Notice of Privacy Practices

Our Commitment to Your Privacy

South Valley Psychiatry PLLC is committed to protecting the privacy of your health information. We are required by law to maintain the privacy of your protected health information (PHI), to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of the Notice currently in effect.

How We May Use and Disclose Your Health Information

The following describes the ways we may use and disclose health information that identifies you.

Treatment

We may use your health information to provide, coordinate, or manage your healthcare and related services, including sharing information with other providers involved in your care to ensure coordinated treatment.

Payment

We may use and disclose your health information to bill and receive payment for services, such as providing your insurance company with diagnosis and treatment information.

Healthcare Operations

We may use and disclose your health information for practice operations including quality assessment, training, licensing, and audits.

Other Permitted Uses and Disclosures

We may also use or disclose your health information without authorization in the following circumstances:

• As required by federal, state, or local law
• For public health activities
• To report abuse, neglect, or domestic violence
• For health oversight activities by government agencies
• In response to a court order, subpoena, or other legal process
• For law enforcement purposes under specific circumstances
• To prevent or lessen a serious and imminent threat to health or safety
• For workers’ compensation purposes
• For research under conditions approved by an institutional review board

Uses and Disclosures Requiring Your Authorization

Other uses and disclosures not described above will only be made with your written authorization, including most uses of psychotherapy notes, marketing purposes, and any sale of your health information. You may revoke any authorization in writing at any time, except where we have already acted in reliance on it.

Your Rights Regarding Your Health Information

Right to Access

You have the right to inspect and obtain a copy of your health information. Submit a written request to our office. A reasonable fee may apply for copies.

Right to Amendment

You may request an amendment if you believe information we hold about you is incorrect or incomplete. We may deny the request under certain circumstances.

Right to an Accounting of Disclosures

You may request a list of certain disclosures we have made of your health information in the past six years.

Right to Request Restrictions

You may request restrictions on how we use or disclose your information. We are not required to agree, except in limited circumstances defined by law.

Right to Confidential Communications

You may request that we contact you in a specific way. We will accommodate reasonable requests.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this Notice upon request at any time.

Right to Notification of a Breach

You have the right to be notified if there is a breach of your unsecured protected health information.

Changes to This Notice

We reserve the right to change this Notice at any time. Changes will be effective for health information we already hold. The current Notice will always be posted in our office and on our website.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our practice or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

HHS complaints: Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, D.C. 20201 or online at hhs.gov/ocr/privacy/hipaa/complaints.