the right to:
Request Access
You may request a copy of your health records.
Request an Amendment
You may request corrections to your health record if you believe information is inaccurate or incomplete.
Request Restrictions
You may request limits on how your information is used or shared.
Request Confidential Communications
You may request that we contact you in a specific way (for example, only by phone or only at a certain address).
Receive an Accounting of Disclosures
You may request a list of certain disclosures we have made of your information.
Receive a Paper Copy of This Notice
You may request a paper copy of this Notice at any time.
Our Responsibilities
We are required to:
Maintain the privacy and security of your health information
Notify you if a breach occurs that may have compromised your information
Follow the terms of this Notice
We reserve the right to change this Notice and will update the effective date accordingly. The updated Notice will be posted on our website.
Telehealth Privacy
If you participate in teletherapy services, we use HIPAA-compliant platforms designed to protect your privacy. While we take reasonable steps to protect your information, electronic communication carries some inherent risks.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with:
Evermore Therapy & Wellness Group
[Insert Contact Email]
[Insert Mailing Address]
You may also file a complaint with the U.S. Department of Health and Human Services. Filing a complaint will not affect your care.
Contact Information
If you have questions about this Notice or your privacy rights, please contact:
Evermore Therapy & Wellness Group
[Insert Phone Number]
[Insert Email Address]
[Insert Business Address]