NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

We understand the importance of privacy and are committed to maintaining the confidentiality of your health information. We are required by law to maintain the privacy of protected health information, to provide individuals notice of our legal duties and privacy practices with respect to health information, and to notify affected individuals following any breach of unsecured protected health information. This notice describes how we may use and disclose your health information. It also describes your rights and our legal obligations with respect to your health information. If you have any questions about this notice, please contact our office at 3051 W. Maple Loop Dr., Ste 210, Lehi, UT 84043 or call (801) 872-5516. 

How and When Our Practice May Use or Disclose Your Health Information
Health Record: Our practice collects health information about you (your “health record”) and stores it electronically. The health record (the paper or electronic file) is the property of our practice, but the information in the health record belongs to you. The law permits us to use or disclose your health information for the following purposes.

Psychotherapy Notes: We will not use or disclose your psychotherapy notes without your prior written authorization except for the following: 1) consultation within the practice with the clinical director, another clinician, the psychiatrist or Advanced Practice Registered Nurse (APRN); 2) to defend ourselves if you sue or bring other legal proceedings; 3) if the law or a court order requires us to disclose; 4) to avoid a serious and imminent danger to health and safety. If you sign a written authorization to release and disclose information, you may revoke it at any time with written notice.

Payment: We use and disclose payment information about you to obtain payment for the services we provide.

Healthcare Operations: We may use and disclose information about you to operate our practice. This includes health reviews, legal services, auditors, our billing services, and internal quality of care reviews.
Appointment Reminders: We may use and disclose your information to remind you of appointments including, but not limited to, phone calls, emails or text messages. If you are not at home we may leave a message or a reminder with a family member. Please let us know if you do not want a particular type of reminder or if you do not want a message left with anyone else so that we can note this for our staff.

Sign-in Sheet: We may use or disclose your information by having you sign in when you arrive at our office for your appointment. We may also call out your name when we are ready to see you.

Notification to Family and Significant Others: We will ask you to identify an emergency contact. In the event of an emergency situation or a disaster we may notify your emergency contact. We may also disclose information to someone who is involved in your care and helps pay for your care. If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures, although we may disclose in an emergency situation, even over your objections, if we believe it is necessary to respond to the emergency. If you are unable or unavailable to agree or object, our health professionals will use their best judgement in communication with your family and significant others.

Note: custodial parents of children under 18 do not require a release of information to obtain information about their dependent children.
Notification to Emergency Personnel and/or Law Enforcement: If you present a danger to yourself we may contact 911 and involve emergency personnel. If you are physically incapacitated we may contact an ambulance to take you to the nearest Emergency Room. If you commit a criminal act or become threatening to any person or persons while on property we may notify law enforcement. If you disclose a plan to harm another person, we have a duty to warn that person and make a report to law enforcement.

Required by Law: As required by law we will use and disclose your health information, but we will limit our disclosure to the relevant requirements of the law. When the law requires us to report abuse, neglect or domestic violence, or respond to judicial or administrative proceedings, or to law enforcement officials, we will further comply with the requirement set forth below (Public Health) concerning those activities.

Public Health: We may and are sometimes required by law to disclose your health information to public health authorities for purposes related to: preventing or controlling disease; injury or disability, reporting child, elder, or dependent adult abuse or neglect; reporting domestic violence; reporting threat to harm another person; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease and infection exposure.

Health Oversight Activities: We may (and are sometimes required by law) disclose your health information to health oversight agencies during the course of audits, investigations, inspections, licensure and other proceedings, subject to limitations imposed by law.

Judicial and Administrative Proceedings: We may (and are sometimes required by law) disclose your health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order. We may also disclose information about you in response to a subpoena, discovery request, or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order.

Law Enforcement: We may (and are sometimes required by law) disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness, or missing person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes.

Coroners: We may (and are sometimes required by law) disclose your health information to coroners with their investigations of deaths.
Specialized Governmental Functions: We may disclose your health information for military or national security purposes or to law enforcement or correctional facilities if you are in their custody.

Your Health Information Rights
Right to Request Special Privacy Protections: You have the right to request restrictions on certain uses and disclosures of your health information by a written request specifying what information you want to limit, and what limitations on use or disclosure of that information you wish to have imposed. If you tell us not to disclose information to your commercial health plan concerning services for which you paid in full out-of-pocket, we will abide by your request, unless we must disclose the information for treatment or legal reasons. We reserve the right to accept or reject any other request, and will notify you of our decision.

Right to Inspect and Copy: You have a right to inspect and copy your health record with limited exceptions. You must submit a written request detailing what information you want access to and whether you want to inspect it or get a copy of it. We will also send a copy to any other person you designate in writing. We will charge a reasonable fee to cover our costs for labor, supplies, postage etc. Under limited conditions we may deny a request if we believe allowing access will cause substantial harm. You will have the right to appeal this decision.

Right to Amend and Supplement: You have the right to request that we amend your health information that you believe is incorrect or incomplete. You must make a request to amend in writing, and include the reasons you believe the information is inaccurate or incomplete. We are not required to change your health information and if the request is denied we will provide you information about how you can disagree with the denial. Any documents in your health record that we did not create cannot be amended by our practice.

Right to An Accounting of Disclosures: You have a right to receive an accounting of disclosures of your health information made by our practice. Exceptions to this are disclosures provided pursuant to your written authorization; disclosures for payment, disclosures for healthcare operation, disclosures for specialized government functions, and disclosures to law enforcement officials if the practice has received notice from that agency or official that providing this accounting would be reasonably likely to impede their activities. You have a right to notice of our legal duties and privacy practices with respect to your health information, including a right to a paper copy of this Notice of Privacy Practices.

Changes to Notice of Privacy Practices
We reserve the right to amend this Notice of Privacy Practices at any time in the future. Until such amendment is made we are required by law to comply with the terms of this notice currently in effect. After an amendment is made, the revised Notice of Privacy Practices will apply to all protected health information that we maintain, regardless of when it was created or received. Any amendments will be posted in our lobby and on our website and new notices will be available to all clients.