Notice of Privacy Practices

Effective Date: January 1, 2025

Our Commitment to Your Privacy

Root & Sail Integrative Mental Health is committed to protecting your health information. We are 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.

How We May Use and Disclose Your Health Information

Treatment

We may use and disclose your health information to provide, coordinate, or manage your healthcare and related services. For example:

• Coordinating care with your therapist or primary care physician
• Consulting with other healthcare professionals about your treatment
• Sharing information with specialists or laboratories as needed

Payment

We may use and disclose your health information to obtain payment for services. For example:

• Submitting claims to insurance companies
• Providing information to insurance companies for authorization
• Collecting payment for services rendered

Healthcare Operations

We may use and disclose your health information for healthcare operations including:

• Quality assessment and improvement activities
• Training healthcare professionals
• Compliance and licensing activities
• Business planning and administrative activities

Other Uses and Disclosures

Required by Law

We will disclose your health information when required to do so by federal, state, or local law, including:

• Mandatory reporting of suspected child abuse or neglect
• Reporting suspected elder abuse
• Reporting communicable diseases to public health authorities
• Responding to court orders or subpoenas

Public Health and Safety

We may disclose your health information for public health activities and to prevent serious threats to health or safety, including:

• Preventing or controlling disease, injury, or disability
• Reporting adverse events or product defects
• Warning of serious threats to public health or safety

Specialized Government Functions

We may disclose your health information for:

• Military and national security purposes
• Correctional institutions (if you are an inmate)
• Law enforcement purposes under specific circumstances

Uses and Disclosures with Your Authorization

Other uses and disclosures of your health information will be made only with your written authorization. You may revoke such authorization in writing at any time, except to the extent we have already taken action in reliance on the authorization.

Your Rights Regarding Your Health Information

Right to Access

You have the right to inspect and copy your health information. To access your records, submit a written request. We may charge a reasonable fee for copying costs.

Right to Amend

If you believe your health information is incorrect or incomplete, you may request an amendment. We may deny your request if the information:

• Was not created by us
• Is not part of the medical information kept by us
• Would not be permitted to be inspected and copied
• Is accurate and complete

Right to an Accounting of Disclosures

You have the right to request a list of disclosures we made of your health information for purposes other than treatment, payment, healthcare operations, and certain other activities.

Right to Request Restrictions

You have the right to request restrictions on our use or disclosure of your health information. We are not required to agree to your request unless:

• The disclosure is to a health plan for payment or healthcare operations
• The information pertains solely to items or services for which you have paid in full

Right to Request Confidential Communications

You have the right to request that we communicate with you about health matters in a certain way or at a certain location. We will accommodate reasonable requests.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this notice, even if you have agreed to receive it electronically.

Breach Notification

We will notify you if there is a breach of your unsecured protected health information that may compromise the privacy or security of your information.

Our Responsibilities

We are required to:

• Maintain the privacy of your protected health information
• Provide you with this Notice of our legal duties and privacy practices
• Follow the terms of the Notice currently in effect
• Notify you if we are unable to agree to a requested restriction
• Accommodate reasonable requests for confidential communications

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.

How to File a Complaint

Changes to This Notice

We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice on our website and in our office.

Contact Information

For more information about this Notice or our privacy practices, contact:

This notice complies with the HIPAA Privacy Rule (45 CFR Parts 160 and 164) and Pennsylvania state privacy laws.