At Elevate Psychotherapy, we are committed to protecting the privacy of your protected health information (PHI). This Notice of Privacy Practices describes how we may use and disclose your health information, your rights regarding your health information, and our responsibilities under federal law.

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Your Rights​

You have a right to:

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Get a copy of your health information
You may request to inspect or obtain a copy of your health information, including your psychotherapy records, as permitted by law.

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Request corrections
You may ask us to correct health information that you believe is inaccurate or incomplete. We may deny your request in certain circumstances, but we will provide you with a written explanation.

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Request confidential communications
You may ask us to contact you in a specific way or at a particular location. We will accommodate reasonable requests.

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Ask us to limit what we use or share
You may ask us to limit how we use or disclose your health information. We are not required to agree to every request.

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Request an accounting of disclosures
You may request a list of certain disclosures we have made of your health information.

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Receive a copy of this Notice
You may request a paper or electronic copy of this Notice at any time.

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Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices about your health information as permitted by law.

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File a complaint
You may file a complaint with us or with the U.S. Department of Health and Human Services if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

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Your Choices

For certain health information, you may have choices about how we use or share your information. You may ask us about:

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• Sharing information with family members or others involved in your care;

• Using your information for certain communications or fundraising activities; and

• Other uses or disclosures that require your written authorization.

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We will not use or disclose your health information for marketing purposes or sell your health information without your written authorization, except as permitted by law.

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How We May Use And Disclose Your Health Information

We may use or disclose your health information without your written authorization for the following purposes:

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Treatment
We may use or share your health information with other health care professionals involved in your care when appropriate.

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Payment
We may use and disclose your health information to bill and receive payment from health plans or other entities. This may include providing information to your insurance company when submitting claims.

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Health Care Operations
We may use and disclose your health information to operate our practice, improve our services, coordinate care, and perform other activities necessary to manage our practice.

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Business Associates

​We may share your health information with business associates that provide services on our behalf, such as billing, claims processing, payment processing, technology, or administrative services. These entities are required to appropriately safeguard your health information and use or disclose it only as permitted by law.

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Required by Law
We may disclose your health information when required by federal, state, or local law.

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Public Health
We may disclose health information for certain public health activities permitted or required by law.

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Abuse or Neglect
We may disclose information when required or permitted by law to report suspected abuse, neglect, or domestic violence.

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Serious Threats to Health or Safety
We may disclose information when necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

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Judicial and Administrative Proceedings
We may disclose health information in response to a court or administrative order, or in certain circumstances in response to a subpoena or other lawful process.

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Law Enforcement
We may disclose health information for certain law enforcement purposes when permitted or required by law.

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Workers' Compensation
We may disclose health information as authorized by and to the extent necessary to comply with workers' compensation laws.

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Other uses and disclosures not described in this Notice will be made only with your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already relied on it.

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Psychotherapy Notes

Psychotherapy notes receive special protection under federal law. In most circumstances, your written authorization is required before psychotherapy notes may be used or disclosed, except for certain limited circumstances permitted by law.

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Your Right to Request Restrictions

You may request that we restrict the use or disclosure of your health information for treatment, payment, or health care operations. We are not required to agree to your request.

If you pay for a service or health care item completely out of pocket and request that we not disclose information about that service to your health plan for payment or health care operations, we will agree to your request unless disclosure is required by law.

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Our Responsibilities

We are required by law to:

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• Maintain the privacy and security of your protected health information;

• Provide you with this Notice describing our legal duties and privacy practices;

• Follow the terms of the Notice currently in effect;

• Notify you promptly if a breach occurs that may have compromised the privacy or security of your health information; and

• Not use or disclose your health information other than as described in this Notice unless you provide written authorization or the disclosure is otherwise permitted or required by law.

 

We reserve the right to change this Notice. Any revised Notice will apply to all health information we maintain about you and will be made available upon request and on our website.

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For More Information or to File a Complaint

If you have questions about this Notice or believe your privacy rights have been violated, you may contact:

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Elevate Psychotherapy

Charlotte Howson, Psy.D., Owner

drhowson@elevatetherapy.online

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To file a complain with the U.S. Department of Health and Human Services:

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.

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U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775
https://www.hhs.gov/ocr/privacy/index.html

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Acknowledgement of Receipt

You will be asked to acknowledge that you have received this Notice of Privacy Practices. Your acknowledgment does not mean that you have agreed to any particular use or disclosure of your health information.