This notice describes how your medical information may be used and disclosed and how you can get access to this information. Please review it carefully.
Policy: HIPAA Date: June 25, 2025
MM, Reviewed/Revised, 06/2025.
This Notice describes how your medical information may be used and disclosed and how you can get access to this information.
We reserve the right to change this Notice of Privacy Practices to make a new Notice of Privacy Practices effective for all protected health information as necessary and appropriate.
Any new Notice of Privacy Practices adopted will be made available at your next appointment.
Protected Health Information ("PHI") is demographic and individually identifiable health information that will or may identify the patient and relates to the patient's past, present, or future physical or mental health or condition and related health care services.
Under Federal Law, we are permitted to use and disclose personal health information without authorization for treatment, payment, and healthcare operations.
Healthcare operations include activities such as communications among healthcare providers, conducting quality assessment and improving activities, evaluating the qualifications, competence, and performance of healthcare professionals, and training future healthcare professionals.
Healthcare operations may also include related services that may benefit you, such as case management and care coordination, contracting with insurance companies, conducting medical review and auditing services, compiling and analyzing information in anticipation of or for use in legal proceedings, and general administrative and business functions.
We use medical records as a way of recording health information, planning care and treatment, and as a tool for routine health care operations.
Your insurance company may request information such as procedure and diagnosis information that we are required to submit to bill for the treatment we provide to the patient.
Other healthcare providers or health plans reviewing your records must follow the same confidentiality laws and rules required of us.
Patient records are also a valuable tool used by researchers to find the best possible treatment for diseases and medical conditions. All researchers must follow the same rules and laws that other healthcare providers are required to follow to ensure the privacy of patient information.
Information that may identify patients will not be released for research purposes to anyone without written authorization from the patient or the patient's parent or legal guardian.
When you, as the patient or guardian of a patient, sign the consent form, you are giving us permission to use and disclose protected health information for treatment, payment, and healthcare operations.
This permission does not include psychotherapy notes, psychosocial information, alcoholism and drug abuse treatment records, and other privileged categories of information that require a separate authorization.
You will need to sign a separate authorization to have protected health information released for any reason other than treatment, payment, or healthcare operations.
Psychotherapy notes are notes recorded in any medium by a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session that are separated from the rest of the patient's medical record.
Psychotherapy notes exclude medication prescription and monitoring, counseling session start and stop times, modalities and frequencies of treatment furnished, results of clinical tests, and any summary of diagnosis, functional status, treatment plan, symptoms, prognosis, and progress to date.
There are some services provided through contracts and business associates. Examples include billing services, transcription services, and laboratory services.
When these services are contracted, we may disclose your health information to the business associate so that they can perform the job we have contracted them to do.
The following is a statement of your rights concerning your protected health information and a brief description of how you may exercise these rights.
You have the right to inspect and obtain a copy of your protected health information that is contained in a designated record set for as long as we maintain the PHI.
A designated record set contains medical and billing records and any other records that we use in making decisions about your healthcare.
Certain records may not be available for inspection or copying, including psychotherapy notes, information compiled in reasonable anticipation of or use in a civil, criminal, or administrative action or proceeding, and certain PHI subject to laws that prohibit access.
Depending on the circumstances, a decision to deny access may be reviewable. Please contact our Privacy Officer if you have questions about access to your medical record.
You may ask us to restrict or limit the medical information we use or disclose for treatment, payment, or healthcare operations.
We are not required to agree to every requested restriction. We will notify you if your request is denied.
If we agree to a requested restriction, we may not use or disclose your PHI in violation of that restriction unless the information is needed to provide emergency treatment.
You may request a restriction by contacting our Privacy Officer.
You have the right to request to receive confidential communications by alternative means or at alternative locations.
We will accommodate reasonable requests. We may ask you to provide an alternate address or another method of contact.
We will not request an explanation from you as the basis for the request. Requests must be made in writing to our Privacy Officer.
You may request an amendment of protected health information about you in a designated record set for as long as we maintain that information.
In certain cases, we may deny your request. If your request is denied, you have the right to file a statement of disagreement with our Privacy Officer.
We may prepare a rebuttal to your statement and will provide you with a copy of that rebuttal.
Requests for amendments must be made in writing.
You have the right to request an accounting of certain disclosures of your protected health information.
This right generally applies to disclosures for purposes other than treatment, payment, or healthcare operations as described in this Notice.
We are also not required to account for certain disclosures that you requested, disclosures you agreed to by signing an authorization form, disclosures to family or friends involved in your care, or certain other disclosures permitted without authorization.
The request for an accounting must be made in writing to the Privacy Officer and should specify the period requested. Accounting requests may not be made for periods greater than six years.
You have the right to receive a paper copy of this Notice of Privacy Practices.
If you have questions regarding your privacy rights, please contact your clinician.
If you believe your privacy rights have been violated, you may file a complaint by contacting our office or by filing a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.
You will not be penalized for filing a complaint.
Mary-Anne Adewakun, M.Ed., CAMS II, CGS, CRPS, CMAC, LPC, CPCS
500 W Lanier Ave
Email:
info@mendedmind.com
Phone:
678-355-8117
Office for Civil Rights
Southeast Region - Atlanta
Customer Response Center:
800-368-1019
Fax:
202-619-3818
TDD:
800-537-7697
My signature below certifies that I have read and understand what the Notice of Privacy Practices procedures are as a participant in Mended Minds.
Please sign a copy of this Notice of Privacy Practices for the records of Mended Minds.
I have received a copy of this Notice on the date indicated below.