Notice of Privacy Practices

Our commitment to your privacy

Empowered Mental Health, PLLC is committed to protecting the privacy of your protected health information, or PHI. PHI is information about your health status, treatment, or payment that can be used to identify you. This notice describes how we may use and disclose your PHI and your rights regarding it. We are required by law to maintain the privacy of your PHI, to give you 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 PHI

• Treatment. To provide, coordinate, or manage your mental health care, including sharing information with other providers involved in your care.
• Payment. To bill and collect payment for services, such as sharing information with your insurer if you use insurance.
• Health care operations. For operations such as quality improvement, staff training, and clinical supervision.
• As required by law. We will disclose your PHI when required by federal, state, or local law. This includes mandatory reporting of suspected child abuse or neglect and of vulnerable adult abuse to the proper authorities.
• To prevent a serious threat. When necessary to prevent a serious and imminent threat to your health or safety or that of others.
• Public health and safety. For public health activities, such as reporting communicable diseases.
• Law enforcement and legal proceedings. To law enforcement or in response to a valid court order or other lawful process.

Uses and disclosures that require your written authorization

Most uses and disclosures of psychotherapy notes, uses and disclosures for marketing, and any sale of your PHI require your written authorization. Any other use or disclosure not described in this notice will be made only with your written authorization. You may revoke an authorization in writing at any time, and we will stop using or disclosing your PHI for that purpose, except to the extent we have already relied on it.

Psychotherapy notes receive special protection under HIPAA and are generally not disclosed without your specific authorization.

Your rights regarding your PHI

• Right to access. To inspect and receive a copy of your PHI, in paper or electronic form, subject to limited exceptions.
• Right to amend. To request that we amend PHI you believe is incorrect or incomplete.
• Right to an accounting of disclosures. To request a list of certain disclosures we made of your PHI.
• Right to request restrictions. To request restrictions on how we use or disclose your PHI. We are not required to agree to all requests, but we will honor a request to restrict disclosure to a health plan for services you paid for in full out of pocket.
• Right to request confidential communications. To request that we communicate with you in a specific way or at a specific location.
• Right to a paper copy. To a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Right to be notified of a breach. To be notified in the event of a breach of your unsecured PHI.
• Right to file a complaint. To file a complaint if you believe your privacy rights have been violated. You may complain to us using the contact information below, or to the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

Changes to this notice

We reserve the right to change this notice and to make the revised notice effective for PHI we already have as well as any we receive in the future. The current notice will be posted on our website and available at our office, with its effective date shown above.

Contact

If you have questions about this notice or wish to exercise any of your rights, contact our Privacy Officer.

Empowered Mental Health, PLLC
101 Slate Dr Ste 7
Bismarck, ND 58503
(701) 805-1939